title: Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring, incidence of low-birth-weight infants (<2500 g), and early neonatal morbidity.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Two hundred pregnant women (of 13 465 approached) with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of less than 18.5 and/or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation. One hundred forty-six neonates (73.0%) were available for analysis of birth size and 170 (85.0%) for analysis of morbidity in the 7 days after delivery. Intervention The micronutrient supplementation group (n = 99) received a multimicronutrient supplement containing 29 vitamins and minerals once a day, from enrollment until delivery (median duration, 58 days; interquartile range, 37-77 days; compliance, 87%). The comparison group (n = 101) received placebo for 52 (15-66) days, with 85% compliance. All subjects also received supplements of iron (given in the form of ferrous sulfate, containing 60 mg of elemental iron), 60 mg/d, and folic acid, 500 mug/d.
  
  
  METHODS
  Birth weight, length, midarm circumference, incidence of low birth weight, and early neonatal morbidity.
  
  
  RESULTS
  Infants in the micronutrient group were heavier by 98 g (95% confidence interval [CI], -16 to 213 g) and measured 0.80 cm (95% CI, 0.03-1.57 cm) longer and 0.20 cm (95% CI, 0.04-0.36 cm) larger in midarm circumference compared with the placebo group. Incidence of low birth weight declined from 43.1% to 16.2% with multimicronutrient supplementation a (a 70% decrease; relative risk, 0.30; 95% CI, 0.13-0.71; P=.006), and that of early neonatal morbidity declined from 28.0% to 14.8% (a 58% decrease; relative risk, 0.42; 95% CI, 0.19-0.94; P=.04).
  
  
  CONCLUSIONS
  Compared with iron and folic acid supplementation, the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity.
authors.affiliation: Department of Pediatrics, University College of Medical Sciences, Block R-6A, Dilshad Garden, Delhi 110095, India. drpiyush@satyam.net.in
authors.forename: Piyush
authors.initials: P
authors.lastname: Gupta
authors.forename: Mily
authors.initials: M
authors.lastname: Ray
authors.forename: Tarun
authors.initials: T
authors.lastname: Dua
authors.forename: Gita
authors.initials: G
authors.lastname: Radhakrishnan
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.forename: H P S
authors.initials: HP
authors.lastname: Sachdev
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000187:drug effects*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D044342:Malnutrition / Q000188:drug therapy*; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D039401:Prenatal Nutritional Physiological Phenomena; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018977:Micronutrients