title: Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe.
abstract: BACKGROUND
  Multiple micronutrient deficiencies may contribute to low birth weight, which is a major global determinant of mortality.
  
  
  OBJECTIVE
  We assessed the effect of prenatal multimicronutrient supplementation on gestational length and birth size.
  
  
  METHODS
  We conducted a randomized, placebo-controlled, double-blind effectiveness trial among antenatal care attendees in Harare, Zimbabwe. Pregnant women (22-35 wk of gestation) were randomly allocated to receive a multimicronutrient or placebo supplement daily until delivery. Supplementation with iron and folic acid was part of antenatal care.
  
  
  RESULTS
  Of 1669 women, birth data were available from 1106 (66%), of whom 360 (33%) had HIV infection. The mean gestational length was 39.1 wk, and 16.6% of the women had a gestational length < 37 wk. The mean birth weight was 3030 g, and 10.5% of the infants had a birth weight < 2500 g. Multimicronutrient supplementation was associated with tendencies for increased gestational length (0.3 wk; 95% CI: -0.04, 0.6 wk; P = 0.06), birth weight (49 g; -6, 104 g; P = 0.08), and head circumference (0.2 cm; -0.02, 0.4 cm; P = 0.07) but was not associated with low birth weight (birth weight < 2500 g) (relative risk: 0.84; 0.59, 1.18; P = 0.31). The effect of multimicronutrient supplementation on birth weight was not significantly different between HIV-uninfected (26 g; -38, 91 g) and HIV-infected (101 g; -3, 205 g) subjects (interaction, P > 0.10).
  
  
  CONCLUSIONS
  Antenatal multimicronutrient supplementation may be one strategy to increase birth size.
authors.affiliation: Department of Epidemiology, Institute of Public Health, University of Copenhagen, Denmark. h.friis@pubhealth.ku.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.forename: Exnevia
authors.initials: E
authors.lastname: Gomo
authors.forename: Norman
authors.initials: N
authors.lastname: Nyazema
authors.forename: Patricia
authors.initials: P
authors.lastname: Ndhlovu
authors.forename: Henrik
authors.initials: H
authors.lastname: Krarup
authors.forename: Pernille
authors.initials: P
authors.lastname: Kaestel
authors.forename: Kim F
authors.initials: KF
authors.lastname: Michaelsen
mesh_terms: D001724:Birth Weight / Q000187:drug effects*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005865:Gestational Age; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency*; D010919:Placebos; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D039401:Prenatal Nutritional Physiological Phenomena; D015030:Zimbabwe
chemical_list: D018977:Micronutrients; D010919:Placebos; D005492:Folic Acid; D007501:Iron