Efficacy of Antenatal Multiple Micronutrient (MM) vs Iron‐Folic Acid (IFA) Supplementation in Improving Gestational and Postnatal Viability in Rural Bangladesh: The JiVitA‐3 Trial

Abstract

Antenatal micronutrient deficiencies may impair fetal and infant health. We conducted a cluster‐randomized, double‐masked trial among 44,567 pregnant women and 28,516 infants to assess efficacy of daily MM vs IFA supplementation, from the 1st trimester to 12 wk postpartum, in improving fetal and infant viability. Groups were similar in sample size (Nmm=22,162, NIFA=22,405), baseline SES, diet, maternal and gestational (GA) ages at enrollment, and supplement adherence [median: ~94 (IQR: ~84–100)%]. MM vs IFA supplementation was associated with the following relative risks (RR; 95% CI, adjusted for design effect): Still birth (.89; .81‐.99), low birth weight (.88; .85‐.91), preterm birth (.87; .82‐.92), SGA (.99; .96–1.01) and 6 (.95; .86–1.06) and 12 (.94; .85–1.04) mo mortality. Lower mortality occurred by ages 6 and 12 mo in girls (.87; .74–1.01 and .85; .73‐.97) but not boys (1.02; .89–1.17, both ages), with PInterax=.08 and .06, respectively. MM supplementation increased weight, length, arm, chest and head circumference by 55 g, .21 cm, .11 cm, .25 cm and .21 cm, respectively, explained by a 0.30 wk longer gestation in both sexes (all p<0.0001). In rural Bangladesh, antenatal MM reduced risk of still birth and lengthened gestation, lowering risk of preterm birth, increasing birth size, and reducing risk of low birth weight. Supported by The Bill and Melinda Gates Foundation (Grant GH614).