Academic journal article Bulletin of the World Health Organization

Maternal Multiple Micronutrient Supplementation and Pregnancy Outcomes in Developing Countries: Meta-Analysis and Meta-regression/Supplementation Maternelle En Micronutriments Multiples et Issues De la Grossesse Dans Les Pays En Voie De Developpement: Meta-Analyse et Meta-regression/Administracion De Multiples Micronutrientes Durante El Embarazo Y Resultados En Los Paises

Academic journal article Bulletin of the World Health Organization

Maternal Multiple Micronutrient Supplementation and Pregnancy Outcomes in Developing Countries: Meta-Analysis and Meta-regression/Supplementation Maternelle En Micronutriments Multiples et Issues De la Grossesse Dans Les Pays En Voie De Developpement: Meta-Analyse et Meta-regression/Administracion De Multiples Micronutrientes Durante El Embarazo Y Resultados En Los Paises

Article excerpt

Introduction

Every year more than 20 million infants are born with low birth weight worldwide (1). About 3.6 million infants die during the neonatal period. (2) Two thirds of these deaths occur in southern Asia and sub-Saharan Africa. More than one third of child deaths are thought to be attributable to maternal and child undernutrition. (3) Deficiencies in micronutrients such as folate, iron and zinc and vitamins A, B6, B12, C, E and riboflavin are highly prevalent and may occur concurrently among pregnant women. (3) Micronutrient deficiencies result from inadequate intake of meat, fruits and vegetables, and infections can also be a cause. Multiple micronutrient supplementation in pregnant women may be a promising strategy for reducing adverse pregnancy outcomes through improved maternal nutritional and immune status. (4,5) The World Health Organization (WHO) currently recommends iron and folic acid supplementation to reduce the risk of iron deficiency anaemia among pregnant women. Since many developing countries already have systems in place for the delivery of iron and folic acid supplements, micronutrient supplements could be provided at little additional cost. (6)

Several systematic reviews of trials examining the effects of maternal multiple micronutrient supplementation have been conducted, (7-10) but they have had limitations. Although some researchers have raised concerns that micronutrient supplementation may increase perinatal mortality, none of the previous review articles has adequately addressed this issue. (7-9,11) None has examined the potential sources of heterogeneity in the effect of supplementation on perinatal mortality. The effects of maternal micronutrient supplementation on perinatal mortality and other pregnancy outcomes can differ depending on trial characteristics and study population. An updated systematic review is essential to provide the basis for future research and for a discussion of policy implications. We conducted a systematic review of trials comparing the effect of maternal multiple micronutrient supplementation with that of iron and folic acid supplementation on pregnancy outcomes in developing countries. We also conducted subgroup meta-analysis and meta-regression to explore sources of heterogeneity.

Methods

Search strategy and inclusion criteria

We searched MEDLINE and EMBASE up to 1 August 2010 and identified potentially relevant published trials using the combination of medical subject headings (MESH) and text words denoting micronutrient supplements and pregnancy outcomes. We used the terms micronutrient, multivitamin, vitamin, mineral and supplement in combination with pregnancy, birth, newborn, infant, low birth weight, preterm, fetal growth, small-for-gestational-age, perinatal mortality and neonatal mortality.

We also searched the references cited by the retrieved articles for additional references. We applied the following inclusion criteria: (i) only randomized controlled trials conducted in developing countries; (ii) only trials that compared an intervention group receiving multiple micronutrient supplements (defined as more than three micronutrients) with a control group receiving iron and folic acid, and (iii) only trials that examined any of the following outcomes: birth weight, low birth weight (birth weight < 2500 g), preterm birth (birth before the 37th week of gestation), small size for gestational age (birth weight below the 10th percentile of weight for gestational age), perinatal death (death from the 28th week of gestation through the first week after delivery) and neonatal death (death within 28 days of delivery).

We included only trials in developing countries because micronutrient malnutrition among pregnant women is much more common in developing countries than in industrialized countries. Furthermore, no recommendations for prenatal micronutrient supplements exist in most developing countries, whereas such supplements are routinely recommended in some developed countries. …

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