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Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso

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Abstract
Background: Intrauterine growth retardation is a major predictor of child health in developing countries. Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates. Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed. Results: Pregnancy outcome was known in 96.3% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMAP group (OR: 1.78; 95% CI: 0.95, 3.32; P = 0.07), and this seemed to affect mainly primiparous women (OR: 3.44; 95% CI: 1.1, 10.7; P for interaction = 0.11). Conclusions: Maternal UNIMMAP modestly but significantly increased fetal growth. The resulting benefit on infant growth and survival needs to be assessed. The possible lack of benefit and potential harm in primiparous women should be further investigated. This trial was registered at clinicaltrials. gov as NCT00642408. Am J Clin Nutr 2008; 88: 1330-40.
Keywords
PREGNANCY, GESTATIONAL-AGE, CHILD UNDERNUTRITION, MULTIMICRONUTRIENT SUPPLEMENTATION, LOW-BIRTH-WEIGHT, OF-THE-LITERATURE, NEPAL, RETARDATION, MORTALITY, INFANTS

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Chicago
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, Marie-Claire Henry, Nicolas Meda, Joris Menten, and Patrick Kolsteren. 2008. “Effects of Maternal Multiple Micronutrient Supplementation on Fetal Growth: a Double-blind Randomized Controlled Trial in Rural Burkina Faso.” American Journal of Clinical Nutrition 88 (5): 1330–1340.
APA
Roberfroid, D., Huybregts, L., Lanou, H. B., Henry, M.-C., Meda, N., Menten, J., & Kolsteren, P. (2008). Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. AMERICAN JOURNAL OF CLINICAL NUTRITION, 88(5), 1330–1340.
Vancouver
1.
Roberfroid D, Huybregts L, Lanou HB, Henry M-C, Meda N, Menten J, et al. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. AMERICAN JOURNAL OF CLINICAL NUTRITION. 2008;88(5):1330–40.
MLA
Roberfroid, Dominique, Lieven Huybregts, Hermann Biénou Lanou, et al. “Effects of Maternal Multiple Micronutrient Supplementation on Fetal Growth: a Double-blind Randomized Controlled Trial in Rural Burkina Faso.” AMERICAN JOURNAL OF CLINICAL NUTRITION 88.5 (2008): 1330–1340. Print.
@article{685408,
  abstract     = {Background: Intrauterine growth retardation is a major predictor of child health in developing countries.
Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates.
Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed.
Results: Pregnancy outcome was known in 96.3\% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95\% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95\% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95\% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMAP group (OR: 1.78; 95\% CI: 0.95, 3.32; P = 0.07), and this seemed to affect mainly primiparous women (OR: 3.44; 95\% CI: 1.1, 10.7; P for interaction = 0.11).
Conclusions: Maternal UNIMMAP modestly but significantly increased fetal growth. The resulting benefit on infant growth and survival needs to be assessed. The possible lack of benefit and potential harm in primiparous women should be further investigated. This trial was registered at clinicaltrials. gov as NCT00642408. Am J Clin Nutr 2008; 88: 1330-40.},
  author       = {Roberfroid, Dominique and Huybregts, Lieven and Lanou, Hermann Bi{\'e}nou and Henry, Marie-Claire and Meda, Nicolas and Menten, Joris and Kolsteren, Patrick},
  issn         = {0002-9165},
  journal      = {AMERICAN JOURNAL OF CLINICAL NUTRITION},
  language     = {eng},
  number       = {5},
  pages        = {1330--1340},
  title        = {Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso},
  url          = {http://dx.doi.org/10.3945/ajcn.2008.26296},
  volume       = {88},
  year         = {2008},
}

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