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Prenatal micronutrient supplements cumulatively increase fetal growth

Dominique Roberfroid, Lieven Huybregts UGent, Hermann Biénou Lanou UGent, Jean-Pierre Habicht, Marie-Claire Henry, Nicolas Medas and Patrick Kolsteren UGent (2012) JOURNAL OF NUTRITION. 142(3). p.548-554
abstract
Abstract: Prenatal multiple micronutrients (UNIMMAP) improve fetal growth only moderately compared to iron and folic acid alone (IFA). Whether this is due to insufficient amounts of UNIMMAP or to IFA being in reality an active control is unknown. We assessed the association between cumulative micronutrient intake (CMI) and fetal growth by secondary analysis of a randomized controlled trial in Burkina Faso where tablet intake was directly observed. We applied 2-part residual regression models adjusted for main confounders. Among the 1056 single pregnancies included, the mean CMI (+/- SD) was 124 +/- 54 tablets. The odds of delivering a small-for-gestational-age baby was reduced by 21% [(95%CI: 5, 35); P = 0.013] for each additional tertile of CMI. The association between CMI and birth weight was positively modified by gestational age at enrollment (P-interaction = 0.001). Each unit of CMI was associated with a 1.6-g [(95%CI: 0.3, 3.1); P = 0.019] higher birth weight at a mean-centered gestational age at enrollment, with a higher gradient observed later in pregnancy. Maternal BMI at enrollment was also a positive modifying factor (P-interaction = 0.02), with no association of CMI with birth weight for low BMI. There was no evidence of an effect modification by group allocation; i.e., we observed the same change in birth weight per unit of CMI with either IFA or UNIMMAP. Yet UNIMMAP increased birth weight by 69 g [(95%CI: 58, 81); P < 0.001] relative to IFA. We found similar results for thoracic and cephalic circumferences. In conclusion, for both IFA and UNIMMAP, the effect on fetal growth is cumulative. The supplementation should therefore begin as early as possible in pregnancy, even if the growth increment per CMI is higher in late than in early pregnancy. Women with a low BMI should also receive extra energy.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
MULTIMICRONUTRIENT SUPPLEMENTATION, DOUBLE-BLIND, PREGNANT-WOMEN, IRON SUPPLEMENTATION, BIRTH-WEIGHT, MULTIPLE MICRONUTRIENT, LOW-INCOME COUNTRIES, RANDOMIZED CONTROLLED-TRIAL, MATERNAL ANEMIA, BURKINA-FASO
journal title
JOURNAL OF NUTRITION
J. Nutr.
volume
142
issue
3
pages
548 - 554
Web of Science type
Article
Web of Science id
000300815900021
JCR category
NUTRITION & DIETETICS
JCR impact factor
4.196 (2012)
JCR rank
10/75 (2012)
JCR quartile
1 (2012)
ISSN
0022-3166
DOI
10.3945/jn.111.148015
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2130604
handle
http://hdl.handle.net/1854/LU-2130604
date created
2012-06-04 11:37:03
date last changed
2015-06-17 10:04:25
@article{2130604,
  abstract     = {Abstract: Prenatal multiple micronutrients (UNIMMAP) improve fetal growth only moderately compared to iron and folic acid alone (IFA). Whether this is due to insufficient amounts of UNIMMAP or to IFA being in reality an active control is unknown. We assessed the association between cumulative micronutrient intake (CMI) and fetal growth by secondary analysis of a randomized controlled trial in Burkina Faso where tablet intake was directly observed. We applied 2-part residual regression models adjusted for main confounders. Among the 1056 single pregnancies included, the mean CMI (+/- SD) was 124 +/- 54 tablets. The odds of delivering a small-for-gestational-age baby was reduced by 21\% [(95\%CI: 5, 35); P = 0.013] for each additional tertile of CMI. The association between CMI and birth weight was positively modified by gestational age at enrollment (P-interaction = 0.001). Each unit of CMI was associated with a 1.6-g [(95\%CI: 0.3, 3.1); P = 0.019] higher birth weight at a mean-centered gestational age at enrollment, with a higher gradient observed later in pregnancy. Maternal BMI at enrollment was also a positive modifying factor (P-interaction = 0.02), with no association of CMI with birth weight for low BMI. There was no evidence of an effect modification by group allocation; i.e., we observed the same change in birth weight per unit of CMI with either IFA or UNIMMAP. Yet UNIMMAP increased birth weight by 69 g [(95\%CI: 58, 81); P {\textlangle} 0.001] relative to IFA. We found similar results for thoracic and cephalic circumferences. In conclusion, for both IFA and UNIMMAP, the effect on fetal growth is cumulative. The supplementation should therefore begin as early as possible in pregnancy, even if the growth increment per CMI is higher in late than in early pregnancy. Women with a low BMI should also receive extra energy.},
  author       = {Roberfroid, Dominique and Huybregts, Lieven and Lanou, Hermann Bi{\'e}nou and Habicht, Jean-Pierre and Henry, Marie-Claire and Medas, Nicolas and Kolsteren, Patrick},
  issn         = {0022-3166},
  journal      = {JOURNAL OF NUTRITION},
  keyword      = {MULTIMICRONUTRIENT SUPPLEMENTATION,DOUBLE-BLIND,PREGNANT-WOMEN,IRON SUPPLEMENTATION,BIRTH-WEIGHT,MULTIPLE MICRONUTRIENT,LOW-INCOME COUNTRIES,RANDOMIZED CONTROLLED-TRIAL,MATERNAL ANEMIA,BURKINA-FASO},
  language     = {eng},
  number       = {3},
  pages        = {548--554},
  title        = {Prenatal micronutrient supplements cumulatively increase fetal growth},
  url          = {http://dx.doi.org/10.3945/jn.111.148015},
  volume       = {142},
  year         = {2012},
}

Chicago
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, Jean-Pierre Habicht, Marie-Claire Henry, Nicolas Medas, and Patrick Kolsteren. 2012. “Prenatal Micronutrient Supplements Cumulatively Increase Fetal Growth.” Journal of Nutrition 142 (3): 548–554.
APA
Roberfroid, D., Huybregts, L., Lanou, H. B., Habicht, J.-P., Henry, M.-C., Medas, N., & Kolsteren, P. (2012). Prenatal micronutrient supplements cumulatively increase fetal growth. JOURNAL OF NUTRITION, 142(3), 548–554.
Vancouver
1.
Roberfroid D, Huybregts L, Lanou HB, Habicht J-P, Henry M-C, Medas N, et al. Prenatal micronutrient supplements cumulatively increase fetal growth. JOURNAL OF NUTRITION. 2012;142(3):548–54.
MLA
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, et al. “Prenatal Micronutrient Supplements Cumulatively Increase Fetal Growth.” JOURNAL OF NUTRITION 142.3 (2012): 548–554. Print.