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Meta-Analysis
. 2020 Feb 14;12(2):491.
doi: 10.3390/nu12020491.

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Christina Oh  1 , Emily C Keats  1 , Zulfiqar A Bhutta  1   2
Affiliations
Meta-Analysis

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Christina Oh et al. Nutrients. .

Abstract

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

Keywords: developing countries; micronutrient supplementation; pregnancy; vitamin supplementation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot for comparison vitamin A supplementation versus placebo/no vitamin A baseline to post-intervention for maternal serum/plasma retinol concentration (umol/L).
Figure 3
Figure 3
Forest plot for comparison zinc supplementation versus placebo/no zinc from baseline to post-intervention for maternal serum/plasma zinc concentration (umol/L).
Figure 4
Figure 4
Forest plot for comparison iron supplementation versus placebo/no iron from baseline to post-intervention on the risk of maternal anemia.
Figure 5
Figure 5
Forest plot for comparison iron supplementation versus placebo/no iron from baseline to post-intervention on the risk of low birthweight infants.
Figure 6
Figure 6
Forest plot for comparison vitamin D supplementation versus placebo/no vitamin D on the risk of preterm births.
Figure 7
Figure 7
Forest plot for comparison calcium supplementation versus no calcium/placebo on the risk of pre-eclampsia/eclampsia in mothers during pregnancy.
Figure 8
Figure 8
Forest plot of comparison Iron-Folic Acid (IFA) versus Folic Acid (FA) supplementation/placebo, from baseline to post-intervention on the risk of maternal anemia.
Figure 9
Figure 9
Forest plot of comparison IFA versus FA supplementation/placebo, from baseline to post-intervention on the risk of low birthweight infants.
Figure 10
Figure 10
Forest plot of comparison MMN versus IFA supplementation, from baseline to post-intervention, on the risk of low birthweight infants.
Figure 11
Figure 11
Forest plot of comparison MMN versus IFA supplementation, from baseline to post-intervention, on the risk of stillbirths.
Figure 12
Figure 12
Forest plot of comparison MMN versus IFA supplementation, from baseline to post-intervention, on the risk of small-for-gestational-age (SGA) infants.
Figure 13
Figure 13
Forest plot of comparison MMN versus IFA supplementation, from baseline to post-intervention, on the risk of diarrhea in children.
Figure 14
Figure 14
Forest plot of MMN versus IFA supplementation, a subgroup analysis of the risk of low birthweight infants by multiple micronutrient formulation (UNIMMAP versus adapted-UNIMMAP versus non-UNNIMAP).
Figure 15
Figure 15
Forest plot for comparison LNS supplementation versus MMN from baseline to post-intervention for the risk of small-for-gestational age infants.
See this image and copyright information in PMC

References

    1. Black R.E., Victora C.G., Walker S.P., Bhutta Z.A., Christian P., de Onis M., Ezzati M., Grantham-McGregor S., Katz J., Martorell R., et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–451. doi: 10.1016/S0140-6736(13)60937-X. - DOI - PubMed
    1. Darnton-Hill I., Mkparu U.C. Micronutrients in pregnancy in low- and middle-income countries. Nutrients. 2015;7:1744–1768. doi: 10.3390/nu7031744. - DOI - PMC - PubMed
    1. WHO . Vitamin and Mineral Requirements in Human Nutrition. Joint FAO/WHO Expert Consultation on Human Vitamin and Mineral Requirements. World Health Organization; Geneva, Switzerland: 2004.
    1. Bailey R.L., West K.P., Jr., Black R.E. The epidemiology of global micronutrient deficiencies. Ann. Nutr. Metab. 2015;66(Suppl. 2):22–33. doi: 10.1159/000371618. - DOI - PubMed
    1. FAO. IFAD. WHO. WFP. UNICEF . The State of Food Security and Nutrition in the World 2019. Safeguarding against Economic Slowdowns and Downturns. FAO; Rome, Italy: 2019.

MeSH terms