| A comparative evaluation of multiple micronutrient and iron-folic acid supplementation during pregnancy in Pakistan: impact on pregnancy outcomes. | |
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MedLine Citation:
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PMID: 20120791 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation. Intervention strategies largely consist of administration of iron-folic acid supplements during pregnancy. OBJECTIVE: We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-randomized design. METHODS: We randomly assigned 2378 pregnant women to receive either iron-folic acid or multiple micronutrient supplements. The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers. RESULTS: The women in both groups consumed about 75% of the supplements provided, and few reported adverse effects such as vomiting, abdominal pain, etc. There was a small (70 g) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron-folic acid supplements (2.95 +/- 0.6 vs. 2.88 +/- 0.5 kg, p = .01). This translated into a 10% reduction (p < 0.17) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients. Although stillbirth rates were comparable in the two groups, the early neonatal mortality rate in the group receiving multiple micronutrients was higher, although not significantly, than that in the group receiving iron-folic acid (43.2 vs. 23.5 deaths per 1000 live births; RR = 1.64; 95% CI, 0.94 to 2.87). Comparable reductions in anemia (hemoglobin < 11 g/dL) were observed, although the proportion with low iron stores (assessed by serum ferritin) was lower in the iron-folic acid group in the postnatal period. Although the proportion of women with subclinical vitamin A deficiency after supplementation did not differ between the two groups, the iron-folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period. CONCLUSIONS: These data suggest that multiple micronutrient supplements are well tolerated during pregnancy, but the effect on birthweight is modest. The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system settings. |
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Authors:
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Zulfiqar A Bhutta; Arjumand Rizvi; Farrukh Raza; Sunil Hotwani; Shujaat Zaidi; S Moazzam Hossain; Sajid Soofi; Shereen Bhutta |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Food and nutrition bulletin Volume: 30 ISSN: 0379-5721 ISO Abbreviation: Food Nutr Bull Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2010-02-03 Completed Date: 2010-03-11 Revised Date: 2010-05-18 |
Medline Journal Info:
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Nlm Unique ID: 7906418 Medline TA: Food Nutr Bull Country: Japan |
Other Details:
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Languages: eng Pagination: S496-505 Citation Subset: IM |
Affiliation:
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The Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anemia, Iron-Deficiency / drug therapy, prevention & control Birth Weight Dietary Supplements* Female Fetal Growth Retardation / prevention & control Folic Acid / administration & dosage*, adverse effects Humans Iron / administration & dosage*, adverse effects Micronutrients / administration & dosage*, adverse effects, deficiency Nutritional Status* Pakistan Patient Compliance / statistics & numerical data Pregnancy Pregnancy Complications / drug therapy, prevention & control Pregnancy Outcome* Prenatal Nutritional Physiological Phenomena* Rural Population / statistics & numerical data Urban Population / statistics & numerical data Young Adult Zinc / blood |
| Chemical | |
Reg. No./Substance:
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0/Micronutrients; 59-30-3/Folic Acid; 7439-89-6/Iron; 7440-66-6/Zinc |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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