Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality.
BACKGROUND
Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes.


OBJECTIVE
To conduct a meta-analysis of the effects on stillbirths and on early and late neonatal mortality of supplementation during pregnancy with multiple micronutrients compared with iron-folic acid in recent randomized, controlled trials.


METHODS
Twelve randomized, controlled trials were included in the analysis (Bangladesh; Burkina Faso; China; Guinea-Bissau; Indramayu and Lombok, Indonesia; Mexico; Sarlahi and Janakur, Nepal; Niger; Pakistan; and Zimbabwe), all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients or iron-folic acid to presumed HIV-negative women.


RESULTS
Supplementation providing approximately I RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neonatal mortality (OR = 1.23; 95% CI, 0.95 to 1.59), late neonatal mortality (OR = 0.94; 95% CI, 0.73 to 1.23), or perinatal mortality (OR = 1.11; 95% CI, 0.93 to 1.33).


CONCLUSIONS
Our meta-analysis provides consistent evidence that supplementation providing approximately 1 RDA of multiple micronutrients during pregnancy does not result in any reduction in stillbirths or in early or late neonatal deaths compared with iron-folic acid alone.
Ronsmans
Carine
C
London School of Hygiene and Tropical Medicine, London, UK. Carine.ronsmans@lshtm.ac.uk
Fisher
David J
DJ
Osmond
Clive
C
Margetts
Barrie M
BM
Fall
Caroline H D
CH
D003906:Developing Countries / Q000706:statistics & numerical data*; D019587:Dietary Supplements; D005260:Female; D046689:Fetal Mortality; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000517:prevention & control; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D050497:Stillbirth
D018977:Micronutrients; D005492:Folic Acid; D007501:Iron