Antenatal micronutrient supplements in Nepal

The Journal of nutrition, 2006

Certain antenatal micronutrient supplements increased birth weight by 40-70 g in rural Nepal. The effect was estimated by calculating the mean difference in birth weight between control and treatment groups, which assumes a constant treatment effect across the birth weight distribution. By estimating differences (and CI) in birth weight between treatment and control groups as a nonlinear, smooth function of the percentiles of the birth weight distribution, we can examine whether the shape of the birth weight distribution for a treatment group is different from that of the control group. Supplementation groups were folic acid, folic acid and iron, folic acid and iron and zinc, and a multiple micronutrient supplement all with vitamin A, compared with the control group of vitamin A alone. The shape of the birth weight distribution in the multiple micronutrient group was the same as that of the control group; however, the location of the distribution had shifted. The folic acid and iron...

BMJ, 2003

To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. Double blind cluster randomised controlled trial. Rural community in south eastern Nepal. 4926 pregnant women and 4130 live born infants. 426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control). Birth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined <2500 g. Supplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval -16 g to 90 g) and reduced the percentage of low birthweight babies (<2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length. Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk.

The Lancet, 2005

Background-The negative effects of low birthweight on the later health of children in developing countries have been well studied. However, undertaking programmes to address this issue can be difficult since there is no simple correlation between increasing birthweight and improving child health. In 2005, we published results of a randomised controlled trial in Nepal, in which 1200 women received either iron and folic acid or a supplement that provided the recommended daily allowance of 15 vitamins and minerals, over the second and third trimesters of pregnancy. Here, we report on 2-3 years' follow-up of children born during the trial.

ABSTRACT BACKGROUND Pregnancy is a critical period for both woman and baby from a nutritional perspective. Poor nutrition, during pregnancy is associated with adverse maternal and fetal outcomes. However, due to various factors, pregnant women do not increase the quality or quantity of diet during pregnancy. OBJECTIVE To find out the prevalence of nutritional supplementations taken during pregnancy and to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. MATERIALS AND METHODS The cross-sectional study was conducted from 1st March to 14th March, 2014 among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semistructured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. RESULT The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy. CONCLUSION The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy.

Food and nutrition bulletin, 2009

Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact. To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron-folic acid supplementation. We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron-folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality. The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron-folic acid group). Th...

Background: We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by Ϸ15%. Objective: We examined the effect of daily maternal micronutrient supplementation on fetal loss and infant mortality. Design: The study was a double-blind, cluster-randomized, controlled trial among 4926 pregnant women and their 4130 infants in rural Nepal. In addition to vitamin A (1000 g retinol equivalents), the intervention groups received either folic acid (FA; 400 g), FA ϩ iron (60 mg), FA ϩ iron ϩ zinc (30 mg), or multiple micronutrients (MNs; the foregoing plus 10 g vitamin D, 10 mg vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 2.2 mg vitamin B-6, 2.6 g vitamin B-12, 100 mg vitamin C, 64 g vitamin K, 20 mg niacin, 2 mg Cu, and 100 mg Mg). The control group received vitamin A only. Results: None of the supplements reduced fetal loss. Compared with control infants, infants whose mothers received FA alone or with iron or iron ϩ zinc had a consistent pattern of 15-20% lower 3-mo mortality; this pattern was not observed with MNs. The effect on mortality was restricted to preterm infants, among whom the relative risks (RRs) were 0.36 (95% CI: 0.18, 0.75) for FA, 0.53 (0.30, 0.92) for FA ϩ iron, 0.77 (0.45, 1.32) for FA ϩ iron ϩ zinc, and 0.70 (0.41, 1.17) for MNs. Among term infants, the RR for mortality was close to 1 for all supplements except MNs (RR: 1.74; 95% CI: 1.00, 3.04). Conclusions: Maternal micronutrient supplementation failed to reduce overall fetal loss or early infant mortality. Among preterm infants, FA alone or with iron reduced mortality in the first 3 mo of life. MNs may increase mortality risk among term infants, but this effect needs further evaluation.

The Lancet, 2008

Background-The negative effects of low birthweight on the later health of children in developing countries have been well studied. However, undertaking programmes to address this issue can be difficult since there is no simple correlation between increasing birthweight and improving child health. In 2005, we published results of a randomised controlled trial in Nepal, in which 1200 women received either iron and folic acid or a supplement that provided the recommended daily allowance of 15 vitamins and minerals, over the second and third trimesters of pregnancy. Here, we report on 2-3 years' follow-up of children born during the trial.

BMC Public Health, 2014

Background: Evidence is often missing on social differentials in effects of nutrition interventions. We evaluated the adherence to and effect of prenatal food and micronutrient supplementations on mortality before the age of five years in different social groups as defined by maternal schooling. Methods: Data came from the MINIMat study (Maternal and Infant Nutrition Interventions, Matlab), a randomized trial of prenatal food supplementation (invitation early, about 9 weeks [E], or at usual time, about 20 weeks [U] of pregnancy) and 30 mg or 60 mg iron with 400 μgm folic acid, or multiple micronutrients (Fe30F, Fe60F, MMS) resulting in six randomization groups, EFe30F, UFe30F, EFe60F, UFe60F, EMMS, and UMMS (n = 4436). Included in analysis after omissions (fetal loss and out-migration) were 3625 women and 3659 live births of which 3591 had information on maternal schooling. The study site was rural Matlab, Bangladesh. The main stratifying variable was maternal schooling dichotomized as <6 years and ≥6 years. We used Cox proportional hazard model for survival analyses. Results: Overall, women having <6 years of schooling adhered more to food (81 vs. 69 packets, P=0.0001) but a little less to micronutrient (104 vs. 120 capsules, P = 0.0001) supplementation compared to women having more schooling, adjusted for maternal age (years), parity and body mass index (BMI, kg/m 2) at week 8 pregnancy. Children of mothers with ≥6 years of schooling had lower under-five mortality, but the EMMS supplementation reduced the social difference in mortality risk (using standard program and schooling <6 years as reference; standard program and schooling ≥6 years HR 0.54, 95% CI 0.27-1.11; EMMS and schooling ≥6 years HR 0.28, 95% CI 0.12-0.70; EMMS and schooling <6 years HR 0.26, 95% CI 0.11-0.63), adjusted for maternal age (years), parity and body mass index (kg/m 2) at week 8 pregnancy. Conclusions: The combination of an early invitation to prenatal food supplementation and multiple micronutrient supplementation lowered mortality in children before the age of five years and reduced the gap in child survival chances between social groups. The pattern of adherence to the supplementations was complex; women with less education adhered more to food supplementation while those with more education had higher adherence to micronutrients. Trial registration: ISRCTN16581394.

Journal of the American College of Nutrition, 2008

Varying results of worldwide intervention programs to pregnant mothers necessitate the need to understand the relationship between maternal nutrition and birth size among well nourished and undernourished mothers.

This study investigated the micronutrient status of 50 pregnant women attending Government Medical College and Hospital (GMH) and Private Maternity Clinics (PMC) from Central India and correlated its effect to the pregnancy outcome. Socioeconomic data, pregnancy related information, 24 hour dietary recall and information regarding the frequency of consumption of iron, folic acid, carotene and vitamin B12 rich foods was collected. Results indicated a low positive correlation between the mean dietary iron (r = 0.012, r = 0.158, p<.05) of the subjects and folic acid intake (r = 0.175, r = 0.022 p<.05) of the subjects and respective mean birth weights of infants among both GMH and PMC groups. Carotene had a low positive correlation (r = 0.021 p<.05,) with birth weight among the GMH subjects but low negative correlation (r = -0.227, p<.05) amongst the PMC group. Vitamin B12 intake and mean birth weight in the PMC group subjects showed a low positive correlation (r = 0.364, p<.05) while a low positive correlation ( r = 0.021 p<.05,) was observed in the GMH group. Multivariate analysis reflected an interrelationship between the socioeconomic status, pregnancy associated and dietary factors. The study concluded that a positive relation exists between the micronutrient intake of pregnant women and the birth weight of the infant.