Is Multiple Micronutrient Supplementation More Effective Than Iron and Folic Acid?

The micronutrient intake of pregnant women may be insufficient, especially in underdeveloped countries. Thus, nutritional supplements are necessary, but some of them have proven inefficient.

Maternal nutrient deficiency has been linked to multiple pathologies in newborns, such as low birth weight. It has other serious consequences on children’s health and development as well, including growth problems, a higher risk of early mortality, cognitive deficits, poor academic performance, and even poverty.

To combat this problem, the United Nations has implemented a plan to reduce the number of infants born underweight. In particular, the World Health Organization recommends taking multimicronutrients as a prenatal supplement in several regions of the world.

A group of African researchers analyzed a UNICEF/WHO pilot program in a study entitled “Prenatal Multiple Micronutrient Supplementation Has Greater Impact on Birthweight Than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger.” In the study, they compared the effects of prenatal supplementation using a multiple micronutrient preparation with supplementation using iron/folic acid. They specifically focused on its impact on birth weight.

Where and How Did They Do This Study?

The study was designed so that all the villages covered by the local health centers in rural Niger were included. Women were eligible to participate in the study if they lived in one of the selected villages and if at least twelve weeks had passed since their last menstruation. The women were then informed of the study objectives, expectations, advantages, and difficulties when a pregnancy was confirmed. Enrollment was effective once the mothers and the husbands agreed to participate.

The participants were divided into two groups based on their geographical location. Women in one region received a multiple micronutrient preparation, and those in the other region received an iron/folic acid supplement. In each region, a traditional midwife and a data collector were trained to distribute prenatal supplements, to collect data during the entire study period (which included delivery), and to continuously monitor the participants.

A total of 3,670 pregnant women from seventy-eight villages were recruited between January 2004 and March 2005. Of the 3,670 women recruited, 1,893 received multimicronutrients and 1,777 received iron/folic acid. Baseline characteristics were similar in both groups; however, more women in the multimicronutrients group lived in larger houses and used more preventive measures against malaria. Women in the iron/folic acid group tended to be poorer and less educated.

In addition to routine monthly pregnancy checkups, the participants received a free package of reproductive health services, including malaria chemoprophylaxis and appropriate case management.

During the study, the women were interviewed in order to obtain data on their socioeconomic status, maternal age, obstetrical history, and health and diet. Maternal height and body weight were measured at every monthly checkup. The newborns were weighed as soon as possible after birth.

Conclusion

According to the results, the incidence of low birth weight was highly improved for both groups compared with the national statistics of Niger, but more importantly, the incidence of low birth weight was significantly lower in the multimicronutrients group than in the iron/folic acid group. In fact, prenatal supplementation with multimicronutrients consistently had a greater effect on mean birth weight than iron/folic acid supplementation.

It is worth noting that at least five months of prenatal supplementation is necessary to gain maximum benefit. Also, the distribution of supplements must be reinforced at the local community level to ensure good coverage and compliance.

Preventing low birth weight is a vital factor in the UN’s goal to reduce infant mortality. This study suggests that using a multiple micronutrient prenatal supplement can improve birth weight. Visit a doctor for more information about what nutritional supplements to use during pregnancy. Remember to breastfeed. Breast milk is always the best food for a baby.

Reference

Zagré, Noël M., Gwénola Desplats, Pierre Adou, Aïssa Mamadoultaibou, and Victor M. Aguayo. “Prenatal Multiple Micronutrient Supplementation Has Greater Impact on Birthweight Than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger.” Food and Nutrition Bulletin 28, no. 3 (2007): 317–327. Retrieved from http://journals.sagepub.com