Abstract
BackgroundMultiple micronutrient supplementation for pregnant women reduces low birth weight and has been recommended in low- and middle-income countries (LMICs) to improve child survival, growth and health. We aimed to review the evidence from long-term follow-up studies of multiple micronutrient supplementation beginning in the later first or second trimester.MethodsWe searched systematically for follow-up reports from all trials in a 2015 Cochrane review of multiple micronutrient supplementation in pregnancy. The intervention comprised three or more micronutrients and the comparison group received iron (60 mg) and folic acid (400 μg), where possible. Median gestation of commencement varied from 9 to 23 weeks. Primary outcomes were offspring mortality, height, weight and head circumference, presented as unadjusted differences in means or proportions (intervention minus control). Secondary outcomes included other anthropometry, body composition, blood pressure, and cognitive and lung function.ResultsWe found 20 follow-up reports from nine trials (including 88,057 women recruited), six of which used the UNIMMAP supplement designed to provide recommended daily allowances. The age of follow-up ranged from 0 to 9 years. Data for mortality estimates were available from all trials. Meta-analysis showed no difference in mortality (risk difference –0.05 per 1000 livebirths; 95 % CI, –5.25 to 5.15). Six trials investigated anthropometry and found no difference at follow-up in weight-for-age z score (0.02; 95 % CI, –0.03 to 0.07), height-for-age z score (0.01; 95 % CI, –0.04 to 0.06), or head circumference (0.11 cm; 95 % CI, –0.03 to 0.26). No differences were seen in body composition, blood pressure, or respiratory outcomes. No consistent differences were seen in cognitive function scores.ConclusionsThere is currently no evidence that, compared with iron and folic acid supplementation, routine maternal antenatal multiple micronutrient supplementation improves childhood survival, growth, body composition, blood pressure, respiratory or cognitive outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0633-3) contains supplementary material, which is available to authorized users.
Highlights
Multiple micronutrient supplementation for pregnant women reduces low birth weight and has been recommended in low- and middle-income countries (LMICs) to improve child survival, growth and health
The World Health Organization (WHO) considers micronutrient deficiency to be of particular concern in low-income countries, where women’s diets are likely to be deficient in both quantity and quality
Eligibility criteria Types of report We attempted to find all reports of follow-up of children born in the individual or cluster randomized controlled trials included in the 2015 Cochrane review
Summary
Multiple micronutrient supplementation for pregnant women reduces low birth weight and has been recommended in low- and middle-income countries (LMICs) to improve child survival, growth and health. Micronutrient deficiency is believed to affect approximately two billion people worldwide, with pregnant women being at particular risk because of their high metabolic demands [1]. 38 % of pregnant women have iron deficiency leading to anaemia [5] and 15 % have vitamin A deficiency causing night blindness and increasing the risk of infection [6, 7]. While the evidence base is not substantial for iron and folic acid, a Cochrane review described a mean increase in birthweight of 57.7 g (95 % CI, 7.7–107.8 g) [10]
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