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Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial

Dominique Roberfroid, Lieven Huybregts UGent, Hermann Biénou Lanou UGent, Laetitia Ouedraogo, Marie-Claire Henry, Nicolas Meda and Patrick Kolsteren UGent (2012) AMERICAN JOURNAL OF CLINICAL NUTRITION. 95(4). p.916-924
abstract
Background: Although prenatal multiple micronutrients can improve fetal growth, their benefit on postnatal health remains uncertain. Objective: We assessed the effect of the UNICEF/WHO/United Nations University multiple micronutrient supplement for pregnant and lactating women (UNIMMAP) compared with the usual iron and folic acid supplement (IFA) on survival, growth, and morbidity during infancy. Design: In a double-blind, randomized trial, we followed 1294 singleton newborns whose mothers had prenatally received either the UNIMMAP or IFA. We assessed monthly anthropometric measures and health variables up to age 12 mo. Children were assessed again at a mean age of 30 mo. Mixed-effects models accounted for repeated measurements. Results: The UNIMMAP resulted in a 27% (HR: 0.73; 95% CI: 0.60, 0.87; P = 0.002) reduction in the rate of stunting in 15,261 infant-months with a higher length-for-age z score of 0.13 (95% CI: 0.02, 0.24; P = 0.02) over the whole observation period. However, by age 30 mo, this difference was not observed. An effect of the UNIMMAP on weight-for-length (P-interaction = 0.004) and head circumference for-age (P-interaction = 0.03) became apparent by the end of the first year of life. By the age of 30 mo, children from the UNIMMAP group had a higher weight-for-height z score of 0.20 (95% CI: 0.06, 0.34; P = 0.004). No difference in mortality or morbidity was identified in groups, except a 14% reduction in reported episodes of fever (95% CI: 1%, 28%; P = 0.04). Conclusions: Improved linear fetal growth with continuation into early life and enhanced postnatal growth were 2 mechanisms that mediated the effect of the prenatal UNIMMAP on infant nutritional status. Additional follow-up to assess long-term effects is warranted. This trial was registered at clinicaltrials.gov as NCT00642408.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
BLOOD-PRESSURE, PREGNANCY, PERINATAL-MORTALITY, LINEAR GROWTH, ZINC SUPPLEMENTATION, BIRTH-WEIGHT, FOLIC-ACID SUPPLEMENTATION, DOUBLE-BLIND, FETAL, IRON
journal title
AMERICAN JOURNAL OF CLINICAL NUTRITION
Am. J. Clin. Nutr.
volume
95
issue
4
pages
916 - 924
Web of Science type
Article
Web of Science id
000301894400017
JCR category
NUTRITION & DIETETICS
JCR impact factor
6.504 (2012)
JCR rank
3/75 (2012)
JCR quartile
1 (2012)
ISSN
0002-9165
DOI
10.3945/ajcn.111.029033
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2130535
handle
http://hdl.handle.net/1854/LU-2130535
date created
2012-06-04 11:25:49
date last changed
2015-06-17 10:04:23
@article{2130535,
  abstract     = {Background: Although prenatal multiple micronutrients can improve fetal growth, their benefit on postnatal health remains uncertain. 
Objective: We assessed the effect of the UNICEF/WHO/United Nations University multiple micronutrient supplement for pregnant and lactating women (UNIMMAP) compared with the usual iron and folic acid supplement (IFA) on survival, growth, and morbidity during infancy. 
Design: In a double-blind, randomized trial, we followed 1294 singleton newborns whose mothers had prenatally received either the UNIMMAP or IFA. We assessed monthly anthropometric measures and health variables up to age 12 mo. Children were assessed again at a mean age of 30 mo. Mixed-effects models accounted for repeated measurements. 
Results: The UNIMMAP resulted in a 27\% (HR: 0.73; 95\% CI: 0.60, 0.87; P = 0.002) reduction in the rate of stunting in 15,261 infant-months with a higher length-for-age z score of 0.13 (95\% CI: 0.02, 0.24; P = 0.02) over the whole observation period. However, by age 30 mo, this difference was not observed. An effect of the UNIMMAP on weight-for-length (P-interaction = 0.004) and head circumference for-age (P-interaction = 0.03) became apparent by the end of the first year of life. By the age of 30 mo, children from the UNIMMAP group had a higher weight-for-height z score of 0.20 (95\% CI: 0.06, 0.34; P = 0.004). No difference in mortality or morbidity was identified in groups, except a 14\% reduction in reported episodes of fever (95\% CI: 1\%, 28\%; P = 0.04). 
Conclusions: Improved linear fetal growth with continuation into early life and enhanced postnatal growth were 2 mechanisms that mediated the effect of the prenatal UNIMMAP on infant nutritional status. Additional follow-up to assess long-term effects is warranted. This trial was registered at clinicaltrials.gov as NCT00642408.},
  author       = {Roberfroid, Dominique and Huybregts, Lieven and Lanou, Hermann Bi{\'e}nou and Ouedraogo, Laetitia and Henry, Marie-Claire and Meda, Nicolas and Kolsteren, Patrick},
  issn         = {0002-9165},
  journal      = {AMERICAN JOURNAL OF CLINICAL NUTRITION},
  keyword      = {BLOOD-PRESSURE,PREGNANCY,PERINATAL-MORTALITY,LINEAR GROWTH,ZINC SUPPLEMENTATION,BIRTH-WEIGHT,FOLIC-ACID SUPPLEMENTATION,DOUBLE-BLIND,FETAL,IRON},
  language     = {eng},
  number       = {4},
  pages        = {916--924},
  title        = {Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial},
  url          = {http://dx.doi.org/10.3945/ajcn.111.029033},
  volume       = {95},
  year         = {2012},
}

Chicago
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, Laetitia Ouedraogo, Marie-Claire Henry, Nicolas Meda, and Patrick Kolsteren. 2012. “Impact of Prenatal Multiple Micronutrients on Survival and Growth During Infancy: a Randomized Controlled Trial.” American Journal of Clinical Nutrition 95 (4): 916–924.
APA
Roberfroid, D., Huybregts, L., Lanou, H. B., Ouedraogo, L., Henry, M.-C., Meda, N., & Kolsteren, P. (2012). Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial. AMERICAN JOURNAL OF CLINICAL NUTRITION, 95(4), 916–924.
Vancouver
1.
Roberfroid D, Huybregts L, Lanou HB, Ouedraogo L, Henry M-C, Meda N, et al. Impact of prenatal multiple micronutrients on survival and growth during infancy: a randomized controlled trial. AMERICAN JOURNAL OF CLINICAL NUTRITION. 2012;95(4):916–24.
MLA
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, et al. “Impact of Prenatal Multiple Micronutrients on Survival and Growth During Infancy: a Randomized Controlled Trial.” AMERICAN JOURNAL OF CLINICAL NUTRITION 95.4 (2012): 916–924. Print.