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Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes
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Orientador(es)
Resumo(s)
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.
Descrição
Funding Information: We would like to thank Dr Noel Zagre, Dr Zuguo Mei and Dr Seth Adu‐Afarwuah for providing the additional information that confirmed the method used for gestational age assessment in the trials they were involved in (Adu‐Afarwuah et al., 2015 ; Liu et al., 2013 ; Zagre et al., 2007 ). This research was funded by a grant from the Bill & Melinda Gates Foundation (OPP1171060). Publisher Copyright: © 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
Palavras-chave
birth outcomes gestational age assessment iron and folic acid supplements multiple micronutrient supplements nutrition pregnancy ultrasound Pediatrics, Perinatology, and Child Health Obstetrics and Gynaecology Nutrition and Dietetics Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being