Effects of prenatal micronutrient and early food supplementation on maternal hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial.
Study Goal
The researchers aimed to determine whether prenatal multiple micronutrient supplementation (including iron) and early food supplementation improved maternal hemoglobin levels, birth weight, and reduced infant mortality compared to standard iron and folic acid supplementation.
Results Summary
The study found no significant differences in maternal hemoglobin levels or birth weight among micronutrient groups, but early invitation with MMS (including iron) significantly reduced infant and under-5 mortality rates compared to standard iron and folic acid supplementation.
Population
Pregnant women in poor communities in Bangladesh.
Effective Dosage
30 mg of iron and 400 μg of folic acid daily (in MMS group); 60 mg of iron and 400 μg of folic acid daily (in another group).
Duration
Supplementation began at 9 or 20 weeks' gestation and continued until delivery; follow-up lasted until June 23, 2009.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
prenatal multiple micronutrient supplementation (MMS) | increase | maternal hemoglobin level | pregnant women | - | would increase | #1 |
prenatal multiple micronutrient supplementation (MMS) | increase | birth weight | pregnant women | - | would increase | #2 |
prenatal multiple micronutrient supplementation (MMS) | decrease | infant mortality | pregnant women | - | would decrease | #3 |
early invitation to food supplementation | increase | maternal hemoglobin level | pregnant women | - | would increase | #4 |
early invitation to food supplementation | increase | birth weight | pregnant women | - | would increase | #5 |
early invitation to food supplementation | decrease | infant mortality | pregnant women | - | would decrease | #6 |
capsules of 30 mg of iron and 400 μg of folic acid | no change | maternal hemoglobin level at 30 weeks' gestation | pregnant women | - | no significant differences | #7 |
capsules of 60 mg of iron and 400 μg of folic acid | no change | maternal hemoglobin level at 30 weeks' gestation | pregnant women | - | no significant differences | #8 |
MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid | no change | maternal hemoglobin level at 30 weeks' gestation | pregnant women | - | no significant differences | #9 |
early invitation (9 weeks' gestation) to food supplementation | decrease | mean maternal hemoglobin level | pregnant women | -0.9 g/L | was lower | #10 |
capsules of 30 mg of iron and 400 μg of folic acid | no change | mean birth weight | singletons | - | no significant differences | #11 |
capsules of 60 mg of iron and 400 μg of folic acid | no change | mean birth weight | singletons | - | no significant differences | #12 |
MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid | no change | mean birth weight | singletons | - | no significant differences | #13 |
early invitation with MMS | decrease | infant mortality | live births | 16.8 per 1000 live births | had an infant mortality rate of | #14 |
early invitation with MMS | decrease | under 5-year mortality | live births | 18 per 1000 live births | had an under 5-year mortality rate of | #15 |
usual invitation with MMS | increase | spontaneous abortions | pregnant women | - | had the highest incidence of | #16 |
usual invitation with MMS | increase | infant mortality rate | live births | - | had the highest | #17 |
multiple micronutrients, including iron and folic acid combined with early food supplementation | decrease | childhood mortality | pregnant women in poor communities in Bangladesh | - | resulted in decreased | #18 |
CONTEXT: Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences. OBJECTIVES: To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes. DESIGN, SETTING, AND PARTICIPANTS: A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009. INTERVENTIONS: Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation). MAIN OUTCOME MEASURES: Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed. RESULTS: Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, -0.9 g/L; 95% CI, -1.7 to -0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births (54 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid; HR, 0.34; 95% CI, 0.18-0.65). Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate. CONCLUSION: Among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including iron and folic acid combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN16581394.