Vitamins and perinatal outcomes among HIV-negative women in Tanzania.
BACKGROUND
Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes.


METHODS
In a double-blind trial in Dar es Salaam, Tanzania, we randomly assigned 8468 pregnant women (gestational age of fetus, 12 to 27 weeks) who were negative for human immunodeficiency virus infection to receive daily multivitamins (including multiples of the recommended dietary allowance) or placebo. All the women received prenatal supplemental iron and folic acid. The primary outcomes were low birth weight (<2500 g), prematurity, and fetal death.


RESULTS
The incidence of low birth weight was 7.8% among the infants in the multivitamin group and 9.4% among those in the placebo group (relative risk, 0.82; 95% confidence interval [CI], 0.70 to 0.95; P=0.01). The mean difference in birth weight between the groups was modest (67 g, P<0.001). The rates of prematurity were 16.9% in the multivitamin group and 16.7% in the placebo group (relative risk, 1.01; 95% CI, 0.91 to 1.11; P=0.87), and the rates of fetal death were 4.3% and 5.0%, respectively (relative risk, 0.87; 95% CI, 0.72 to 1.05; P=0.15). Supplementation reduced both the risk of a birth size that was small for gestational age (<10th percentile; 10.7% in the multivitamin group vs. 13.6% in the placebo group; relative risk, 0.77; 95% CI, 0.68 to 0.87; P<0.001) and the risk of maternal anemia (hemoglobin level, <11 g per deciliter; relative risk, 0.88; 95% CI, 0.80 to 0.97; P=0.01), although the difference in the mean hemoglobin levels between the groups was small (0.2 g per deciliter, P<0.001).


CONCLUSIONS
Multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death. Multivitamins should be considered for all pregnant women in developing countries. (ClinicalTrials.gov number, NCT00197548 [ClinicalTrials.gov].).
Fawzi
Wafaie W
WW
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. mina@hsph.harvard.edu
Msamanga
Gernard I
GI
Urassa
Willy
W
Hertzmark
Ellen
E
Petraro
Paul
P
Willett
Walter C
WC
Spiegelman
Donna
D
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000517:prevention & control; D000328:Adult; D001205:Ascorbic Acid / Q000627:therapeutic use; D001724:Birth Weight / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000517:prevention & control; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control; D013636:Tanzania / Q000453:epidemiology; D014803:Vitamin B Complex / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use*
D014815:Vitamins; D014803:Vitamin B Complex; D014810:Vitamin E; D001205:Ascorbic Acid