Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau

Abstract

Objectives: To assess the effects of daily prenatal multimicronutrient supplementation on birth weight (BW) and perinatal mortality. Design: Randomised, controlled, double masked trial. Setting: Urban Guinea-Bissau, West Africa. Subjects: A total of 2100 pregnant women (2277 weeks pregnant at entry) were recruited through antenatal clinics, of which 1670 (79.5%) completed the trial. BW was available for 1100 live born babies. Interventions: Identical-looking supplements containing one (MN-1) or two (MN-2) Recommended Dietary Allowances (RDA) of 15 micronutrients, or iron and folic acid (control). Results: Mean BW among 1100 live born infants was 30507498 g with 11.9% being low birth weight (LBW, BWo2500 g). Perinatal mortality was 82 per 1000 deliveries (N ¼ 1670), and neonatal mortality 45 per 1000 live births (N ¼ 1599). Mean BW in MN-1 (n ¼ 360) and MN-2 (n ¼ 374) groups were 53 [À19; 125] and 95 [24; 166] g higher than controls (n ¼ 366). Proportion of LBW was 13.6% in control, and 12.0 and 10.1% in the MN-1 and MN-2 groups, respectively (P ¼ 0.33). Among anaemic women (30%), MN-2 increased BW with 218 [81; 354] g compared to controls, with a decreased risk of LBW of 69 [27; 87]%. There were apparently no differences in perinatal mortality between groups. Conclusions: Prenatal micronutrient supplementation increased BW but did not reduce perinatal mortality in this study. Multimicronutrient supplementation with two RDA should be considered in future programmes to reduce the proportion of LBW.

Multiple Micronutrient Supplementation during Pregnancy in Low-Income Countries: Review of Methods and Characteristics of Studies Included in the Meta-Analyses

“…Nine of these (conducted in Bangladesh; Burkina Faso; China; Guinea-Bissau; Lombok, Indonesia; Indramayu, Indonesia; Janakpur, Nepal; Niger; and Pakistan) [5][6][7][8][9][10][11][12][13] used UNIM-MAP (see table 1), and the other three (conducted in Mexico [14]; Sarlahi, Nepal [15]; and Zimbabwe [16]) used other multiple micronutrient supplements. The composition of the supplements used in these trials is summarized in table 1.…”

“…Guinea-Bissau [12] Semiurban area of Bissau: women were identified through monthly pregnancy surveillance in the Bandim Health Project and recruited until late pregnancy. Compliance: women were given containers with 25 tablets; tablets were counted every 2 weeks and replenished during home visits.…”

Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis

“…5,[12][13][14][15][16][17][18][19][20][21][22][23] We excluded 14 reports (the reasons for exclusion are given in Appendix 4, available at www.cmaj .ca/cgi/content/full/cmaj.081777/DC3).…”

The Impact of Third Trimester Maternal Serum Vitamin B12 and Folate Status on Fetal Birth Weight. Is Maternal Serum Homocysteine a Predictor of Low Birth Weight Infants?

“…Relton et al [15] in their large study stated that early pregnancy red cell folate level was an important determinant of infant birth Open Journal of Obstetrics and Gynecology weight. Therefore, the maternal micronutrients status during pregnancy has a direct impact on birth weight, and the adequate supply of these micronutrients is known to be very crucial during pregnancy, and has been shown to increase birth weight by approximately 100 g [2] [16].…”