Written by Jessica Patella, ND. In a study including 4436 pregnant women in Bangladesh, early use of a multivitamin reduced infant mortality by 62% and five year mortality by 67%.
An estimated 3.5 million deaths occur worldwide each year due to undernutrition (1,2). Long-term effects of undernutrition in early life can result in cognitive impairment and chronic illness later in life (1,3,4). For the first time, research has shown that supplementing with food and vitamins in pregnant women can decrease childhood mortality (1).
In many areas of the world, malnourishment in women and children remains high, especially in Southern Asia, where 25% of newborns are underweight (1, 5). A recent study was conducted in rural Bangladesh to determine if supplements taken by pregnant women would have an effect on fetal outcome.
The study involved 4436 pregnant women who were randomly assigned to one of the following groups:
| Group | Supplementation Type | Number of Participants |
|---|---|---|
| Early intervention* low dose | 30 mg iron and 400 micrograms folic acid | 739 |
| Early intervention high dose | 60 mg iron and 400 micrograms of folic acid | 738 |
| Early intervention with multivitamin | 30 mg iron and 400 micrograms of folic acid plus 15 other nutrients** | 740 |
| Usual intervention*** low dose | 30 mg iron and 400 micrograms folic acid | 741 |
| Usual intervention high dose | 60 mg iron and 400 micrograms of folic acid | 738 |
| Usual intervention with multivitamin | 30 mg iron and 400 micrograms of folic acid plus 15 other nutrients | 740 |
*Early intervention occurred at 9 weeks gestation, when the pregnancy was confirmed.
**The 15 other nutrients included vitamins A, D, E, C B1, B2, B6, B12, zinc, copper, selenium and iodine.
***Usual intervention occurred at 20 weeks gestation.
All groups also received a rice powder food supplementation (608 kcal, 6 days per week) (1).
Overall, there were 3625 live births with 40% receiving skilled assistance at delivery. Those that did not receive skilled assistance at delivery had trained paramedics conduct birth measurements within 72 hours of the birth (1). A total of 845 women were lost to follow-up, 19% before birth with 10% due to fetal loss, 4% due to migration out of the area and 3% refusal to participate mostly due to religious reasons (1). Community health research workers detected and recorded death through monthly household visits. (1).
The average birth weight was 5.9 pounds, with 31% of newborns weighing less than 5.5 pounds (1). There were no significant differences in birth weight among the treatment groups. The average gestational age was 39.1 +/- 2.3 weeks without any significant difference between groups.
Infant mortality rate and under 5-year mortality rate in the early intervention multivitamin group showed decreased mortality in the infants (16.8 and 18.0 deaths per 1000 births, respectively) compared to the usual intervention (44.1 and 54.0 deaths per 1000 births, respectively) (1).
The usual care intervention (intervention at 20 weeks with multivitamin) had the highest infant mortality rate (47.1 per 1000 births), highest occurrence of spontaneous abortion or miscarriage (n=50, RR 1.59, 95% CI 1.02-2.47) and the largest number of deaths due to asphyxia (14 per 595 live births, 7 times higher than early intervention with multivitamin (2 per 595 live births) (1).
In conclusion, early intervention with food and multivitamin supplementation at around 9 weeks gestational age decreased infant mortality rate and infant mortality over a 5-year period (1). Therefore, increasing nutrient supplementation in areas with poor dietary intake in early pregnancy may decrease the risk of infant loss (1). The effect of timing prenatal food and vitamin supplementation on infant survival has not been studied before in human trials and should be repeated to confirm results (1).
Source: Persson, Lars Åke, et al. “Effects of prenatal micronutrient and early food supplementation on maternal hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial.” Jama 307.19 (2012): 2050-2059.
© 2012 American Medical Association. All rights reserved
Posted February 10, 2015.
Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health. She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at www.awarenesswellness.com.
References:
- Persson LA, et al. Effects of Prenatal Micronutrient and Early Food Supplementation on Maternal Hemoglobin, Birth Weight, and Infant Mortality Among Children in Bangladesh. JAMA 2012; 307; 19: 2050-2059.
- Black RE, et al. Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371 (9608): 243-260.
- Grantham-McGregor S, et al. International Child Development Steering Group. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007; 369 (9555): 60-70.
- Prentice AM, Moore SE. Early programming of adult diseases in poor countries. Arch Dis Child. 2005; 90(4): 429-432.
- The State of the World’s Children 2011. New York, NY UNICEF, 2011.
