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  • Title: Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial.
    Author: Christian P, Khatry SK, Katz J, Pradhan EK, LeClerq SC, Shrestha SR, Adhikari RK, Sommer A, West KP.
    Journal: BMJ; 2003 Mar 15; 326(7389):571. PubMed ID: 12637400.
    Abstract:
    OBJECTIVE: To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. DESIGN: Double blind cluster randomised controlled trial. SETTING: Rural community in south eastern Nepal. PARTICIPANTS: 4926 pregnant women and 4130 live born infants. INTERVENTIONS: 426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control). MAIN OUTCOME MEASURES: Birth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined <2500 g. RESULTS: Supplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval -16 g to 90 g) and reduced the percentage of low birthweight babies (<2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length. CONCLUSIONS: Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk.
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