title: Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster-randomized, double-blind, controlled programmatic study in rural Niger.
abstract: BACKGROUND
  Micronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes, including reduced birthweight. Low birthweight is associated with increased risk of infant mortality and growth failure.
  
  
  OBJECTIVE
  To assess the effects of prenatal supplementation with UNIMMAP (United Nations International Multiple Micronutrient Preparation) compared with iron/folic acid on average birthweight and incidence of low birthweight.
  
  
  METHODS
  Pregnant women from 78 villages in Niger were included in a cluster-randomized, double-blinded, controlled supplementation trial. Baseline, monthly follow-up, and birth data were collected. Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models. Analyses were stratified by nutrition status and duration of supplementation.
  
  
  RESULTS
  Of the 3,670 women recruited, 2,550 completed the study and provided complete birthweight data (1,328 received multiple micronutrients and 1,222 received iron/folic acid). Mean birthweight was significantly higher (67 g, p < .001) with multiple micronutrients (3,092 +/- 190 g) than with iron/folic acid (3,025 +/- 205 g); this corresponded to a 14% fall in the incidence of low birthweight (from 8.4% with multiple micronutrients to 7.2% with folic acid fortification). The impact of multiple micronutrients was greater when the supplements were taken for more than 150 days. The incidence of low birthweight was further reduced in women who entered pregnancy with a poorer nutrition status.
  
  
  CONCLUSIONS
  Prenatal supplementation with multiple micronutrients had a greater positive impact on birthweight than supplementation with iron/folic acid. Our data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight.
authors.affiliation: Nutrition Section, UNICEF-Niger, PO Box 12 481, 2, Rue de l'Oasis, Niamey, Niger. nzagre@unicef.org
authors.forename: Noël M
authors.initials: NM
authors.lastname: Zagré
authors.forename: Gwénola
authors.initials: G
authors.lastname: Desplats
authors.forename: Pierre
authors.initials: P
authors.lastname: Adou
authors.forename: Aïssa
authors.initials: A
authors.lastname: Mamadoultaibou
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aguayo
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000187:drug effects*; D016000:Cluster Analysis; 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; D019266:Iron, Dietary / Q000008:administration & dosage*; D008297:Male; D018977:Micronutrients; D009548:Niger; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011256:Pregnancy Outcome; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*
chemical_list: D019266:Iron, Dietary; D018977:Micronutrients; D005492:Folic Acid