Document Detail

Effects of prenatal micronutrient and early food supplementation on maternal hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial.
MedLine Citation:
PMID:  22665104     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences.
OBJECTIVES: To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009.
INTERVENTIONS: Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation).
MAIN OUTCOME MEASURES: Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed.
RESULTS: Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, -0.9 g/L; 95% CI, -1.7 to -0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births (54 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid; HR, 0.34; 95% CI, 0.18-0.65). Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate.
CONCLUSION: Among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including iron and folic acid combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality.
Lars Åke Persson; Shams Arifeen; Eva-Charlotte Ekström; Kathleen M Rasmussen; Edward A Frongillo; Md Yunus;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  307     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-05     Completed Date:  2012-06-08     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2050-9     Citation Subset:  AIM; IM    
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MeSH Terms
Bangladesh / epidemiology
Birth Weight*
Dietary Supplements*
Folic Acid / administration & dosage
Hemoglobins / analysis*
Infant Mortality*
Infant, Newborn
Iron / administration & dosage
Malnutrition / drug therapy*
Maternal Nutritional Physiological Phenomena
Micronutrients / administration & dosage*
Pregnancy Complications / diet therapy*
Pregnancy Outcome
Prenatal Care
Young Adult
Grant Support
089276//Wellcome Trust; //Medical Research Council
Reg. No./Substance:
0/Hemoglobins; 0/Micronutrients; 935E97BOY8/Folic Acid; E1UOL152H7/Iron
Dewan Alam / ; Lauren S Blum / ; Badal Dhar / ; Jena Hamadani / ; Waheedul Hoque / ; Iqbal Kabir / ; Ruchhira T Naved / ; Anisur Rahman / ; Mahfuzar Rahman / ; Motiur Rahman / ; Rubhana Raqib / ; Kuntal K Saha / ; Rubina Shaheen / ; Peter K Streatfield / ; Fahmida Tofail / ; M A Wahed / ; Mushtaque Chowdhury / ; Sophie Moore / ; Andrew Prentice / ; Sally G McGregor / ; Bo Lönnerdal / ; Lynnette M Neufeld / ; Marie Vahter / ; Yukiko Wagatsuma /
Comment In:
JAMA. 2012 May 16;307(19):2094-6   [PMID:  22665110 ]
JAMA. 2012 Sep 12;308(10):971; author reply 971-2   [PMID:  22968877 ]

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