Micronutrient Supplementation In Impoverished Area Reduced Adverse Pregnancy Outcomes

Keith P. West, Jr., Dr.P.H., R.D. Professor and Director Program and Center in Human Nutrition Department of International Health Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland 21205 MedicalResearch.com Interview with:
Keith P. West, Jr., Dr.P.H., R.D.
Professor and Director
Program and Center in Human Nutrition
Department of International Health
Bloomberg School of Public Health
Johns Hopkins University Baltimore, Maryland 21205

Medical Research: What is the background for this study? What are the main findings?

Dr. West: Deficiencies in vitamins and minerals (micronutrients) that must be provided by the diet, are a major public health concern in undernourished societies. In rural South Asia, where some 35 million babies are born each year, maternal micronutrient deficiencies are common and may increase risk of adverse pregnancy outcomes such as preterm birth, low birth weight or stillbirth and infant mortality. Further, a newborn of low birth weight faces higher risks of poor postnatal growth, infection and mortality. Where prenatal care exists, iron-folic acid supplements are often prescribed as standard care to prevent iron deficiency anemia. But it is likely that many micronutrient deficiencies emerge from an inadequate diet, raising the possibility that a supplement that provides each day a recommended dietary allowance of most essential vitamins and minerals could measurably improve the health of the mother, fetus and infant. Because prenatal multinutrient supplements are rarely taken in low income countries, it is important to assess their potential to improve health before recommending this practice. We did this be conducting a large prenatal supplementation trial in rural Bangladesh, randomizing 44,567 pregnant women in their 1st trimester to receive a supplement with 15 vitamins and minerals or only iron and folic acid, followed their pregnancies and survival of their 28,516 infants to 6 months of age.

Medical Research: What are the main findings?

Dr. West: The multiple micronutrient supplement had the effect of extending the length of gestation compared to the iron-folic acid supplement, by about 2 days on average. This was enough to lower risk of preterm birth, below 37 weeks, by 15%. The extra time in the womb also allowed the fetus to grow a little larger, increasing birth weight (by 54 grams or about 2 ounces) as well as length and other measures of size, leading to a 12% reduction in low birth weight. In addition, there was an 11% reduction in risk of stillbirth. These are all indications of a healthier pregnancy. Although we observed a 14% lower mortality from all causes in girls, there was not a similar effect in boys, leading to no overall effect. We are continuing to investigate possible reasons for this difference.

Medical Research: What should clinicians and patients take away from your report?

Dr. West: The findings of this study are most relevant to doctors and the 35 million pregnant women who give birth each year in South Asia, where dietary deficiencies may adversely affect the health of the mother and infant. In this region, where iron-folic acid supplement use is the norm, a multiple micronutrient supplement taken daily from early pregnancy on may do a better job in keeping the baby healthy. However, women, everywhere, should be eating a nutritionally balanced diet during pregnancy, starting as early as possible to give their the best chance possible.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. West: There is a need to discover the effects of preconceptional nutrient deficiencies on pregnancy health. Also, micronutrient deficiencies have been labeled “hidden hunger” because they are expensive to measure and thus rarely evaluated. There is a need for less expensive, widely used methods to better understand the breadth and severity of these nutrient deficiencies in high risk populations, to better inform prevention and nutrition care to protect mothers and their infants.

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