Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

Haider, Batool Azra; Yakoob, Mohammad Yawar; Bhutta, Zulfiqar A.
January 2011
BMC Public Health;2011 Supplement 3, Vol. 11 Issue Suppl 3, p1
Academic Journal
Objectives/background: Given the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA) births, low birth weight, stillbirths, perinatal and neonatal mortality. This review evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST). Data sources/review methods: A systematic review of randomized controlled trials was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction and Child Health Epidemiology Reference (CHERG) adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) technique were used for data abstraction and overall quality of evidence. Meta-analyses were performed to calculate summary estimates of utility to the LiST model for the specified outcome of incidence of SGA births. We also evaluated the potential impact of multiple micronutrients on neonatal mortality according to the proportion of deliveries occurring in facilities (using a threshold of 60% to indicate functionality of health systems for skilled births). Results: We included 17 studies for detailed data abstraction. There was no significant benefit of multiple micronutrients as compared to iron folate on maternal anemia in third trimester [Relative risk (RR) = 1.03; 95% confidence interval (CI): 0.87 - 1.22 (random model)]. Our analysis, however, showed a significant reduction in SGA by 9% [RR = 0.91; 95% CI: 0.86 - 0.96 (fixed model)]. In the fixed model, the SGA outcome remained significant only in women with mean body mass index (BMI) ≥ 22 kg/m2. There was an increased risk of neonatal mortality in studies with majority of births at home [RR = 1.47, 95% CI: 1.13-1.92]; such an effect was not evident where ≥ 60% of births occurred in facility settings [RR = 0.94, 95% CI: 0.81-1.09]. Overall there was no increase in the risk of neonatal mortality [RR = 1.05, 95% CI: 0.92 - 1.19 (fixed model)]. Conclusion: This review provides evidence of a significant benefit of MMN supplementation during pregnancy on reducing SGA births as compared to iron-folate, with no significant increase in the risk of neonatal mortality in populations where skilled birth care is available and majority of births take place in facilities. Given comparability of impacts on maternal anemia, the decision to replace iron-folate with multiple micronutrients during pregnancy may be taken in the context of available services in health systems and birth outcomes monitored.


Related Articles

  • Total and Cancer Mortality After Supplementation With Vitamins and Minerals: Follow-up of the Linxian General Population Nutrition Intervention Trial. You-Lin Qiao; Dawsey, Sanford M.; Kamangar, Farm; Jin-Hu Fan; Abnet, Christian C.; Xiu-Di Sun; Johnson, Laura Lee; Gail, Mitchell H.; Zhi-Wei Dong; Binbing Yu; Mark, Steven D.; Taylor, Philip R. // JNCI: Journal of the National Cancer Institute;4/1/2009, Vol. 101 Issue 7, p507 

    Background The General Population Nutrition Intervention Trial was a randomized primary esophageal and gastric cancer prevention trial conducted from 1985 to 1991, in which 29584 adult participants in Linxian, China, were given daily vitamin and mineral supplements. Treatment with "factor D," a...

  • Interpreting clinical trials.  // British Medical Journal;11/11/1978, Vol. 2 Issue 6148, p1318 

    Reports on the influence of confidence limits on the conclusiveness of the interpretations of clinical trials in Great Britain. Importance of the information of the calculation to the clinician; Impact of the item of statistical and clinical logic on the design and interpretation of trials;...

  • Analysing recurrent hospitalizations in heart failure: a review of statistical methodology, with application to CHARM-Preserved. Rogers, Jennifer K.; Pocock, Stuart J.; McMurray, John J.V.; Granger, Christopher B.; Michelson, Eric L.; Östergren, Jan; Pfeffer, Marc A.; Solomon, Scott D.; Swedberg, Karl; Yusuf, Salim // European Journal of Heart Failure;Jan2014, Vol. 16 Issue 1, p33 

    Aims Heart failure is characterized by recurrent hospitalizations, but often only the first event is considered in clinical trial reports. In chronic diseases, such as heart failure, analysing all events gives a more complete picture of treatment benefit. We describe methods of analysing repeat...

  • The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: insights from the ASCEND-HF Trial. Toma, Mustafa; Ezekowitz, Justin A.; Bakal, Jeffrey A.; O'Connor, Christopher M.; Hernandez, Adrian F.; Sardar, Muhammad Rizwan; Zolty, Ronald; Massie, Barry M.; Swedberg, Karl; Armstrong, Paul W.; Starling, Randall C. // European Journal of Heart Failure;Mar2014, Vol. 16 Issue 3, p334 

    Aim Acute decompensated heart failure (ADHF) is associated with significant morbidity and mortality but the relationship between LVEF and outcomes is unclear. We explored the association between LVEF and 30 and 180 day mortality in 7007 ADHF patients enrolled in the Acute Studies of Nesiritide...

  • Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis. Schuetz, Philipp; Briel, Matthias; Christ-Crain, Mirjam; Stolz, Daiana; Bouadma, Lila; Wolff, Michel; Luyt, Charles-Edouard; Chastre, Jean; Tubach, Florence; Kristoffersen, Kristina B.; Wei, Long; Burkhardt, Olaf; Welte, Tobias; Schroeder, Stefan; Nobre, Vandack; Tamm, Michael; Bhatnagar, Neera; Bucher, Heiner C.; Mueller, Beat // Clinical Infectious Diseases;Sep2012, Vol. 55 Issue 5, p651 

    This individual patient data meta-analysis of clinical trials investigating procalcitonin algorithms for antibiotic decision making found no increased risk of death or setting-specific treatment failure but did find significantly lower antibiotic exposure across different acute respiratory...

  • Emergence of Endemic Serogroup W135 Meningococcal Disease Associated with a High Mortality Rate in South Africa. von Gottberg, Anne; duPlessis, Mignon; Cohen, Cheryl; Prentice, Elizabeth; Schrag, Stephanie; de Gouveia, Linda; Coulson, Garry; de Jong, Gillian; Klugman, Keith // Clinical Infectious Diseases;2/1/2008, Vol. 46 Issue 3, p377 

    Background. In the African meningitis belt, Neisseria meningitidis serogroup W135 has emerged as a cause of epidemic disease. The establishment of W135 as the predominant cause of endemic disease has not been described. Methods. We conducted national laboratory-based surveillance for invasive...

  • Meta-Analysis of a Possible Signal of Increased Mortality Associated with Cefepime Use. Kim, Peter W.; Yu-te Wu; Cooper, Charles; Rochester, George; Valappil, Thamban; Yan Wang; Kornegay, Cynthia; Nambiar, Sumathi // Clinical Infectious Diseases;8/15/2010, Vol. 51 Issue 4, p381 

    Background. On the basis of meta-analyses, concern has been raised regarding a possible signal of increased mortality associated with the use of cefepime versus other b-lactam antibiotics. To further investigate this possible signal, we accessed findings and data from published and unpublished...

  • Carbapenems versus other beta-lactams in treating severe infections in intensive care: a systematic review of randomised controlled trials. Edwards, S. J.; Clarke, M. J.; Wordsworth, S.; Emmas, C. E. // European Journal of Clinical Microbiology & Infectious Diseases;Jul2008, Vol. 27 Issue 7, p531 

    Carbapenems have not been comprehensively compared in clinical trials with fourth-generation cephalosporins (4GC) and antipseudomonal penicillins (APP) in the treatment of severe infections (SI) and febrile neutropenia (FN). A systematic review of CENTRAL, EMBASE, MEDLINE and JICST-EPlus for...

  • Increased perioperative mortality following aprotinin withdrawal: a real-world analysis of blood management strategies in adult cardiac surgery. Walkden, Graham; Verheyden, Veerle; Goudie, Rosalind; Murphy, Gavin // Intensive Care Medicine;Oct2013, Vol. 39 Issue 10, p1808 

    Purpose: To evaluate the effect of aprotinin withdrawal in 2008 on patient outcomes, to assess the likely risks and benefits of its re-introduction, and to consider the relevance of existing evidence from clinical trials to 'real-world' practice. Methods: We performed a nested case-control study...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics