1. When compared to iron-folic acid supplementation, maternal multiple micronutrient supplementation demonstrated no difference in 6 month infant mortality in a cluster randomized trial performed in rural Bangladesh.
2. In contrast, maternal multiple micronutrient supplementation was associated with a statistically significant decrease in the number of pre-term and low weight births in the region.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Maternal malnutrition and associated adverse fetal outcomes are common in developing countries that possess limited available resources. While prior studies have demonstrated greater improvements in birth weight in such settings with maternal micronutrient supplementation versus iron-folic acid supplementation, they have not been able to comment on the effects of such supplementation on infant mortality due to the poor power afforded by limited study sample sizes. This study consequently aimed to answer these questions by incorporating a robust sample size of 127, 282 patients comparing a micronutrient supplementation groups versus iron-folic acid supplements alone. In accord with prior findings, an improvement in birth weight and pre term deliveries was noted with multiple micronutrient supplementation. Of note, however, no difference in effect on infant mortality was seen between the two supplementation groups. While this study may be limited in its generalizability due to environmental characteristics particular to the study location, its large sample size and randomized design allows for a critical assessment of infant mortality that may aid in the development of appropriate public health recommendations for the region.
In-Depth [cluster randomized trial]: This cluster randomized trial included 127,282 patients that were randomized to daily oral micronutrient supplementation containing 15 micronutrients or iron-folic acid supplementation. Gestational age at study intake was recorded and pregnancy outcomes were measured, including miscarriages, stillbirths, live birth size, and complications. Infant health status was subsequently assessed at 1, 3, and 6 months of age. There was no difference in infant mortality between the iron-folic acid and multiple micronutrient supplementation groups (54.0 vs. 51.6 per 1000 live births, respectively; RR 0.95, 95%CI 0.86-1.06). The multiple micronutrient supplementation group demonstrated fewer preterm (RR 0.85; 95%CI 0.80-0.91) and low birth weight babies (RR 0.88; 95%CI 0.85-0.91) than the iron-folic acid supplementation group.
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