Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.

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Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality : a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.

Smith, Emily R (författare): Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Shankar, Anuraj H (författare): Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Wu, Lee S-F (författare): The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh

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Aboud, Said (författare): Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Adu-Afarwuah, Seth (författare): Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana

Ali, Hasmot (författare): The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh

Agustina, Rina (författare): Summit Institute of Development, Mataram, Indonesia

Arifeen, Shams (författare): International Centre for Diarrhoeal Diseases Research Bangladesh (ICDDR,B), Dhaka, Bangladesh

Ashorn, Per (författare): Centre for Child Health Research and Department of Paediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland

Bhutta, Zulfiqar A (författare): Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada

Christian, Parul (författare): The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh

Devakumar, Delanjathan (författare): UCL Institute for Global Health, London, UK

Dewey, Kathryn G (författare): Department of Nutrition and Program in International and Community Nutrition, University of California-Davis, Davis, CA, USA

Friis, Henrik (författare): Department of Nutrition Exercise and Sports, University of Copenhagen, Copenhagen, Denmark

Gomo, Exnevia (författare): College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe

Gupta, Piyush (författare): Department of Pediatrics, University College of Medical Sciences, Delhi, India

Kæstel, Pernille (författare): Department of Nutrition Exercise and Sports, University of Copenhagen, Copenhagen, Denmark

Kolsteren, Patrick (författare): Nutrition and Child Health Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Lanou, Hermann (författare): Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso

Maleta, Kenneth (författare): School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi

Mamadoultaibou, Aissa (författare): Food and Agriculture Organization of the United Nations, Libreville, Gabon

Msamanga, Gernard (författare): Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Osrin, David (författare): UCL Institute for Global Health, London, UK

Persson, Lars-Åke, 1947- (författare): Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH),Internationell barnhälsa och nutrition/Mårtensson

Ramakrishnan, Usha (författare): Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA

Rivera, Juan A (författare): Instituto Nacional de Salud Publica, Cuernavaca, Mexico

Rizvi, Arjumand (författare): Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan

Sachdev, H P S (författare): Pediatric and Clinical Epidemiology Unit, Sitar am Bhartia Institute of Science and Research, New Delhi, India

Urassa, Willy (författare): Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

West, Keith P, Jr (författare): The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh

Zagre, Noel (författare): UNICEF Regional Office for West and Central Africa, Dakar, Senegal

Zeng, Lingxia (författare): Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China

Zhu, Zhonghai (författare): Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China

Fawzi, Wafaie W (författare): Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Sudfeld, Christopher R (författare): Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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Department of Global Health and Population, Harvard TH. Chan School of Public Health, Boston, MA, USA Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA (creator_code:org_t)

2017
2017
Engelska.
Ingår i: The Lancet Global Health. - 2214-109X. ; 5:11, s. e1090-e1100

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://uu.diva-port... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; visa färre...

Tidskriftsartikel (refereegranskat)

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BACKGROUND: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries.METHODS: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in 112 953 pregnant women. We generated study-specific estimates and pooled subgroup estimates using fixed-effects models and assessed heterogeneity between subgroups with the χ(2) test for heterogeneity. We did sensitivity analyses using random-effects models, stratifying by iron-folic acid dose, and exploring individual study effect.FINDINGS: Multiple micronutrient supplements containing iron-folic acid provided significantly greater reductions in neonatal mortality for female neonates compared with male neonates than did iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75-0·96 vs 1·06, 0·95-1·17; p value for interaction 0·007). Multiple micronutrient supplements resulted in greater reductions in low birthweight (RR 0·81, 95% CI 0·74-0·89; p value for interaction 0·049), small-for-gestational-age births (0·92, 0·87-0·97; p=0·03), and 6-month mortality (0·71, 0·60-0·86; p=0·04) in anaemic pregnant women (haemoglobin <110g/L) as compared with non-anaemic pregnant women. Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI <18·5 kg/m(2); RR 0·84, 95% CI 0·78-0·91; p=0·01). Initiation of multiple micronutrient supplements before 20 weeks gestation provided greater reductions in preterm birth (RR 0·89, 95% CI 0·85-0·93; p=0·03). Generally, the survival and birth outcome effects of multiple micronutrient supplementation were greater with high adherence (≥95%) to supplementation. Multiple micronutrient supplements did not significantly increase the risk of stillbirth or neonatal, 6-month, or infant mortality, neither overall or in any of the 26 examined subgroups.INTERPRETATION: Antenatal multiple micronutrient supplements improved survival for female neonates and provided greater birth-outcome benefits for infants born to undernourished and anaemic pregnant women. Early initiation in pregnancy and high adherence to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex.

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Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality : a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.

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