title: Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial.
abstract: BACKGROUND
  Although prenatal multiple micronutrients can improve fetal growth, their benefit on postnatal health remains uncertain.
  
  
  OBJECTIVE
  We assessed the effect of the UNICEF/WHO/United Nations University multiple micronutrient supplement for pregnant and lactating women (UNIMMAP) compared with the usual iron and folic acid supplement (IFA) on survival, growth, and morbidity during infancy.
  
  
  METHODS
  In a double-blind, randomized trial, we followed 1294 singleton newborns whose mothers had prenatally received either the UNIMMAP or IFA. We assessed monthly anthropometric measures and health variables up to age 12 mo. Children were assessed again at a mean age of 30 mo. Mixed-effects models accounted for repeated measurements.
  
  
  RESULTS
  The UNIMMAP resulted in a 27% (HR: 0.73; 95% CI: 0.60, 0.87; P = 0.002) reduction in the rate of stunting in 15,261 infant-months with a higher length-for-age z score of 0.13 (95% CI: 0.02, 0.24; P = 0.02) over the whole observation period. However, by age 30 mo, this difference was not observed. An effect of the UNIMMAP on weight-for-length (P-interaction = 0.004) and head circumference-for-age (P-interaction = 0.03) became apparent by the end of the first year of life. By the age of 30 mo, children from the UNIMMAP group had a higher weight-for-height z score of 0.20 (95% CI: 0.06, 0.34; P = 0.004). No difference in mortality or morbidity was identified in groups, except a 14% reduction in reported episodes of fever (95% CI: 1%, 28%; P = 0.04).
  
  
  CONCLUSIONS
  Improved linear fetal growth with continuation into early life and enhanced postnatal growth were 2 mechanisms that mediated the effect of the prenatal UNIMMAP on infant nutritional status. Additional follow-up to assess long-term effects is warranted.
authors.affiliation: Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. droberfroid@itg.be
authors.forename: Dominique
authors.initials: D
authors.lastname: Roberfroid
authors.forename: Lieven
authors.initials: L
authors.lastname: Huybregts
authors.forename: Hermann
authors.initials: H
authors.lastname: Lanou
authors.forename: Laetitia
authors.initials: L
authors.lastname: Ouedraogo
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Henry
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
mesh_terms: D001827:Body Height; D002050:Burkina Faso / Q000453:epidemiology; D002657:Child Development; D046688:Child Mortality; D015362:Child Nutrition Disorders / Q000517:prevention & control; D002675:Child, Preschool; D003906:Developing Countries; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007228:Infant Nutrition Disorders / Q000517:prevention & control; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage*; D011247:Pregnancy; D015430:Weight Gain
chemical_list: D018977:Micronutrients