Maternal Multiple Micronutrient Supplementation and Pregnancy Outcomes in Developing Countries: Meta-analysis and Meta-regression

Overview

Journal Bull World Health Organ

Specialty Public Health

Date 2011 Jun 16

PMID 21673856

Citations 34

Authors

Kosuke Kawai

Donna Spiegelman

Anuraj H Shankar

Wafaie W Fawzi

Affiliations

Soon will be listed here.

Abstract

Objective: To systematically review randomized controlled trials comparing the effect of supplementation with multiple micronutrients versus iron and folic acid on pregnancy outcomes in developing countries.

Methods: MEDLINE and EMBASE were searched. Outcomes of interest were birth weight, low birth weight, small size for gestational age, perinatal mortality and neonatal mortality. Pooled relative risks (RRs) were estimated by random effects models. Sources of heterogeneity were explored through subgroup meta-analyses and meta-regression.

Findings: Multiple micronutrient supplementation was more effective than iron and folic acid supplementation at reducing the risk of low birth weight (RR: 0.86, 95% confidence interval, CI: 0.79-0.93) and of small size for gestational age (RR: 0.85; 95% CI: 0.78-0.93). Micronutrient supplementation had no overall effect on perinatal mortality (RR: 1.05; 95% CI: 0.90-1.22), although substantial heterogeneity was evident (I(2) = 58%; P for heterogeneity = 0.008). Subgroup and meta-regression analyses suggested that micronutrient supplementation was associated with a lower risk of perinatal mortality in trials in which > 50% of mothers had formal education (RR: 0.93; 95% CI: 0.82-1.06) or in which supplementation was initiated after a mean of 20 weeks of gestation (RR: 0.88; 95% CI: 0.80-0.97).

Conclusion: Maternal education or gestational age at initiation of supplementation may have contributed to the observed heterogeneous effects on perinatal mortality. The safety, efficacy and effective delivery of maternal micronutrient supplementation require further research.

Citing Articles

Daily oral iron supplementation during pregnancy.

Finkelstein J, Cuthbert A, Weeks J, Venkatramanan S, Larvie D, De-Regil L Cochrane Database Syst Rev. 2024; 8:CD004736.

PMID: 39145520 PMC: 11325660. DOI: 10.1002/14651858.CD004736.pub6.

Folic acid supplements and perinatal mortality in China.

Liu X, Liu X, An H, Li Z, Zhang L, Zhang Y Front Nutr. 2024; 10:1281971.

PMID: 38260077 PMC: 10800445. DOI: 10.3389/fnut.2023.1281971.

PROTOCOL: Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: a systematic review.

Keats E, Imdad A, Bhutta Z Campbell Syst Rev. 2023; 14(1):1-33.

PMID: 37131399 PMC: 8427982. DOI: 10.1002/CL2.191.

PROTOCOL: Efficacy and effectiveness of micronutrient supplementation and fortification interventions on the health and nutritional status of children under-five in low and middle-income countries: a systematic review.

Keats E, Imdad A, Das J, Bhutta Z Campbell Syst Rev. 2023; 14(1):1-36.

PMID: 37131367 PMC: 8428012. DOI: 10.1002/CL2.196.

Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: A systematic review.

Keats E, Oh C, Chau T, Khalifa D, Imdad A, Bhutta Z Campbell Syst Rev. 2023; 17(2):e1127.

PMID: 37051178 PMC: 8356361. DOI: 10.1002/cl2.1127.

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