Abstract
IntroductionMaternal multiple micronutrients (MMN) supplementation as compared to iron‐folic acid (IFA) can increase birth weight and decrease infant mortality, but the physiological basis remains unclear. We examined Apgar scores to assess the impact of MMN on the dynamic process of neonatal adaptation after birth.MethodsWe selected 3667 singleton live births from the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) of maternal MMN versus IFA (ISRCTN34151616) with Apgar scores at the 1st and 5th minute, after excluding those with midline anomaly, inborn diseases and if not a spontaneous vaginal birth. Mixed effect multiple linear regression models were used to adjust for clustered randomization, covariates and interactions.ResultsOverall, there were no significant differences between Apgar scores of children from the MMN and IFA groups at the 1st (adjusted β ‐0.416, 95% CI ‐0.339‐0.047) or 5th minute (adjusted β 0.077, 95% CI ‐0.097‐0.252), or changes from 1 to 5 minutes (adjusted β 0.003, 95% CI ‐0.065‐0.072), nor were there effects on specific component scores. In subgroup analysis, MMN decreased the 1st minute score for full term and small for gestational (SGA) neonates, and MMN increased improvement from 1 to 5minutes in full term and SGA neonates, and those born of well‐nourished mothers (upper arm circumference > 23.5 cm).DiscussionWe observed certain subgroups of neonates of mothers given MMN tended toward lower 1st minute Apgar scores and greater improvement of Apgar scores from the 1st to 5th minute. MMN supplementation may enhance the dynamic adaptive processes of certain neonates after delivery, thereby improving infant survival.
Published Version
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