Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method
Abstract Meta‐analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional tr...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-07-01
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| Series: | Maternal and Child Nutrition |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/mcn.13509 |
| _version_ | 1797805381965053952 |
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| author | Filomena Gomes Sufia Askari Robert E. Black Parul Christian Kathryn G. Dewey Martin N. Mwangi Ziaul Rana Sarah Reed Anuraj H. Shankar Emily R. Smith Alison Tumilowicz |
| author_facet | Filomena Gomes Sufia Askari Robert E. Black Parul Christian Kathryn G. Dewey Martin N. Mwangi Ziaul Rana Sarah Reed Anuraj H. Shankar Emily R. Smith Alison Tumilowicz |
| author_sort | Filomena Gomes |
| collection | DOAJ |
| description | Abstract Meta‐analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age (SGA) was considered inconsistent. We conducted meta‐analyses to determine if the effects of MMS on LBW, preterm birth and SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine test and recall of LMP. The effects of MMS versus IFA on birthweight, preterm birth and SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratios of 0.87 (95% confidence interval [CI] 0.78–0.97) for LBW, 0.90 (95% CI, 0.79–1.03) for preterm birth and 0.9 (95% CI, 0.83–0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low‐ and middle‐income countries. |
| first_indexed | 2024-03-13T05:51:13Z |
| format | Article |
| id | doaj.art-c101043f3c3c4faca9dcf625979ae980 |
| institution | Directory Open Access Journal |
| issn | 1740-8695 1740-8709 |
| language | English |
| last_indexed | 2024-03-13T05:51:13Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Maternal and Child Nutrition |
| spelling | doaj.art-c101043f3c3c4faca9dcf625979ae9802023-06-13T13:13:45ZengWileyMaternal and Child Nutrition1740-86951740-87092023-07-01193n/an/a10.1111/mcn.13509Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment methodFilomena Gomes0Sufia Askari1Robert E. Black2Parul Christian3Kathryn G. Dewey4Martin N. Mwangi5Ziaul Rana6Sarah Reed7Anuraj H. Shankar8Emily R. Smith9Alison Tumilowicz10The New York Academy of Sciences New York City New York USASight and Life Foundation Basel SwitzerlandJohns Hopkins Bloomberg School of Public Health Baltimore Maryland USAJohns Hopkins Bloomberg School of Public Health Baltimore Maryland USADepartment of Nutrition University of California, Davis Davis California USAThe Micronutrient Forum Washington District of Columbia USAThe New York Academy of Sciences New York City New York USAThe Bill & Melinda Gates Foundation Seattle Washington USANuffield Department of Medicine University of Oxford Oxford UKMilken Institute School of Public Health The George Washington University Washington District of Columbia USAThe Bill & Melinda Gates Foundation Seattle Washington USAAbstract Meta‐analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age (SGA) was considered inconsistent. We conducted meta‐analyses to determine if the effects of MMS on LBW, preterm birth and SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine test and recall of LMP. The effects of MMS versus IFA on birthweight, preterm birth and SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratios of 0.87 (95% confidence interval [CI] 0.78–0.97) for LBW, 0.90 (95% CI, 0.79–1.03) for preterm birth and 0.9 (95% CI, 0.83–0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low‐ and middle‐income countries.https://doi.org/10.1111/mcn.13509birth outcomesgestational age assessmentiron and folic acid supplementsmultiple micronutrient supplementsnutritionpregnancy |
| spellingShingle | Filomena Gomes Sufia Askari Robert E. Black Parul Christian Kathryn G. Dewey Martin N. Mwangi Ziaul Rana Sarah Reed Anuraj H. Shankar Emily R. Smith Alison Tumilowicz Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method Maternal and Child Nutrition birth outcomes gestational age assessment iron and folic acid supplements multiple micronutrient supplements nutrition pregnancy |
| title | Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method |
| title_full | Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method |
| title_fullStr | Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method |
| title_full_unstemmed | Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method |
| title_short | Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method |
| title_sort | antenatal multiple micronutrient supplements versus iron folic acid supplements and birth outcomes analysis by gestational age assessment method |
| topic | birth outcomes gestational age assessment iron and folic acid supplements multiple micronutrient supplements nutrition pregnancy |
| url | https://doi.org/10.1111/mcn.13509 |
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