Prenatal Micronutrient, Food Supplementation Intervention In Bangladesh Decreases Child Death Rate

Lars Ake Persson, MD, PhD of Uppsala University, Sweden, and colleagues conducted a study (the MINIMat trial) to examine whether a prenatal multiple micronutrient supplementation (MMS), as well as an early invitation to a daily food supplementation, would increase maternal haemoglobin level at 30 weeks' gestation, birth weight, and infant survival, and that a combination of these interventions (early invitation with MMS) would further improve these outcomes. The randomised trial, conducted in Matlab, Bangladesh, included 4 436 pregnant women who were recruited between November 2001 and October 2003, with follow-up until June 2009. One third of the women were illiterate and one fifth experienced occasional or constant deficit in their perceived income-expenditure status.

Participants were randomised into six groups; a double-masked supplementation with capsules of 30 mg of iron and 400μg of folic acid, 60 mg of iron and 400μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400μg of folic acid, was combined with food supplementation randomised to either early invitation (nine weeks' gestation), or usual invitation (20 weeks' gestation).

There were 3 625 live births out of 4 436 pregnancies. The average birth weight among 3 267 single-birth infants was 2 694 g (5.9 lbs.). Overall, 31% of newborns weighed less than 2 500 g (5.5 lbs.). There was no significant difference in birth weight among treatment groups, and no main-effect differences between food groups or among micronutrient groups. The researchers found that infants in the early invitation with MMS group had a lower risk of death, with a mortality rate of 16.8 per 1 000 live births vs. 44.1 per 1 000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid. The early invitation with MMS group had an under five-year mortality rate of 18 per 1 000 live births (54 per 1 000 live births for usual invitation with 60 mg of iron and 400μg of folic acid). Usual care invitation with MMS had the highest infant mortality rate (47.1 per 1 000 live births).

Adjusted maternal haemoglobin level at 30 weeks' gestation was 115.0 g/L, with no significant differences among micronutrient groups. Women in the early invitation group had a small (0.9 g/L), but statistically significant lower haemoglobin level concentration than those in the usual invitation group.

"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 foetal 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," the researchers conclude.

Persson L, Arifeen S, Ekström E, et al. Effects of prenatal micronutrient and early food supplementation on maternal haemoglobin, birth weight, and infant mortality among children in Bangladesh, the minimal randomised trial prenatal micronutrient and early food supplementation. JAMA. 2012;307(19):2050-2059

http://www.eurekalert.org/pub_releases/2012-05/jaaj-pmf051512.php