Abstract
A previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined whether prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal food supplements, affected child morbidity. This randomised trial enrolled 4436 pregnant women from November 2001 to October 2003 and allocated them to early or standard invitations to food supplements, in the ninth and 20th weeks of pregnancy, respectively, and supplements of either the standard 60 mg iron with 400 μg folic acid, 30 mg iron with 400 μg folic acid or MMS. Quasi-Poisson regression was used to analyse morbidity. There were 3560 single live births and 3516 had morbidity data. The incidence rates of fever, diarrhoea and acute lower respiratory tract infection were 15.3, 3.6 and 2.3 episodes per person-year, respectively. The separate or combined interventions had no effect on morbidity up to 24 months. Early invitations to prenatal food supplements or prenatal MMS had no effect on common infections in rural Bangladesh, suggesting that earlier findings on improved child survival were not mediated by an effect on child morbidity.
Highlights
The nutritional status of women before and during pregnancy is critical for foetal and child growth and survival [1]
Study setting and participants The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial was set in Matlab, a rural subdistrict in Bangladesh, where a well-established health and demographic surveillance system is run by the International Centre for Diarrhoeal Disease Research, Bangladesh
Early: Early invitation to food supplementation; standard: standard timing of invitation to food supplementation; Fe60FA: 60 mg of iron and 400 μg folic acid; Fe30FA: 30 mg of iron and 400 μg folic acid; micronutrient supplements (MMS): multiple micronutrient supplementation including 30 mg iron and 400 μg folic acid and 13 other micronutrients; MN: micronutrient which meant that we had morbidity data on 3516 singleton children
Summary
The nutritional status of women before and during pregnancy is critical for foetal and child growth and survival [1]. Iron deficiency anaemia in pregnancy increases the risk of poor pregnancy outcomes [1], and the World Health Organization has recommended iron folic acid supplements for all pregnant women for several decades and continues to do so [2]. Food supplements during pregnancy have lowered the risk of stillbirths and increased foetal growth, especially among undernourished mothers [5]. Data on the timing of prenatal food supplements are scarce, but evidence from famine studies and animal studies suggests that nutritional deficiencies at different time points in pregnancy have different effects on the offspring later on [6,7]
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