Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK et al.. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial (see comment). Lancet 365, 955-962

Institute of Medicine, Tribhuvan University, Kantipura, Central Region, Nepal
The Lancet (Impact Factor: 45.22). 03/2005; 365(9463):955-62. DOI: 10.1016/S0140-6736(05)71084-9
Source: PubMed


Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years, and low birthweight is a crucial underlying factor. We tested the hypotheses that antenatal multiple micronutrient supplementation would increase infant birthweight and gestational duration.
We did a double-blind, randomised controlled trial in Dhanusha district, Nepal. Women attending for antenatal care with singleton pregnancies at up to 20 weeks' gestation were invited to participate. Participants were randomly allocated either routine iron and folic acid supplements (control; n=600) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals (intervention; n=600). Supplementation began at a minimum of 12 weeks' gestation and continued until delivery. Primary outcome measures were birthweight and gestational duration. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN88625934.
Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group. Mean birthweight was 2733 g (SD 422) in the control group and 2810 g (453) in the intervention group, representing a mean difference of 77 g (95% CI 24-130; p=0.004) and a relative fall in the proportion of low birthweight by 25%. No difference was recorded in the duration of gestation (0.2 weeks [-0.1 to 0.4]; p=0.12), infant length (0.3 cm [-0.1 to 0.6]; p=0.16), or head circumference (0.2 cm [-0.1 to 0.4]; p=0.18).
In a poor community in Nepal, consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a standard iron and folic acid preparation. The effects on perinatal morbidity and mortality need further comparisons between studies. Published online March 3, 2005 http://image.thelancet.com/extras/04art11045web.pdf.

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    • "Most rural Tibetan communities are remote, in high-altitude environments, with low food diversity that lack micronutrient variation in diet (Goldstein & Beall, 1990). Studies from high-altitude Himalayan communities in this region of the world have helped demonstrate that MNS in pregnancy improves foetal growth (Osrin et al., 2005) and helps reduce early neonatal mortality (Zeng et al., 2008). Evidence around the impact of iron supplementation in pregnancy is more elusive but suggests positive benefits on birthweight (Haider et al., 2013). "
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    ABSTRACT: The objective of this study was to identify trends and change in micronutrient supplementation (MNS) knowledge across pregnancy and post-partum and to assess the impact of MNS knowledge (MNS-k) on practice in pregnancy in rural Tibet, an area with endemic micronutrient deficiency. A prospective cohort with repeated measures at early, late and after pregnancy in a rural area in the Tibetan Autonomous Region included women receiving care by community workers. Key messages about MNS-k and optimal MNS practice were communicated through health worker encounters with pregnant women. Outcomes included MNS consumption practice, knowledge and attitudes. The proportion of women in the highest MNS-k category increased by 35% from early to late pregnancy (37.5-50.7%, respectively; p < .005). MNS-k was associated with MNS consumption in a dose-response manner over pregnancy (trend X(2) p-value < .0001), with increasing knowledge associated with increased MNS consumption. By late pregnancy, 32.5% of women had never consumed an MNS in this pregnancy, and 51.5% had not consumed an MNS on the assessed day or the day before. Sustained knowledge of MNS improved in pregnancy and post-partum. Best practice around MNS consumption increased though remained sub-optimal.
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    • "The study was part of a larger follow-up of children born after a randomized controlled trial in which pregnant women were allocated to multiple micronutrient or iron and folic acid supplements (Osrin et al., 2005). We attempted to find all the children from the trial at seven to nine years of age. "
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    • "Multiple micronutrient supplementation had no significant effect on maternal anemia in the third trimester compared to iron-folate based on data from 4 RCTs (RR = 1.03; 95% CI: 0.87 – 1.22; random model) [22,25,28,35] (Additional File 4). There was a statistically significant 9% reduction in the risk of small for gestational age infants with multiple micronutrient supplements (RR = 0.91; 95% CI: 0.86 – 0.96; fixed model) based on fourteen studies [19-24,27-34] (Additional File 5A). "
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