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Meta-Analysis
. 2009 Dec;30(4 Suppl):S547-55.
doi: 10.1177/15648265090304S409.

Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality

Carine Ronsmans  1 , David J Fisher, Clive Osmond, Barrie M Margetts, Caroline H D Fall; Maternal Micronutrient Supplementation Study Group
Collaborators, Affiliations
Meta-Analysis

Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality

Carine Ronsmans et al. Food Nutr Bull. 2009 Dec.

Abstract

Background: Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes.

Objective: To conduct a meta-analysis of the effects on stillbirths and on early and late neonatal mortality of supplementation during pregnancy with multiple micronutrients compared with iron-folic acid in recent randomized, controlled trials.

Methods: Twelve randomized, controlled trials were included in the analysis (Bangladesh; Burkina Faso; China; Guinea-Bissau; Indramayu and Lombok, Indonesia; Mexico; Sarlahi and Janakur, Nepal; Niger; Pakistan; and Zimbabwe), all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients or iron-folic acid to presumed HIV-negative women.

Results: Supplementation providing approximately I RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neonatal mortality (OR = 1.23; 95% CI, 0.95 to 1.59), late neonatal mortality (OR = 0.94; 95% CI, 0.73 to 1.23), or perinatal mortality (OR = 1.11; 95% CI, 0.93 to 1.33).

Conclusions: Our meta-analysis provides consistent evidence that supplementation providing approximately 1 RDA of multiple micronutrients during pregnancy does not result in any reduction in stillbirths or in early or late neonatal deaths compared with iron-folic acid alone.

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Figures

Figure 1
Figure 1
Stillbirths per 1000 births (95% confidence intervals) in Multiple Micronutrient (MMN) and control groups in each study
Figure 2
Figure 2
Early neonatal deaths per 1000 live births (95% confidence intervals) in Multiple Micronutrient (MMN) and control groups in each study
Figure 3
Figure 3
Late neonatal deaths per 1000 children surviving the first week of life (95% confidence intervals) in Multiple Micronutrient (MMN) and control groups in each study
Figure 4
Figure 4
Random effects model forest plots for effects of MMN supplementation on stillbirths
Figure 5
Figure 5
Random effects model forest plots for effects of MMN supplementation on early neonatal deaths
Figure 6
Figure 6
Random effects model forest plots for effects of MMN supplementation on perinatal mortality
Figure 7
Figure 7
Random effects model forest plots for effects of MMN supplementation on late neonatal mortality
See this image and copyright information in PMC

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