Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe. Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. 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. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Effects of antenatal multiple micronutrient supplementation on children's weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau 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 Vitamins and perinatal outcomes among HIV-negative women in Tanzania. Preventing low Birthweight through Maternal Multiple Micronutrient Supplementation: A Cluster-Randomized, Controlled Trial in Indramayu, West Java Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial
Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy BACKGROUND Multiple micronutrient deficiencies may contribute to low birth weight , which is a major global determinant of mortality . OBJECTIVE We assessed the effect of prenatal multimicronutrient supplementation on gestational length and birth size . DESIGN We conducted a r and omized , placebo-controlled , double-blind effectiveness trial among antenatal care attendees in Harare , Zimbabwe . Pregnant women ( 22 - 35 wk of gestation ) were r and omly allocated to receive a multimicronutrient or placebo supplement daily until delivery . Supplementation with iron and folic acid was part of antenatal care . RESULTS Of 1669 women , birth data were available from 1106 ( 66 % ) , of whom 360 ( 33 % ) had HIV infection . The mean gestational length was 39.1 wk , and 16.6 % of the women had a gestational length < 37 wk . The mean birth weight was 3030 g , and 10.5 % of the infants had a birth weight < 2500 g. Multimicronutrient supplementation was associated with tendencies for increased gestational length ( 0.3 wk ; 95 % CI : -0.04 , 0.6 wk ; P = 0.06 ) , birth weight ( 49 g ; -6 , 104 g ; P = 0.08 ) , and head circumference ( 0.2 cm ; -0.02 , 0.4 cm ; P = 0.07 ) but was not associated with low birth weight ( birth weight < 2500 g ) ( relative risk : 0.84 ; 0.59 , 1.18 ; P = 0.31 ) . The effect of multimicronutrient supplementation on birth weight was not significantly different between HIV-uninfected ( 26 g ; -38 , 91 g ) and HIV-infected ( 101 g ; -3 , 205 g ) subjects ( interaction , P > 0.10 ) . CONCLUSION Antenatal multimicronutrient supplementation may be one strategy to increase birth size BACKGROUND We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by approximately 15 % . OBJECTIVE We examined the effect of daily maternal micronutrient supplementation on  fetal loss and infant mortality .  DESIGN The study was a double-blind , cluster-r and omized , controlled trial among 4926 pregnant women and their 4130 infants in rural Nepal . In addition to vitamin A ( 1000 microg retinol equivalents ) , the intervention groups received either folic acid ( FA ; 400 microg ) , FA + iron ( 60 mg ) , FA + iron + zinc ( 30 mg ) , or multiple micronutrients ( MNs ; the foregoing plus 10 microg vitamin D , 10 mg vitamin E , 1.6 mg thiamine , 1.8 mg riboflavin , 2.2 mg vitamin B-6 , 2.6 microg vitamin B-12 , 100 mg vitamin C , 64 microg vitamin K , 20 mg niacin , 2 mg Cu , and 100 mg Mg ) . The control group received vitamin A only . RESULTS None of the supplements reduced fetal loss . Compared with control infants , infants whose mothers received FA alone or with iron or iron + zinc had a consistent pattern of 15 - 20 % lower 3-mo mortality ; this pattern was not observed with MNs . The effect on mortality was restricted to preterm infants , among whom the relative risks ( RRs ) were 0.36 ( 95 % CI : 0.18 , 0.75 ) for FA , 0.53 ( 0.30 , 0.92 ) for FA + iron , 0.77 ( 0.45 , 1.32 ) for FA + iron + zinc , and 0.70 ( 0.41 , 1.17 ) for MNs . Among term infants , the RR for mortality was close to 1 for all supplements except MNs ( RR : 1.74 ; 95 % CI : 1.00 , 3.04 ) . CONCLUSIONS Maternal micronutrient supplementation failed to reduce overall fetal loss or early infant mortality .  Among preterm infants , FA alone or with iron reduced mortality in the first 3 mo of life . MNs may increase mortality risk among term infants , but this effect needs further evaluation BACKGROUND Little is known about the benefits of prenatal multivitamin and mineral supplements in reducing  low birth weight .  OBJECTIVE We conducted a r and omized , double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient ( MM ) supplements with those of iron supplements during pregnancy on birth size . DESIGN Pregnant women ( n = 873 ) were recruited before 13 wk of gestation and received supplements 6 d/wk at home , as well as routine antenatal care , until delivery . Both supplements contained 60 mg Fe , but the MM group also received 1 - 1.5 times the recommended dietary allowances of several micronutrients . RESULTS At recruitment , the women in the 2 groups were not significantly different in age , parity , economic status , height , or hemoglobin concentration but differed significantly in marital status ( 4.6 % and 2.0 % of women in the MM and iron-only groups , respectively , were single mothers ) and mean ( + /- SD ) body mass index ( in kg/m(2 ) ; 24.6 + /- 4.3 and 23.8 + /- 3.9 in the iron-only and MM groups , respectively ) . Losses to follow-up ( 25 % ) and compliance ( 95 % ) did not differ significantly between the groups . In intent-to-treat analyses ( MM group : n = 323 ; iron-only group : n = 322 ) , mean ( + /- SD ) birth weight ( 2.981 + /- 0.391 and 2.977 + /- 0.393 kg in the MM and iron-only groups , respectively ) and birth length ( 48.61 + /- 1.82 and 48.66 + /- 1.83 cm in the MM and iron-only groups , respectively ) did not differ significantly between the groups . CONCLUSION These findings suggest that MM supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation BACKGROUND Intrauterine growth retardation is a major predictor of child health in developing countries . OBJECTIVE We tested whether providing pregnant women with the  UNICEF/WHO/UNU international multiple micronutrient preparation ( UNIMMAP ) , rather than iron and folic acid alone , improved fetal growth and its correlates . DESIGN An intention-to-treat , double-blind , r and omized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso . Tablet intake was directly observed . RESULTS Pregnancy outcome was known in 96.3 % of the participants . After adjustment for gestational age at delivery , both birth weight ( 52 g ; 95 % CI : 4 , 100 ; P = 0.035 ) and birth length ( 3.6 mm ; 95 % CI : 0.8 , 6.3 ; P = 0.012 ) were significantly higher in the UNIMMAP group . UNIMMAP had a differential effect by percentiles of birth weight and length distributions : the risk of large-for-gestational-age infants was higher in the UNIMMAP group ( OR : 1.58 ; 95 % CI : 1.04 , 2.38 ; P = 0.03 ) , although the risk of low birth weight remained unchanged . The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine . Unexpectedly , the risk of perinatal death was marginally significantly increased in the UNIMMAP group ( OR : 1.78 ; 95 % CI : 0.95 , 3.32 ; P = 0.07 ) , and this seemed to affect mainly primiparous women ( OR : 3.44 ; 95 % CI : 1.1 , 10.7 ; P for interaction = 0.11 ) . CONCLUSIONS Maternal UNIMMAP modestly but significantly increased fetal growth . The result ing benefit on infant growth and survival needs to be assessed . The possible lack of benefit and potential harm in primiparous women should be further investigated . This trial was registered at clinical trials.gov as NCT00642408 BACKGROUND According to our current underst and ing , iron absorption with weekly iron supplements is not higher than that with daily supplements ( ie , there is no mucosal block ) . However , community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one . Furthermore , when differences in absorption are found , they are commonly smaller than would be expected on the basis of differences in the amount of iron provided . The possibility of differential compliance between the regimens needs to be evaluated to explain these findings . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d . Compliance was monitored by using a pill bottle equipped with an electronic counting device .  Hemoglobin concentrations were measured at baseline and after 4 , 8 , and 12 wk of supplementation . RESULTS There was no differential effect per iron tablet between weekly and daily regimens . A 12-wk daily regimen ( 68 % compliance ) produced a small but significantly greater hemoglobin response than did the weekly regimen ( 104 % compliance ) . The first 20 tablets consumed produced most of the effect ; after 40 tablets , there was no further response . CONCLUSIONS There was no evidence of a mucosal block in the daily regimen . Over 12 wk , 50 % of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect . The weekly regimen provided a large part of this amount , explaining the limited difference in effect . It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary BACKGROUND Few data exist for the effects of multiple micronutrient ( MM ) or food supplementation to undernourished pregnant women on their offsprings ' development . OBJECTIVE We aim ed to compare the effects on infant development of early ( 8 - 10 wk gestation ) or usual ( approximately 17 wk gestation ) supplementation with food and MM , 30 mg Fe + 400 microg folate , or 60 mg Fe + 400 microg folate . DESIGN A large , r and omized , controlled trial of pregnancy supplementation was conducted in Bangladesh . A sub sample of infants ( n = 2853 ) were assessed on 2 problem-solving tests ( support and cover tests ) , the motor index of the Bayley Scales of Infant Development , and Wolke 's behavior ratings at 7 mo of age . RESULTS There were no significant effects of any intervention in the group as a whole . However , infants of undernourished mothers [ body mass index ( BMI ; in kg/m2 ) < 18.5 ] who received early food supplementation performed slightly but significantly ( P = 0.035 ) better on the support test than did infants of mothers who received usual food supplementation ( z score : 0.17 ; 95 % CI : 0.01 , 0.33 ) . There were no benefits in infants of higher- BMI mothers ( P = 0.024 for BMI x food interaction ) . Children of low- BMI mothers who received MMs had slightly better motor scores ( z score : 0.28 ; 95 % CI : 0.08 , 0.48 ) and activity ratings ( z score : 0.24 ; 95 % CI : 0.037 , 0.45 ) than did those who received 30 mg Fe + 400 microg folate , whereas other children did not benefit ( P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients ) . CONCLUSIONS Small benefits from early food and MM supplementation were found in infants of low- BMI but not of high- BMI mothers . However , the benefits were of doubtful functional importance , and longer follow-up is required to determine programmatic implication OBJECTIVE To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring , incidence of low-birth-weight infants ( < 2500 g ) , and early neonatal morbidity .  DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Tertiary care hospital . PARTICIPANTS Two hundred pregnant women ( of 13 465 approached ) with a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of less than 18.5 and /or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation . One hundred forty-six neonates ( 73.0 % ) were available for analysis of birth size and 170 ( 85.0 % ) for analysis of morbidity in the 7 days after delivery . Intervention The micronutrient supplementation group ( n = 99 ) received a multimicronutrient supplement containing 29 vitamins and minerals once a day , from enrollment until delivery ( median duration , 58 days ; interquartile range , 37 - 77 days ; compliance , 87 % ) . The comparison group ( n = 101 ) received placebo for 52 ( 15 - 66 ) days , with 85 % compliance . All subjects also received supplements of iron ( given in the form of ferrous sulfate , containing 60 mg of elemental iron ) , 60 mg/d , and folic acid , 500 mug/d . MAIN OUTCOME MEASURES Birth weight , length , midarm circumference , incidence of low birth weight , and early neonatal morbidity . RESULTS Infants in the micronutrient group were heavier by 98 g ( 95 % confidence interval [ CI ] , -16 to 213 g ) and measured 0.80 cm ( 95 % CI , 0.03 - 1.57 cm ) longer and 0.20 cm ( 95 % CI , 0.04 - 0.36 cm ) larger in midarm circumference compared with the placebo group . Incidence of low birth weight declined from 43.1 % to 16.2 % with multimicronutrient supplementation a ( a 70 % decrease ; relative risk , 0.30 ; 95 % CI , 0.13 - 0.71 ; P=.006 ) , and that of early neonatal morbidity declined from 28.0 % to 14.8 % ( a 58 % decrease ; relative risk , 0.42 ; 95 % CI , 0.19 - 0.94 ; P=.04 ) . CONCLUSION Compared with iron and folic acid supplementation , the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity Background Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation . Intervention strategies largely consist of administration of iron – folic acid supplements during pregnancy . Objective We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-r and omized design . Methods We r and omly assigned 2,378 pregnant women to receive either iron – folic acid or multiple micronutrient supplements . The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers . Results The women in both groups consumed about 75 % of the supplements provided , and few reported adverse effects such as vomiting , abdominal pain , etc . There was a small ( 70 g ) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron – folic acid supplements ( 2.95 ± 0.6 vs. 2.88 ± 0.5 kg , p = .01 ) . This translated into a 10 % reduction ( p < 0.17 ) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients . Although stillbirth rates were comparable in the two groups , the early neonatal mortality rate in the group receiving multiple micronutrients was higher , although not significantly , than that in the group receiving iron– folic acid ( 43.2 vs. 23.5 deaths per 1,000 live births ; RR = 1.64 ; 95 % CI , 0.94 to 2.87 ) . Comparable reductions in anemia ( hemoglobin < 11 g/dL ) were observed , although the proportion with low iron stores ( assessed by serum ferritin ) was lower in the iron – folic acid group in the postnatal period . Although the proportion of women with sub clinical vitamin A deficiency after supplementation did not differ between the two groups , the iron – folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period . Conclusions These data suggest that multiple micronutrient supplements are well tolerated during pregnancy , but the effect on birthweight is modest . The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system setting BACKGROUND Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years , and low birthweight is a crucial underlying factor . We tested the hypotheses that antenatal multiple micronutrient supplementation would increase  infant birthweight and gestational duration . METHODS We did a double-blind , r and omised controlled trial in Dhanusha district , Nepal . Women attending for antenatal care with singleton pregnancies at up to 20 weeks ' gestation were invited to participate . Participants were r and omly allocated either routine iron and folic acid supplements ( control ; n=600 ) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals ( intervention ; n=600 ) . Supplementation began at a minimum of 12 weeks ' gestation and continued until delivery . Primary outcome measures were birthweight and gestational duration . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N88625934 . FINDINGS Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group .  Mean birthweight was 2733 g ( SD 422 ) in the control group and 2810 g ( 453 ) in the intervention group , representing a mean difference of 77 g ( 95 % CI 24 - 130 ; p=0.004 ) and a relative fall in the proportion of low birthweight by 25 % . No difference was recorded in the duration of gestation ( 0.2 weeks [ -0.1 to 0.4 ] ; p=0.12 ) , infant length ( 0.3 cm [ -0.1 to 0.6 ] ; p=0.16 ) , or head circumference ( 0.2 cm [ -0.1 to 0.4 ] ; p=0.18 ) . INTERPRETATION In a poor community in Nepal , consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a st and ard iron and folic acid preparation . The effects on perinatal morbidity and mortality need further comparisons between studies . Published online March 3 , 2005 http://image.thelancet.com/extras/04art11045web.pdf OBJECTIVE To examine the effect of supplemental prenatal folic acid , folic acid-iron , folic acid-iron-zinc , and multiple micronutrients on  maternal morbidity in rural Nepal . METHODS A cluster-r and omized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation . Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity . RESULTS A total of 3986 ( 97.3 % ) women completed an interview regarding labor and delivery ; morbidity history was available for 3564 ( 87.0 % ) women .  Folic acid-iron reduced the risk of postpartum hemorrhage ( relative risk [ RR ] 0.59 ; 95 % confidence interval [ CI ] 0.35 - 0.98 ) . Risk of dysfunctional labor increased with multiple micronutrient supplementation ( RR 1.28 ; 95 % CI , 1.01 - 1.60 ) , although preterm premature rupture of membrane decreased ( RR 0.40 ; 95 % CI , 0.21 - 0.79 ) . Puerperal sepsis was lower in those receiving folic acid-iron , folic acid-iron-zinc , and multiple micronutrients compared with controls ( P<0.05 ) . CONCLUSION Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting Summary Background The negative effects of low birthweight on the later health of children in developing countries have been well studied . However , undertaking programmes to address this issue can be difficult since there is no simple correlation between increasing birthweight and improving child health . In 2005 , we published results of a r and omised controlled trial in Nepal , in which 1200 women received either iron and folic acid or a supplement that provided the recommended daily allowance of 15 vitamins and minerals , over the second and third trimesters of pregnancy . Here , we report on 2–3 years ' follow-up of children born during the trial . Methods We visited children at home and obtained data for the primary outcomes of weight and height , for childhood illnesses , and maternal blood haemoglobin . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N88625934 . Findings Between December , 2005 , and December , 2006 , we assessed 917 children ( 455 controls , 462 intervention ) at a mean age of 2·5 years . Mean birthweight had been 77 g ( 95 % CI 24–130 ) greater in the micronutrient group than in controls . At 2·5 years old , controls weighed a mean of 10·7 kg ( SD 1·38 ) , and those in the intervention group 10·9 kg ( SD 1·54 ) . Children of women who had  taken multiple micronutrient supplements  during pregnancy were a mean 204 g ( 95 % CI 27–381 ) heavier than controls . They also had greater measurements than controls in the circumference of the head ( 2·4 mm [ 95 % CI 0·6–4·3 ] ) , chest ( 3·2 mm [ 0·4–6·0 ] ) , and mid-upper arm ( 2·4 mm [ 1·1–3·7 ] ) , and in triceps skinfold thickness ( 2·0 mm [ 0·0–0·4 ] ) . Systolic blood pressure was slightly lower in the intervention group ( 2·5 mm Hg [ 0·5–4·6 ] ) . Interpretation In a poor population , the effects of  maternal multiple micronutrient supplementation  on the fetus persisted into childhood , with increases in both weight and body size . These increases were small , however , since those exposed to micronutrients had an average of 2 % higher weight than controls . The public-health implication s of changes in weight and blood pressure need to be clarified through further follow-up Objectives : To assess the effects of daily prenatal multimicronutrient supplementation on  birth weight ( BW ) and perinatal mortality . Design : R and omised , controlled , double masked trial . Setting : Urban Guinea-Bissau , West Africa . Subjects : A total of 2100 pregnant women ( 22±7 weeks pregnant at entry ) were recruited through antenatal clinics , of which 1670 ( 79.5 % ) completed the trial . BW was available for 1100 live born babies . Interventions : Identical-looking supplements containing one ( MN-1 ) or two ( MN-2 ) Recommended Dietary Allowances ( RDA ) of 15 micronutrients , or iron and folic acid ( control ) . Results : Mean BW among 1100 live born infants was 3050±498 g with 11.9 % being low birth weight ( LBW , BW<2500 g ) . Perinatal mortality was 82 per 1000 deliveries ( N=1670 ) , and neonatal mortality 45 per 1000 live births ( N=1599 ) . Mean BW in MN-1 ( n=360 ) and MN-2 ( n=374 ) groups were 53 [ −19 ; 125 ] and 95 [ 24 ; 166 ] g higher than controls ( n=366 ) . Proportion of LBW was 13.6 % in control , and 12.0 and 10.1 % in the MN-1 and MN-2 groups , respectively ( P=0.33 ) . Among anaemic women ( 30 % ) , MN-2 increased BW with 218 [ 81 ; 354 ] g compared to controls , with a decreased risk of LBW of 69 [ 27 ; 87]% . There were apparently no differences in perinatal mortality between groups . Conclusions : Prenatal micronutrient supplementation  increased BW but did not reduce perinatal mortality in this study . Multimicronutrient supplementation with two RDA should be considered in future programmes to reduce the proportion of LBW Background Micronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes , including reduced birthweight . Low birthweight is associated with increased risk of infant mortality and growth failure . Objectives To assess the effects of prenatal supplementation with UNIMMAP ( United Nations International Multiple Micronutrient Preparation ) compared with iron/folic acid on average birthweight and incidence of low birthweight . Methods Pregnant women from 78 villages in Niger were included in a cluster-r and omized , double-blinded , controlled supplementation trial . Baseline , monthly follow-up , and birth data were collected . Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models . Analyses were stratified by nutrition status and duration of supplementation . Results Of the 3,670 women recruited , 2,550 completed the study and provided complete birthweight data ( 1,328 received  multiple micronutrients and 1,222 received iron/folic acid ) . Mean birthweight was significantly higher ( 67 g , p < .001 ) with multiple micronutrients ( 3,092 ± 190 g ) than with iron/folic acid ( 3,025 ± 205 g ) ; this corresponded to a 14 % fall in the incidence of low birthweight ( from 8.4 % with multiple micronutrients to 7.2 % with folic acid fortification ) . The impact of multiple micronutrients was greater when the supplements were taken for more than 150 days . The incidence of low birthweight was further reduced in women who entered pregnancy with a poorer nutrition status . Conclusions Prenatal supplementation with multiple micronutrients had a greater positive impact on birthweight  than supplementation with iron/folic acid . Our data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight BACKGROUND Prematurity and low birth weight are associated with high perinatal and infant mortality , especially in developing countries . Maternal micronutrient deficiencies may contribute to these adverse outcomes . METHODS In a double-blind trial in Dar es Salaam , Tanzania , we r and omly assigned 8468 pregnant women ( gestational age of fetus , 12 to 27 weeks ) who were negative for human immunodeficiency virus infection to receive  daily multivitamins ( including multiples of the recommended dietary allowance ) or placebo . All the women received prenatal supplemental iron and folic acid . The primary outcomes were low birth weight ( < 2500 g ) , prematurity , and fetal death . RESULTS The incidence of low birth weight was 7.8 % among the infants in the multivitamin group and 9.4 % among those in the placebo group ( relative risk , 0.82 ; 95 % confidence interval [ CI ] , 0.70 to 0.95 ; P=0.01 ) . The mean difference in birth weight between the groups was modest ( 67 g , P<0.001 ) . The rates of prematurity were 16.9 % in the multivitamin group and 16.7 % in the placebo group ( relative risk , 1.01 ; 95 % CI , 0.91 to 1.11 ; P=0.87 ) , and the rates of fetal death were 4.3 % and 5.0 % , respectively ( relative risk , 0.87 ; 95 % CI , 0.72 to 1.05 ; P=0.15 ) . Supplementation reduced both the risk of a birth size that was small for gestational age ( < 10th percentile ; 10.7 % in the multivitamin group vs. 13.6 % in the placebo group ; relative risk , 0.77 ; 95 % CI , 0.68 to 0.87 ; P<0.001 ) and the risk of maternal anemia ( hemoglobin level , < 11 g per deciliter ; relative risk , 0.88 ; 95 % CI , 0.80 to 0.97 ; P=0.01 ) , although the difference in the mean hemoglobin levels between the groups was small ( 0.2 g per deciliter , P<0.001 ) . CONCLUSIONS Multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death .  Multivitamins should be considered for all pregnant women in developing countries . ( Clinical Trials.gov number , NCT00197548 [ Clinical Trials.gov ] . ) Background Micronutrient deficiencies may contribute to a higher incidence of  low birthweight ( LBW ) . UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women , and several effectiveness trials were conducted to assess its impact . Objective To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size , pregnancy outcome , and maternal micronutrient status in comparison with iron – folic acid supplementation . Methods We carried out a cluster-r and omized , controlled trial in Indramayu , Indonesia , involving 843 pregnant women . Of these , 432 received multiple micronutrients and 411 received iron – folic acid . Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality . Results The mean number of supplements consumed during pregnancy and 30 days postpartum was high ( 136 in the group receiving multiple micronutrients and 140 in the iron – folic acid group ) . The women consumed the supplements on average 5 days per week . Although there were no significant differences between the groups in the percentage of infants with LBW , there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients ( 6.3 % vs. 7.3 % ) , and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron – folic acid group , although the difference was not significant . Among those who consumed 90 or more supplements during pregnancy , women taking multiple micronutrients had a 3.3 % combined rate of miscarriage , stillbirth , or neonatal death , as compared with 6.9 % for those taking iron – folic acid only ( p < .049 ) . The anemia rates in the two groups were similar after supplementation , even though the amount of iron in the multiple micronutrient supplement was half that in the iron – folic acid supplement . Serum retinol was higher in the group receiving multiple micronutrients . Conclusions Multivitamin supplementation use among pregnant women is as effective as iron – folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status Abstract Objective : To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women . Design : Double blind cluster r and omised controlled trial . Setting : Rural community in south eastern Nepal . Participants : 4926 pregnant women and 4130 live born infants . Interventions : 426 communities were r and omised to five regimens in which pregnant women received daily supplements of folic acid , folic acid-iron , folic acid-iron-zinc , or multiple micronutrients all given with vitamin A , or vitamin A alone ( control ) . Main outcome measures : Birth weight , length , and head and chest circumference assessed within 72 hours of birth . Low birth weight was defined < 2500 g. Results : Supplementation with maternal folic acid alone had no effect on birth size . Folic acid-iron  increased mean birth weight by 37 g ( 95 % confidence interval −16 g to 90 g ) and reduced the percentage of low birthweight babies ( < 2500 g ) from 43 % to 34 % ( 16 % ; relative risk=0.84 , 0.72 to 0.99 ) . Folic acid-iron-zinc had no effect on birth size compared with controls . Multiple micronutrient supplementation  increased birth weight by 64 g ( 12 g to 115 g ) and reduced the percentage of low birthweight babies by 14 % ( 0.86 , 0.74 to 0.99 ) . None of the supplement combinations reduced the incidence of preterm births . Folic acid-iron and multiple micronutrients increased head and chest circumference of babies , but not length . Conclusions : Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight . Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk . What is already known on this topic Deficiencies in micronutrients are common in women in developing countries and have been associated with low birth weight and preterm delivery What this study adds In rural Nepal maternal supplementation with folic acid-iron reduced the incidence of low birth weight by 16 % A multiple micronutrient supplement of 14 micronutrients , including folic acid , iron , and zinc , reduced low birth weight by 14 % , thus conferring no advantage over folic
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 st and ard iron-folate supplements , on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool ( LiST ) .