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Maternal Antenatal Multiple Micronutrient Supplementation for Long-Term Health Benefits in Children: A Systematic Review and Meta-Analysis

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Review

Maternal Antenatal Multiple Micronutrient Supplementation for Long-Term Health Benefits in Children: A Systematic Review and Meta-Analysis

Delan Devakumar et al. BMC Med.

Abstract

Background: Multiple micronutrient supplementation for pregnant women reduces low birth weight and has been recommended in low- and middle-income countries (LMICs) to improve child survival, growth and health. We aimed to review the evidence from long-term follow-up studies of multiple micronutrient supplementation beginning in the later first or second trimester.

Methods: We searched systematically for follow-up reports from all trials in a 2015 Cochrane review of multiple micronutrient supplementation in pregnancy. The intervention comprised three or more micronutrients and the comparison group received iron (60 mg) and folic acid (400 μg), where possible. Median gestation of commencement varied from 9 to 23 weeks. Primary outcomes were offspring mortality, height, weight and head circumference, presented as unadjusted differences in means or proportions (intervention minus control). Secondary outcomes included other anthropometry, body composition, blood pressure, and cognitive and lung function.

Results: We found 20 follow-up reports from nine trials (including 88,057 women recruited), six of which used the UNIMMAP supplement designed to provide recommended daily allowances. The age of follow-up ranged from 0 to 9 years. Data for mortality estimates were available from all trials. Meta-analysis showed no difference in mortality (risk difference -0.05 per 1000 livebirths; 95 % CI, -5.25 to 5.15). Six trials investigated anthropometry and found no difference at follow-up in weight-for-age z score (0.02; 95 % CI, -0.03 to 0.07), height-for-age z score (0.01; 95 % CI, -0.04 to 0.06), or head circumference (0.11 cm; 95 % CI, -0.03 to 0.26). No differences were seen in body composition, blood pressure, or respiratory outcomes. No consistent differences were seen in cognitive function scores.

Conclusions: There is currently no evidence that, compared with iron and folic acid supplementation, routine maternal antenatal multiple micronutrient supplementation improves childhood survival, growth, body composition, blood pressure, respiratory or cognitive outcomes.

Keywords: Child; Micronutrients; Prenatal exposure delayed effects.

Figures

Fig. 1
Fig. 1
Forest plot showing mortality rate per 1000 livebirths (meta-analysis using a random effects model)
Fig. 2
Fig. 2
Forest plot showing weight-for-age (meta-analysis using a random effects model)
Fig. 3
Fig. 3
Forest plot showing height-for-age (meta-analysis using a random effects model)
Fig. 4
Fig. 4
Forest plot showing head circumference (meta-analysis using a random effects model)

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