Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on stillbirths and on early and late neonatal mortality
Ronsmans C., Fisher DJ., Osmond C., Margetts BM., Fall CHD., Adou P., Aguayo VM., Allen LH., Bhutta ZA., Christian P., Dang S., Desplats G., Dibley M., Arifeen SE., Fall C., Fisher D., Friis H., Gomo E., Haider BA., Hidayat A., Jahari A., Kaes-tel P., Kolsteren P., Kusharisupeni None., Mamadoultaibou A., Manandhar DS., Margetts B., Osrin D., Persson LA., Ramakrishnan U., Roberfroid DN., Ronsmans C., Shankar AH., Subarkah None., Sunawang None., Utomo B., Vaidya A., Yan H., Zagre N., Zeng L.
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; lndramayu and Lombok, Indo-nesia; 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 1 RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neo-natal 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. © 2009 (supplement), The United Nations University.