When mothers are given multiple micronutrient supplementation (MMN,) they tend to give birth to children who are bigger and heavier. This is contrast to mothers given just iron and folic acid supplementation (IFA). The effect continues into the first three years of the children’s lives, according to an article in the February 8 issue of The Lancet, which follows up the Lancet Series on Maternal and Child Undernutrition.
While it is already known that low birthweight affects child morbidity and survival rates in developing countries, it is not always clear what effect interventions to increase birthweight can have on child health. Dr David Osrin, UCL Centre for International Health and Development, Institute of Child Health, London, UK and colleagues from Mother and Infant Research Activities, Kathmandu, Nepal, has previously investigated this issue through a randomized controlled trial in Nepal comparing 1,200 women given either IFA (a control) or MMN, a supplement with the recommended daily value of 15 vitamins and minerals, during the second and third trimesters of pregnancy. This first study showed that the birthweight of children born to mothers given MMN was on average 77g heavier than those born to mothers given only IFA.
This study focused on the follow-up of 917 of the children born in this first study. At an average age of 2.5 years, 455 of these children had been born of mothers in the IFA group, while 462 children were in the MMN group. A comparison of the sizes and weights of these children yielded the following results:
- Children of MMN mothers still weighed more. They were an average of 10.9 kg while those of IFA mothers had a mean 10.7 kg. This indicates 204 g discrepancy between the two.
- The children of MMN were generally larger. They had a mean head circumference of 2.4 mm larger. a mean chest circumference 3.2 mm bigger, a mean mid-upper arm circumference of 2.4 mm bigger, and mean triceps skinfold thickness 2.0 mm larger than those born of IFA mothers.
- MMN children had a mean systolic blood pressure that was 2.5 mmHg lower than the IFA children.
The authors conclude with reflections on these results: “In a poor population, the effects of maternal multiple micronutrient supplementation on the fetus persisted into childhood, with increases in both weight and body size. These increases were small, however, since those exposed to micronutrients had an average of 2% higher weight than controls. The public-health implications of changes in weight and blood pressure need to be clarified through follow-up.”
Dr Keith West and Dr Parul Christian, Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA, provided an accompanying comment, in which they point out the success of the randomized trial to indicate a correlation between latent effects: “At present, the clearest lesson from the study by Osrin and colleagues lies in the example it sets for successful follow-up of randomised trial cohorts of children that can reveal latent causal effects of antenatal micronutrient supplementation on growth and chronic-disease risk in undernourished populations.”
Effects of antenatal multiple micronutrient supplementation on children’s weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial
Anjana Vaidya, Naomi Saville, Bhim Prasad Shrestha, Anthony M de L Costello, Dharma S Manandhar, David Osrin
The Lancet,February 8, 2008; 371:492-499
Written by Anna Sophia McKenney