Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial.
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.
Christian
Parul
P
Division of Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. pchristi@jhsph.edu
Khatry
Subarna K
SK
Katz
Joanne
J
Pradhan
Elizabeth K
EK
LeClerq
Steven C
SC
Shrestha
Sharada Ram
SR
Adhikari
Ramesh K
RK
Sommer
Alfred
A
West
Keith P
KP
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
D018977:Micronutrients; D005492:Folic Acid; D007501:Iron; D015032:Zinc