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Table 14 Impact of multiple micronutrient supplementation on stillbirth and perinatal mortality

From: Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews & meta-analyses
Haider and Bhutta 2006 [102] Bangladesh, Nepal, USA, Guinea-Bissau, Pakistan, Mexico.
Meta-analysis (Cochrane). 7 RCTs.
To evaluate impact of multiple-micronutrient supplements in pregnancy, including an assessment of the risk of excess supplementation and potential adverse interactions between micronutrients. PMR: RR = 1.05 (95% CI: 0.90–1.23) [NS]
[363/6050 vs. 310/5906 in intervention vs. control groups, respectively].
Rumbold et al. 2005 [87] Hungary, Nigeria, India, UK, USA, South Africa, Ireland.
Meta-analysis (Cochrane). 9 RCTs included.
Compared the impact of multiple micronutrient supplementation including folic acid vs. folic acid alone on pregnancy outcomes. SBR: (RR = 0.97 (95% CI: 0.14–6.88) [NS]
Say et al. 2003 [103] Germany.
Review (Cochrane). 1 RCT included.
Compared the impact of calf blood extract vs. placebo on pregnancy outcomes. PMR: RR = 0.19 (95% CI: 0.01–3.63) [NS]
Intervention studies
Arifeen et al. 2006 [126] Bangladesh.
RCT. Pregnant women (N = 3737) with gestational age <14 wks, haemoglobin ≥ 80 g/L. N = 1265 intervention group, N = 1248 controls.
Assessed the impact of multiple-micronutrient supplementation in reference to different dosages of iron-folate supplementation on pregnancy outcomes. PMR: RR = 0.99 (95% CI: 0.76–1.29) [NS]
[52/1224 vs. 114/2513 in intervention vs. control groups, respectively]
Czeizel et al. 1996 [127] Hungary (Budapest).
RCT, Hungarian Optimal Family Planning Programme. N = 5502.
Compared supplementation with multivitamins vs. controls given a few trace elements periconceptually on pregnancy outcome. SBR: 13.4% vs. 11.4% in intervention vs. control groups, respectively. (χ2 = 4.82, P = 0.03).
Miscarriage: 10.8% vs. 9.4% in intervention vs. control groups, respectively [NS]2 = 2.69 P = 0.10).
Fawzi et al. 2007 [105] Tanzania (Dar es Salaam).
RCT. HIV-negative pregnant women (N = 8468) 12–27 wks gestation
Assessed the impact of daily multivitamins (multiples of the RDA) vs. placebo on pregnancy outcomes. SBR: RR = 0.87 (95% CI: 0.72–1.05, P = 0.15) [NS]
[129/4069 (4.3%) vs. 148/4052 (5.0%) in intervention vs. control groups, respectively.]
Fleming et al. 1986 [128] Nigeria.
Quasi-RCT. N = 75 primigravida 10–26 wks gestation with haematocrit value (PCV) ≥ 27% who had not yet received treatment.
Assessed the impact of folic acid (5 mg) supplementation every 2 wks until the last trimester (weekly) vs. placebo on pregnancy outcomes. All women received anti-malarials and iron supplements as part of standard ANC at the hospital. SBR: RR = 0.38 (95% CI: 0.02–9.03) [NS]
[0/35 vs. 2/40 in intervention vs. control groups, respectively].
Shankar et al. 2008 [104] Indonesia (Lombok).
Cluster-RCT. 262 midwives randomly allocated to distribute multiple micronutrients (N = 15,804) or iron and folic acid (N = 15,486) to pregnant women through government ANC services.
Assessed daily antenatal administration by midwives of a multiple micronutrient supplement (intervention) or iron-folate (comparison) to pregnant women through government ANC services. Supplements were given from enrollment (at any gestation) to 90 days post partum. PMR: RR = 0.90 (95% CI: 0.79–1.03, P = 0.12)
[492/14532 (33.9/1000) vs. 535/14239 (37.6/1000) in intervention vs. comparison groups, respectively]
Fetal loss+neonatal death (undernourished mothers): RR = 0.85 (95% CI: 0.73–0.98, P = 0.022)
Fetal loss+neonatal death (anaemic mothers):
RR = 0.71 (95% CI: 0.58–0.87, P = 0.001)
SBR: RR = 0.90 (95% CI: 0.75–1.08) [NS]
[245/14618 (16.8) vs. 268/14321 (18.7) in intervention vs. comparison groups, respectively]
Zagre et al. 2007 [129] Niger (Maradi). Rural setting.
Cluster-RCT. 78 villages.
To assess the effects of prenatal supplementation with UNIMMAP (United Nations International Multiple Micronutrient Preparation) compared to iron/folic acid (controls) on pregnancy outcomes. SBR (unpublished data): OR = 1.18 (95% CI = 0.79–1.77) [NS].
[57/1521 vs. 44/1381 in intervention vs. control groups, respectively].
Friis et al. 2004 [130] Zimbabwe (Harare). ANC clinics.
RCT effectiveness trial. N = 1669 pregnant women 22–35 wks gestation (birth data available for N = 1106, of whom 360 (33%) had HIV infection).
Compared the impact of daily multiple micronutrient supplementation to placebo on pregnancy outcomes. All women received iron-folate through standard ANC. SBR: [NS]
[4/564 (0.7%) vs. 7/542 (1.3%) in intervention vs. control groups, respectively, P = 0.39].