Effects of Prenatal Multimicronutrient Supplementation on Pregnancy Outcomes: a Meta-analysis

Overview

Journal CMAJ

Date 2009 Jun 10

PMID 19506270

Citations 40

Authors

Prakesh S Shah

Arne Ohlsson

Affiliations

Soon will be listed here.

Abstract

Background: Reduced intake of micronutrients during pregnancy exposes women to nutritional deficiencies and may affect fetal growth. We conducted a systematic review to examine the efficacy of prenatal supplementation with multimicronutrients on pregnancy outcomes.

Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for relevant articles published in English up to December 2008. We also searched the bibliographies of selected articles as well as clinical trial registries. The primary outcome was low birth weight; secondary outcomes were preterm birth, small-for-gestational-age infants, birth weight and gestational age.

Results: We observed a significant reduction in the risk of low birth weight among infants born to women who received multimicronutrients during pregnancy compared with placebo (relative risk [RR] 0.81, 95% confidence interval [CI] 0.73-0.91) or iron-folic acid supplementation (RR 0.83, 95% CI 0.74-0.93). Birth weight was significantly higher among infants whose mothers were in the multimicronutrient group than among those whose mothers received iron-folic acid supplementation (weighted mean difference 54 g, 95% CI 36 g-72 g). There was no significant differences in the risk of preterm birth or small-for-gestational-age infants between the 3 study groups.

Interpretation: Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron-folic acid supplementation. There was no significant effect of multimicronutrient supplementation on the risk of preterm birth or small-for-gestational-age infants.

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References

Keen C, Clegg M, Hanna L, Lanoue L, Rogers J, Daston G . The plausibility of micronutrient deficiencies being a significant contributing factor to the occurrence of pregnancy complications. J Nutr. 2003; 133(5 Suppl 2):1597S-1605S. DOI: 10.1093/jn/133.5.1597S. View

Ioannidis J, Trikalinos T . The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey. CMAJ. 2007; 176(8):1091-6. PMC: 1839799. DOI: 10.1503/cmaj.060410. View

Christian P, Khatry S, Katz J, Pradhan E, LeClerq S, Shrestha S . Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial. BMJ. 2003; 326(7389):571. PMC: 151518. DOI: 10.1136/bmj.326.7389.571. View

Fawzi W, Msamanga G, Urassa W, Hertzmark E, Petraro P, Willett W . Vitamins and perinatal outcomes among HIV-negative women in Tanzania. N Engl J Med. 2007; 356(14):1423-31. DOI: 10.1056/NEJMoa064868. View

Gupta P, Ray M, Dua T, Radhakrishnan G, Kumar R, Sachdev H . Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007; 161(1):58-64. DOI: 10.1001/archpedi.161.1.58. View

Friis H, Gomo E, Nyazema N, Ndhlovu P, Krarup H, Kaestel P . Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe. Am J Clin Nutr. 2004; 80(1):178-84. DOI: 10.1093/ajcn/80.1.178. View

de Onis M, Villar J, Gulmezoglu M . Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998; 52 Suppl 1:S83-93. View

Catov J, Bodnar L, Ness R, Markovic N, Roberts J . Association of periconceptional multivitamin use and risk of preterm or small-for-gestational-age births. Am J Epidemiol. 2007; 166(3):296-303. DOI: 10.1093/aje/kwm071. View

Osrin D, Vaidya A, Shrestha Y, Baniya R, Manandhar D, Adhikari R . Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet. 2005; 365(9463):955-62. DOI: 10.1016/S0140-6736(05)71084-9. View

10.

Haider B, Bhutta Z . Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2006; (4):CD004905. DOI: 10.1002/14651858.CD004905.pub2. View

11.

Kaestel P, Michaelsen K, Aaby P, Friis H . Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau. Eur J Clin Nutr. 2005; 59(9):1081-9. DOI: 10.1038/sj.ejcn.1602215. View

12.

Susser M . Maternal weight gain, infant birth weight, and diet: causal sequences. Am J Clin Nutr. 1991; 53(6):1384-96. DOI: 10.1093/ajcn/53.6.1384. View

13.

Ramakrishnan U, Gonzalez-Cossio T, Neufeld L, Rivera J, Martorell R . Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico. Am J Clin Nutr. 2003; 77(3):720-5. DOI: 10.1093/ajcn/77.3.720. View

14.

Smith C . Effects of maternal under nutrition upon the newborn infant in Holland (1944-1945). J Pediatr. 2010; 30(3):229-43. DOI: 10.1016/s0022-3476(47)80158-1. View

15.

Zagre N, Desplats G, Adou P, Mamadoultaibou A, Aguayo V . Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster-randomized, double-blind, controlled programmatic study in rural Niger. Food Nutr Bull. 2007; 28(3):317-27. DOI: 10.1177/156482650702800308. View

16.

Shankar A, Jahari A, Sebayang S, Aditiawarman , Apriatni M, Harefa B . Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet. 2008; 371(9608):215-27. DOI: 10.1016/S0140-6736(08)60133-6. View

17.

Roberfroid D, Huybregts L, Lanou H, Henry M, Meda N, Menten J . Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008; 88(5):1330-40. DOI: 10.3945/ajcn.2008.26296. View

18.

Gopalan C . Multiple micronutrient supplementation in pregnancy. Nutr Rev. 2002; 60(5 Pt 2):S2-6. DOI: 10.1301/00296640260130669. View

19.

Hininger I, Favier M, Arnaud J, Faure H, Thoulon J, Hariveau E . Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometrics measurements: a randomized double-blind, placebo-controlled trial in apparently healthy pregnant women. Eur J Clin Nutr. 2003; 58(1):52-9. DOI: 10.1038/sj.ejcn.1601745. View

20.

Fawzi W, Msamanga G, Spiegelman D, Urassa E, McGrath N, Mwakagile D . Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998; 351(9114):1477-82. DOI: 10.1016/s0140-6736(98)04197-x. View