title: Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial.
abstract: OBJECTIVE
  To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women.
  
  
  METHODS
  Double blind cluster randomised controlled trial.
  
  
  METHODS
  Rural community in south eastern Nepal.
  
  
  METHODS
  4926 pregnant women and 4130 live born infants.
  
  
  METHODS
  426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control).
  
  
  METHODS
  Birth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined <2500 g.
  
  
  RESULTS
  Supplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval -16 g to 90 g) and reduced the percentage of low birthweight babies (<2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length.
  
  
  CONCLUSIONS
  Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk.
authors.affiliation: Division of Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. pchristi@jhsph.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Pradhan
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: Sharada Ram
authors.initials: SR
authors.lastname: Shrestha
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Adhikari
authors.forename: Alfred
authors.initials: A
authors.lastname: Sommer
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D001724:Birth Weight; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage*; D009390:Nepal; D010349:Patient Compliance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D012423:Rural Health; D015032:Zinc / Q000008:administration & dosage
chemical_list: D018977:Micronutrients; D005492:Folic Acid; D007501:Iron; D015032:Zinc