Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on birth size and length of gestation

Caroline H D Fall, David J. Fisher, Clive Osmond, Barrie M. Margetts, Pierre Adou, Víctor M. Aguayo, Lindsay H. Allen, Zulfiqar Ahmed Bhutta, Parul S Christian, Shaonong Dang, Gwenola Desplats, Michael Dibley, Shams El Arifeen, Caroline Fall, David Fisher, Henrik Friis, Exnevia Gomo, Batool Azra Haider, Adi Hidayat, Abbas JahariPernille Kaestel, Patrick Kolsteren, Kusharisupeni, Aissa Mamadoultaibou, Dharma Sharna Mandandhar, Barrie Margetts, David Osrin, Lars Ake Persson, Usha Ramakrishnan, Dominique Roberfroid, Carine Ronsmans, Anuraj H. Shankar, Subarkah, Sunawang, Budi Utomo, Anjana Vaidya, Hong Yan, Noel Zagre, Lingxia Zeng

Research output: Contribution to journalArticle

Abstract

Background. Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. Objective. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent rand-omized, controlled trials. Methods. Original data from 12 randomized, control-led trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Out-comes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (<2,500g), small-for-gestational age birth (SGA, birth-weight below the within-each-population 10th percen-tile), large-for-gestational age birth (LGA, birthweight above the within-each- population 90th percentile), and preterm delivery (<37 weeks). Results. Compared with control supplementation (mainly with iron-folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95% CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95% CI, 0.81 to 0.97];p = .01) and SGA birth (pooled OR = 0.90 [95% CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95% CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micro-nutrients on birthweight increased by 7.6 g (95% CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95% CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with -6.0 g (95% CI, -8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95% CI, -0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95% CI, 0.93 to 1.09]; p = .92). Conclusions. Compared with iron-folic acid sup-plementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BMI.

Original languageEnglish (US)
JournalFood and Nutrition Bulletin
Volume30
Issue number4 SUPPL.
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Micronutrients
meta-analysis
dietary minerals
pregnancy
birth weight
Meta-Analysis
income
low income
trace element
Parturition
Body Mass Index
body mass
Pregnancy
body mass index
Mothers
Folic Acid
low birth weight
folic acid
Iron
Gestational Age

Keywords

  • Birth outcomes
  • Birthweight
  • Iron-folic acid
  • Maternal body mass index
  • Meta-analysis
  • Multiple micronutrients
  • Pregnancy
  • Preterm delivery

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Nutrition and Dietetics
  • Food Science

Cite this

Fall, C. H. D., Fisher, D. J., Osmond, C., Margetts, B. M., Adou, P., Aguayo, V. M., ... Zeng, L. (2009). Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on birth size and length of gestation. Food and Nutrition Bulletin, 30(4 SUPPL.).

Multiple micronutrient supplementation during pregnancy in low-income countries : A meta-analysis of effects on birth size and length of gestation. / Fall, Caroline H D; Fisher, David J.; Osmond, Clive; Margetts, Barrie M.; Adou, Pierre; Aguayo, Víctor M.; Allen, Lindsay H.; Bhutta, Zulfiqar Ahmed; Christian, Parul S; Dang, Shaonong; Desplats, Gwenola; Dibley, Michael; Arifeen, Shams El; Fall, Caroline; Fisher, David; Friis, Henrik; Gomo, Exnevia; Haider, Batool Azra; Hidayat, Adi; Jahari, Abbas; Kaestel, Pernille; Kolsteren, Patrick; Kusharisupeni; Mamadoultaibou, Aissa; Mandandhar, Dharma Sharna; Margetts, Barrie; Osrin, David; Persson, Lars Ake; Ramakrishnan, Usha; Roberfroid, Dominique; Ronsmans, Carine; Shankar, Anuraj H.; Subarkah; Sunawang; Utomo, Budi; Vaidya, Anjana; Yan, Hong; Zagre, Noel; Zeng, Lingxia.

In: Food and Nutrition Bulletin, Vol. 30, No. 4 SUPPL., 12.2009.

Research output: Contribution to journalArticle

Fall, CHD, Fisher, DJ, Osmond, C, Margetts, BM, Adou, P, Aguayo, VM, Allen, LH, Bhutta, ZA, Christian, PS, Dang, S, Desplats, G, Dibley, M, Arifeen, SE, Fall, C, Fisher, D, Friis, H, Gomo, E, Haider, BA, Hidayat, A, Jahari, A, Kaestel, P, Kolsteren, P, Kusharisupeni, Mamadoultaibou, A, Mandandhar, DS, Margetts, B, Osrin, D, Persson, LA, Ramakrishnan, U, Roberfroid, D, Ronsmans, C, Shankar, AH, Subarkah, Sunawang, Utomo, B, Vaidya, A, Yan, H, Zagre, N & Zeng, L 2009, 'Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on birth size and length of gestation', Food and Nutrition Bulletin, vol. 30, no. 4 SUPPL..
Fall, Caroline H D ; Fisher, David J. ; Osmond, Clive ; Margetts, Barrie M. ; Adou, Pierre ; Aguayo, Víctor M. ; Allen, Lindsay H. ; Bhutta, Zulfiqar Ahmed ; Christian, Parul S ; Dang, Shaonong ; Desplats, Gwenola ; Dibley, Michael ; Arifeen, Shams El ; Fall, Caroline ; Fisher, David ; Friis, Henrik ; Gomo, Exnevia ; Haider, Batool Azra ; Hidayat, Adi ; Jahari, Abbas ; Kaestel, Pernille ; Kolsteren, Patrick ; Kusharisupeni ; Mamadoultaibou, Aissa ; Mandandhar, Dharma Sharna ; Margetts, Barrie ; Osrin, David ; Persson, Lars Ake ; Ramakrishnan, Usha ; Roberfroid, Dominique ; Ronsmans, Carine ; Shankar, Anuraj H. ; Subarkah ; Sunawang ; Utomo, Budi ; Vaidya, Anjana ; Yan, Hong ; Zagre, Noel ; Zeng, Lingxia. / Multiple micronutrient supplementation during pregnancy in low-income countries : A meta-analysis of effects on birth size and length of gestation. In: Food and Nutrition Bulletin. 2009 ; Vol. 30, No. 4 SUPPL.
@article{6ad5106aa384491cb87cb3d34697805a,
title = "Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on birth size and length of gestation",
abstract = "Background. Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. Objective. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent rand-omized, controlled trials. Methods. Original data from 12 randomized, control-led trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Out-comes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (<2,500g), small-for-gestational age birth (SGA, birth-weight below the within-each-population 10th percen-tile), large-for-gestational age birth (LGA, birthweight above the within-each- population 90th percentile), and preterm delivery (<37 weeks). Results. Compared with control supplementation (mainly with iron-folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95{\%} CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95{\%} CI, 0.81 to 0.97];p = .01) and SGA birth (pooled OR = 0.90 [95{\%} CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95{\%} CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micro-nutrients on birthweight increased by 7.6 g (95{\%} CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95{\%} CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with -6.0 g (95{\%} CI, -8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95{\%} CI, -0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95{\%} CI, 0.93 to 1.09]; p = .92). Conclusions. Compared with iron-folic acid sup-plementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10{\%}. The effect was greater among women with higher BMI.",
keywords = "Birth outcomes, Birthweight, Iron-folic acid, Maternal body mass index, Meta-analysis, Multiple micronutrients, Pregnancy, Preterm delivery",
author = "Fall, {Caroline H D} and Fisher, {David J.} and Clive Osmond and Margetts, {Barrie M.} and Pierre Adou and Aguayo, {V{\'i}ctor M.} and Allen, {Lindsay H.} and Bhutta, {Zulfiqar Ahmed} and Christian, {Parul S} and Shaonong Dang and Gwenola Desplats and Michael Dibley and Arifeen, {Shams El} and Caroline Fall and David Fisher and Henrik Friis and Exnevia Gomo and Haider, {Batool Azra} and Adi Hidayat and Abbas Jahari and Pernille Kaestel and Patrick Kolsteren and Kusharisupeni and Aissa Mamadoultaibou and Mandandhar, {Dharma Sharna} and Barrie Margetts and David Osrin and Persson, {Lars Ake} and Usha Ramakrishnan and Dominique Roberfroid and Carine Ronsmans and Shankar, {Anuraj H.} and Subarkah and Sunawang and Budi Utomo and Anjana Vaidya and Hong Yan and Noel Zagre and Lingxia Zeng",
year = "2009",
month = "12",
language = "English (US)",
volume = "30",
journal = "Food and Nutrition Bulletin",
issn = "0379-5721",
publisher = "United Nations University Press",
number = "4 SUPPL.",

}

TY - JOUR

T1 - Multiple micronutrient supplementation during pregnancy in low-income countries

T2 - A meta-analysis of effects on birth size and length of gestation

AU - Fall, Caroline H D

AU - Fisher, David J.

AU - Osmond, Clive

AU - Margetts, Barrie M.

AU - Adou, Pierre

AU - Aguayo, Víctor M.

AU - Allen, Lindsay H.

AU - Bhutta, Zulfiqar Ahmed

AU - Christian, Parul S

AU - Dang, Shaonong

AU - Desplats, Gwenola

AU - Dibley, Michael

AU - Arifeen, Shams El

AU - Fall, Caroline

AU - Fisher, David

AU - Friis, Henrik

AU - Gomo, Exnevia

AU - Haider, Batool Azra

AU - Hidayat, Adi

AU - Jahari, Abbas

AU - Kaestel, Pernille

AU - Kolsteren, Patrick

AU - Kusharisupeni,

AU - Mamadoultaibou, Aissa

AU - Mandandhar, Dharma Sharna

AU - Margetts, Barrie

AU - Osrin, David

AU - Persson, Lars Ake

AU - Ramakrishnan, Usha

AU - Roberfroid, Dominique

AU - Ronsmans, Carine

AU - Shankar, Anuraj H.

AU - Subarkah,

AU - Sunawang,

AU - Utomo, Budi

AU - Vaidya, Anjana

AU - Yan, Hong

AU - Zagre, Noel

AU - Zeng, Lingxia

PY - 2009/12

Y1 - 2009/12

N2 - Background. Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. Objective. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent rand-omized, controlled trials. Methods. Original data from 12 randomized, control-led trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Out-comes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (<2,500g), small-for-gestational age birth (SGA, birth-weight below the within-each-population 10th percen-tile), large-for-gestational age birth (LGA, birthweight above the within-each- population 90th percentile), and preterm delivery (<37 weeks). Results. Compared with control supplementation (mainly with iron-folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95% CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95% CI, 0.81 to 0.97];p = .01) and SGA birth (pooled OR = 0.90 [95% CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95% CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micro-nutrients on birthweight increased by 7.6 g (95% CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95% CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with -6.0 g (95% CI, -8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95% CI, -0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95% CI, 0.93 to 1.09]; p = .92). Conclusions. Compared with iron-folic acid sup-plementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BMI.

AB - Background. Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. Objective. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent rand-omized, controlled trials. Methods. Original data from 12 randomized, control-led trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Out-comes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (<2,500g), small-for-gestational age birth (SGA, birth-weight below the within-each-population 10th percen-tile), large-for-gestational age birth (LGA, birthweight above the within-each- population 90th percentile), and preterm delivery (<37 weeks). Results. Compared with control supplementation (mainly with iron-folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95% CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95% CI, 0.81 to 0.97];p = .01) and SGA birth (pooled OR = 0.90 [95% CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95% CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micro-nutrients on birthweight increased by 7.6 g (95% CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95% CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with -6.0 g (95% CI, -8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95% CI, -0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95% CI, 0.93 to 1.09]; p = .92). Conclusions. Compared with iron-folic acid sup-plementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BMI.

KW - Birth outcomes

KW - Birthweight

KW - Iron-folic acid

KW - Maternal body mass index

KW - Meta-analysis

KW - Multiple micronutrients

KW - Pregnancy

KW - Preterm delivery

UR - http://www.scopus.com/inward/record.url?scp=76749108130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=76749108130&partnerID=8YFLogxK

M3 - Article

C2 - 20120795

AN - SCOPUS:76749108130

VL - 30

JO - Food and Nutrition Bulletin

JF - Food and Nutrition Bulletin

SN - 0379-5721

IS - 4 SUPPL.

ER -