The Effects of Maternal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Supplementation on Infant Health

Purple PillsMany women take a prenatal vitamin before and during pregnancy to fill in an nutritional gaps. However, the effects of maternal supplementation with multiple micronutrients on fetal and infant health had not been fully investigated. Now a new study published in the journal JAMA finds that multiple micronutrients supplementation compared to iron-folic acid supplementation reduced preterm birth and low birth weight but did not reduce all-cause infant mortality between birth and six  months.

As a result of poor maternal nutrition, many pregnant women in resource-poor regions such as southern Asia suffer from multiple micronutrient deficiencies.

For the present study, researchers led by Keith P. West Jr., Dr.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore sought to assess effects of prenatal multiple micronutrient versus iron-folic acid supplementation on six-month infant mortality and adverse birth outcomes such as  low birth weight, premature birth, small size for gestational age, and stillbirth.

Using a  cluster randomized, double-masked trial in Bangladesh, the researchers studied 44,567 women who became pregnant during the course of the study. Of the total participants, the women delivered 28,516 live-born infants.

The researchers provided the women in the study with supplements containing fifteen micronutrients or only ironfolic acid taken daily from early pregnancy to twelve weeks postpartum.

Of the total pregnancies, 22,405 received the multiple micronutrient supplement and 22,162 the iron-folic acid supplement. A total of 14,374 live births occurred in the multiple micronutrient group and 14,142 in the iron-folic acid group.

At six months of age, maternal supplementation with multiple micronutrients did not significantly reduce infant mortality. A total of 741 deaths (51.6 per 1,000 live births) occurred in the multiple micronutrient group compared to 764 (54.0 per 1,000) in the iron-folic acid group.

In other words, maternal supplementation with multiple micronutrients does not reduce infant mortality.

However, multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight compared to supplementation with only iron-folic acid. Within the multiple micronutrient group, 43.1 stillbirths per 1,000 births occurred compared to 48.2 in the iron-folic acid group. With multiple micronutrient supplementation, 18.6 premature births and 40.2 low birth weight births per 100 live births occurred compared to 21.8 and 45.7 with iron-folic acid supplementation.

Maternal supplementation with multiple micronutrients therefore appears to reduce the risk of premature birth and low birth weight as well as stillbirth.

Write the authors of the study on the findings:

“Our study’s null finding is in agreement with a small number of trials that have provided an antenatal multiple micronutrient vs iron supplement, with or without folic acid, and found no effect on neonatal mortality.”

“Reasons for a null effect on postnatal survival after improvement in some birth outcomes with antenatal multiple micronutrient supplement use remain unknown but may reflect a complex interplay between maternal and newborn sizes and differential responses to supplementation by causes of death.”

Another study from earlier in the year found that less than one in three women supplement with folic acid before pregnancy.


Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh:
Maternal Supplementation with Multiple Micronutrients, Compared with Iron-Folic Acid, Does Not Reduce Infant Mortality:

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