Title: Maternal Multiple Micronutrient Supplementation Has Limited Impact on Micronutrient Status of Bangladeshi Infants Compared with Standard Iron Folic Acid Supplementation Authors
|Eneroth, Hanna - UPPSALA UNIV. SWEDEN|
|Arifeen, Shams El - ICDDR,B,DHAKA, BANGLADESH|
|Persson, Lars Ake - UPPSALA UNIV. SWEDEN|
|Lonnerdal, Bo - UCD, DEPT. OF NUTR.|
|Hossain, Mohammad - UCD & ICDDR, BANGLADESH|
|Ekstrom, Eva Charlotte - UPPSALA UNIV. SWEDEN|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 8, 2009
Publication Date: January 6, 2010
Repository URL: http://jn.nutrition.org/cgi/rapidpdf/jn.109.111740v1
Citation: Eneroth, H., Arifeen, S., Persson, L., Lonnerdal, B., Hossain, M.B., Stephensen, C.B., Ekstrom, E. 2010. Maternal Multiple Micronutrient Supplementation Has Limited Impact on Micronutrient Status of Bangladeshi Infants Compared with Standard Iron Folic Acid Supplementation. Journal of Nutrition. doi:10.3945/jn.109.111740. Interpretive Summary: Mild deficiencies in vitamins and minerals during pregnancy may affect development of the fetus and nutritional status of the infant after birth. To determine if provision of multiple micronutrient supplements to pregnant women improved the nutritional status of their infants, several different interventions were tested in comparison to the standard nutritional intervention (including prenatal iron and folate supplements) for pregnant women in Bangladesh. Data have been analyzed with regard to the effect of this intervention on the nutritional status of the infant at 6 m of age. A substantial improvement was not seen in infant nutritional status when the new multiple micronutrient treatment was compared to the standard regimen, thus a change in the current practice is not warranted based on improving infant nutritional status.
Technical Abstract: We examined the impact of type of maternal micronutrient supplement, time of introduction of a prenatal food supplement and the two interventions combined on micronutrient status of infants in rural Bangladesh. In a community trial, 4436 pregnant women were randomized to Early or Usual start of food supplementation and to a daily micronutrient supplement: folic acid and 30 mg (Fe30F) or 60 mg (Fe60F) iron or a multiple micronutrient including folic acid and 30 mg iron (MMS). Venous blood was collected from 1066 infants at 6 months and analyzed for hemoglobin, plasma ferritin, zinc, plasma retinol, vitamin B-12, folate and C-reactive protein. Apart from a higher prevalence of vitamin B-12 deficiency in infants in the Fe30F group than in Fe60F or MMN groups, there were no effects of micronutrient supplementation when food supplementation groups were combined. In the Early group, mean plasma B-12 in the Fe30F group was lower than in Fe60F or MMS. In the Usual group a higher mean ferritin was found in plasma of infants born to mothers in the MMS group than in the Fe30F or Fe60F groups. Where effects were observed, they were small and of unknown clinical relevance. This study did not provide evidence to suggest a shift from the WHO recommended Fe60F prenatal supplementation to Fe30F or MMS on the basis of infant iron, zinc, vitamin A, vitamin B-12 or folate status. For infant iron status, a prenatal supplement of Fe30F or MMS was as good as Fe60F.