Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial.
The long-term benefits of antenatal iron supplementation in child survival are not known. In 1999-2001, 4,926 pregnant women in rural Nepal participated in a cluster-randomized, double-masked, controlled trial involving 4 alternative combinations of micronutrient supplements, each containing vitamin A. The authors examined the impact on birth weight and early infant mortality in comparison with controls, who received vitamin A only. They followed the surviving offspring of these women at approximately age 7 years to study effects of in utero supplementation on survival. Of 4,130 livebirths, 209 infants died in the first 3 months and 8 were lost to follow-up. Of those remaining, 3,761 were followed, 150 died between ages 3 months and 7 years, and 152 were lost to follow-up. Mortality rates per 1,000 child-years from birth to age 7 years differed by maternal supplementation group, as follows: folic acid, 13.4; folic acid-iron, 10.3; folic acid-iron-zinc, 12.0; multiple micronutrients; 14.0; and controls, 15.2. Hazard ratios were 0.90 (95% confidence interval (CI): 0.65, 1.22), 0.69 (95% CI: 0.49, 0.99), 0.80 (95% CI: 0.58, 1.11), and 0.93 (95% CI: 0.66, 1.31), respectively, in the 4 supplementation groups. Maternal iron-folic acid supplementation reduced mortality among these children by 31% between birth and age 7 years. These results provide additional motivation for strengthening antenatal iron-folic acid programs.
Christian
Parul
P
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Center for Human Nutrition, Baltimore, Maryland 21205, USA.
Stewart
Christine P
CP
LeClerq
Steven C
SC
Wu
Lee
L
Katz
Joanne
J
West
Keith P
KP
Khatry
Subarna K
SK
D001837:Body Weights and Measures; D002648:Child; D046688:Child Mortality; D004032:Diet; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D009390:Nepal / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014801:Vitamin A / Q000008:administration & dosage; D015032:Zinc / Q000008:administration & dosage
D018977:Micronutrients; D014801:Vitamin A; D005492:Folic Acid; D007501:Iron; D015032:Zinc