A study in the May 16 edition of JAMA reveals that survival rates of newborns in poor Bangladeshi communities were significantly improved if their mothers received multiple micronutritions, including iron and folic acid combined with early food supplementation during pregnancy, in comparison with women receiving the usual food supplementation.
The article’s background information says:
“Maternal and child undernutrition is estimated to be the underlying cause of 3.5 million annual deaths and 35 percent of the total disease burden in children younger than 5 years. The potential long-term consequences of nutritional imbalance or insult in fetal or early life also include cognitive impairment and chronic diseases in adulthood. Effective child nutrition interventions are available to reduce stunting, prevent consequences of micronutrient deficiencies, and improve survival.
The knowledge base is weaker regarding prenatal nutrition interventions of benefit for mother and offspring. The proportion of malnourished mothers and children remains high in many areas of the world, especially in South Asia, where more than one-quarter of newborns have a low weight.”
Lars Ake Persson, M.D., Ph.D., from Sweden’s Uppsala University and his team conducted the MINIMat trial to assess whether factors like supplementing a prenatal multiple micronutrient (MMS) and an early introduction of daily food supplements would raise maternal hemoglobin levels at 30 weeks’ gestation, as well as the infants birth weight and survival, and whether a combination of both interventions would further enhance these outcomes.
The randomized trial was conducted in Matlab, Bangladesh and involved 4,436 pregnant women recruited between November 2001 and October 2003, of which one-third were illiterate and one-fifth had an occasional or constant deficit in their perceived income-expenditure status. Follow-up was in June 2009.
The team randomized the women into 6 groups, consisting of a double blind supplementation with 30 mg iron capsules and 400 μg capsules of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS that contained a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, in combination with food supplementation that was randomized at the early invitation at 9 weeks’ gestation, or at the standard invitation at 20 weeks’ gestation.
From the 4,436 pregnancies, the team noted 3,625 live births, of which 3,267 were single-births with an average weight of 2,694 grams or 5.9 lbs, whilst 31% of the newborns weighed less than 2,500 g or 5.5 lbs. There were no considerable differences in birth weight amongst treatment groups, neither were there any main-effect differences between food groups or amongst micronutrient groups.
The team observed that babies in the early invitation with MMS group had a lower mortality rate of 16.8 per 1,000 live births, as compared with 44.1 per 1,000 live births for the standard invitation with 60 mg of iron and 400 μg of folic acid. The less than 5-year mortality rate amongst the early invitation with MMS group was 18 per 1,000 live births and 54 per 1,000 live births for the standard invitation group with 60 mg of iron and 400 μg of folic acid. The highest infant mortality rate of 47.1 per 1,000 live births was observed in the standard care invitation with MMS.
The researchers determined the adjusted maternal hemoglobin level at 30 weeks’ gestation as 115.0 g/L. No considerable differences were noted amongst micronutrient groups although those in the early invitation group displayed a small (0.9 g/L), yet statistically important lower hemoglobin level concentration compared with those in the standard invitation group.
The researchers conclude:
“Scientists and policymakers have recommended replacing the current iron-folic acid supplements with MMS in the package of health and nutrition interventions delivered to pregnant women to improve size at birth and child growth and development. Other studies have questioned this view based on the limited size of the effect on birth weight and the absence of positive effect on fetal and neonatal survival. The MINIMat trial provides evidence that mortality of the offspring was reduced if multiple micronutrients were combined with a balanced protein-energy supplementation that began early in pregnancy.”
Parul Christian, Dr.P.H., M.Sc., and Robert E. Black, M.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, writes in a linked editorial that results from one country, like this study “may not be applicable in other settings for a number of reasons, including variable maternal pre-pregnancy status, levels of macronutrient and micronutrient deficiencies, and antenatal [before birth] and delivery care availability.
He continues:
Several nutrition programs in Asia and Africa have long targeted pregnant and lactating women in large-scale food supplementation programs, such as the one ongoing in Bangladesh when this trial was conducted. Coverage rates in these programs are known to be generally low and women are normally identified late in pregnancy. Further research on the timing of nutritional interventions including prior to and early and late in pregnancy is needed to examine their efficacy and safety both for survival and other long-term developmental consequences.”
Written By Petra Rattue