Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso.
BACKGROUND
Intrauterine growth retardation is a major predictor of child health in developing countries.


OBJECTIVE
We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates.


METHODS
An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed.


RESULTS
Pregnancy outcome was known in 96.3% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMAP group (OR: 1.78; 95% CI: 0.95, 3.32; P = 0.07), and this seemed to affect mainly primiparous women (OR: 3.44; 95% CI: 1.1, 10.7; P for interaction = 0.11).


CONCLUSIONS
Maternal UNIMMAP modestly but significantly increased fetal growth. The resulting benefit on infant growth and survival needs to be assessed. The possible lack of benefit and potential harm in primiparous women should be further investigated. This trial was registered at clinicaltrials.gov as NCT00642408.
Roberfroid
Dominique
D
Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Huybregts
Lieven
L
Lanou
Hermann
H
Henry
Marie-Claire
MC
Meda
Nicolas
N
Menten
Joris
J
Kolsteren
Patrick
P
D000328:Adult; D001724:Birth Weight / Q000187:drug effects* / Q000502:physiology; D001827:Body Height / Q000187:drug effects* / Q000502:physiology; D002050:Burkina Faso; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D047109:Fetal Development / Q000187:drug effects* / Q000502:physiology; D005317:Fetal Growth Retardation / Q000517:prevention & control; D005492:Folic Acid / Q000008:administration & dosage; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage* / Q000009:adverse effects; D009752:Nutritional Status; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011256:Pregnancy Outcome; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*
D018977:Micronutrients; D005492:Folic Acid; D007501:Iron