Effects of maternal micronutrient supplementation on fetal loss and under-2-years child mortality: Long-term follow-up of a randomised controlled trial from GuineaBissau
), Henrik Friis(2), Kim Fleischer Michaelsen(3), Amabelia Rodrigues(4), Christine Stabell Benn(5), Peter Aaby(6), Pernille Kaestel(7),
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Corresponding Author
Abstract
A number of trials on maternal multi-micronutrient supplementation (MMS) have found a benefical effect on birth weight, but few have demonstrated a beneficial effect on infant survival. We examined the effect of two different preparations of antenatal MMS on fetal loss and under-2-years child mortality, as compared with iron-folic acid supplementation among 2,100 pregnant women in Guinea-Bissau. Women receiving a 1xRDA MMS preparation (consisting of 14 vitamins and minerals) had a marginally reduced risk of fetal loss (Relative risk (RR) 0.65, 95% CI 0.40; 1.05), and women receiving a 2xRDA MMS preparation had a similar effect (RR 0.67, 95% CI 0.42; 1.08), the pooled effect being 0.66 (95% CI 0.44; 0.99). None of the supplements reduced under-2-years mortality or the combination of fetal loss and under-2-years mortality. There was a marginally negative effect of both the 1xRDA (RR 2.10, 95% CI 0.99; 4.46) and the 2xRDA (RR 2.02, 95% CI 0.95; 4.32) MMS preparation on mortality specifically between 92365 days of age. (Afr. J. Reprod. Health 2010; 14[2]:17-26).
RĖSUMĖ
Effets de la recherche micro-nourricière matérielle sur la perte du fœtus et la mortalité infantile de moins de deux ans : suite d’observation d’un essai contrôlé au hasard de la Guinée Bissau. Un certain nombre d’essais sur la recharge multi micro – nourricière maternelle (MMN) ont porté des bénéfices à l’égard de la perte de poids, mais très peu ont fait preuve d’un effet salutaire sur la survie de l’enfant. Nous avons examiné l’effet de deux différentes préparations de la MMN prénatale sur la perte du fœtus et la mortalité infantile de moins de deux ans comparé à la recharge en acide folique de fer chez 2,100 femmes enceintes en Guinée Bissau. Les femmes qui prenaient la préparation 1xRDA MMS (qui se compose de 14 vitamines et des substances minérales) risquaient une perte réduite du fœtus de manière négligeable (Risque relatif (RR) 0,65, 95% CI 0,40 ; 1,05), et les femmes qui prenaient la préparation 2xRDA MMS ont eu l’effet pareil (RR 0,67, 95% C10, 42 ; 1,08), l’effet réuni étant 0,66 (95% CI 0,44 ; 0,99). Aucun des suppléments n’a réduit la mortalité de moins de deux ans ou la combinaison de la perte du fœtus et la mortalité de moins de deux ans. Il y avait un effet négatif négligeable de 1xRDA (RR 2,10, 95% CI 0,99.4,46) et 2xRDA (RR 2, 02, 95% CI 0,95 ; 4,32) sur la mortalité en particulier entre l’âge de 92 – 365 jours. (Afr. J. Reprod. Health 2010; 14[2]:17-26).
KEYWORDS: Micronutrients, Pregnancy, Infant Mortality, Fetal Death, Randomized Controlled Trial, Survival Analysis.
References
UNICEF, WHO, UNU. Multiple Micronutrient Supplementation During Pregnancy (MMSDP): A Review of Progress of Efficacy Trials. 2004. UNICEF.
UNICEF/WHO/UNU. Composition of a multimicronutrient supplement to be used in pilot programmes among pregnant women in developing countries. 1999. New York.
Christian P, Khatry SK, Katz J, Pradhan EK, Leclerq SC, Shrestha SR et al. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial. BMJ 2003; 326(7389):571.
Friis H, Gomo E, Nyazema N, Ndhlovu P, Krarup H, Kaestel P et al. 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.
Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK et al. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial. Lancet 2005; 365(9463):955-62.
Kaestel P, Michaelsen KF, 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.
Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, McGrath N, Mwakagile D et al. 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):147782.
Shankar AH, Jahari AB, Sebayang SK,
Aditiawarman, Apriatni M, Harefa B et al. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a doubleblind cluster-randomised trial. Lancet 2008; 371(9608):215-27.
Christian P, West KP, Khatry SK, Leclerq SC, Pradhan EK, Katz J et al. Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Am J Clin Nutr 2003; 78(6):1194-202.
Huffman SL, Habicht JP, Scrimshaw N. Micronutrient supplementation in pregnancy. Lancet 2005; 366(9502):2001-3.
Christian P, Osrin D, Manandhar DS, Khatry SK, de LCA, West KP, Jr. Antenatal micronutrient supplements in Nepal. Lancet 2005; 366(9487):711-2.
Bhutta ZA, Haider BA. Maternal micronutrient deficiencies in developing countries. Lancet 2008; 371(9608):186-7.
Osrin D, West KP, Christian P, Mandandhar DS, Khatry SK, Costello A. Micronutrient supplementation in pregnancy. Lancet 2005; 366:2002-3.
Barker DJ. The origins of the developmental origins theory. J. Intern. Med. 2007; 261(5):412-7.
Godfrey KM, Barker DJ. Fetal nutrition and adult disease. Am. J. Clin. Nutr. 2000; 71(5 Suppl):1344S52S.
Sodemann M, Aaby P. The Bandim Health Project, 1978-2003. 2003.
Kaestel P. Micronutrient supplementation and other predictors of birth size and perinatal mortality in Guinea-Bissau, PhD-Thesis, Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; 2004.
Gerster H. High-dose vitamin C: a risk for persons with high iron stores? Int. J. Vit. Nutr. Res. 1999; 69(2):67-82.
Jacobs P, Wood L. Hematology of malnutrition, part one. Dis Mon 2003; 49(10):555-618.
Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am. J. Clin. Nutr. 2005; 81(5):1218S-22S.
Benn CS, Martins C, Rodrigues A, Jensen H, Lisse IM, Aaby P. Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality. BMJ 2005; 331(7530):1428-32.
Symons MJ, Moore DT. Hazard rate ratio and prospective epidemiological studies. J. Clin. Epidemiol. 2002; 55(9):893-9.
Rumbold A, Middleton P, Crowther CA. Vitamin supplementation for preventing miscarriage.
Cochrane Database Syst Rev 2005;(2):CD004073.
Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2006;(4):CD004905.
Fawzi WW, Msamanga GI, Urassa W, Hertzmark E, Petraro P, Willett WC et al. Vitamins and perinatal outcomes among HIV-negative women in Tanzania. N. Engl. J. Med. 2007; 356(14):1423-31.
Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EM et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ 1997; 315(7111):786-90.
Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A et al. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 2006; 367(9505):133-43.
Benn CS, Diness BR, Roth A, Nante E, Fisker AB, Lisse IM et al. Effect of 50,000 IU vitamin A given with BCG vaccine on mortality in infants in GuineaBissau: randomised placebo controlled trial. BMJ 2008; 336(7658):1416-20.
Malaba LC, Iliff PJ, Nathoo KJ, Marinda E, Moulton LH, Zijenah LS et al. Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe. Am. J. Clin. Nutr. 2005; 81(2):454-60.
Article Metrics
Abstract View
: 469 times
Download : 0 times
Refbacks
- There are currently no refbacks.
