Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries

DSpace/Manakin Repository

Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries

Citable link to this page

 

 
Title: Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries
Author: Smith, Emily Rose ORCID  0000-0001-5715-9459 ; Shankar, Anuraj H.; Wu, Lee S-F; Aboud, Said; Adu-Afarwuah, Seth; Ali, Hasmot; Agustina, Rina; Arifeen, Shams; Ashorn, Per; Bhutta, Zulfiqar A; Christian, Parul; Devakumar, Delanjathan; Dewey, Kathryn G; Friis, Henrik; Gomo, Exnevia; Gupta, Piyush; Kæstel, Pernille; Kolsteren, Patrick; Lanou, Hermann; Maleta, Kenneth; Mamadoultaibou, Aissa; Msamanga, Gernard; Osrin, David; Persson, Lars-Åke; Ramakrishnan, Usha; Rivera, Juan A; Rizvi, Arjumand; Sachdev, H P S; Urassa, Willy; West, Keith P; Zagre, Noel; Zeng, Lingxia; Zhu, Zhonghai; Fawzi, Wafaie W.; Sudfeld, Christopher Robert

Note: Order does not necessarily reflect citation order of authors.

Citation: Smith, Emily R, Anuraj H Shankar, Lee S-F Wu, Said Aboud, Seth Adu-Afarwuah, Hasmot Ali, Rina Agustina, et al. 2017. “Modifiers of the Effect of Maternal Multiple Micronutrient Supplementation on Stillbirth, Birth Outcomes, and Infant Mortality: a Meta-Analysis of Individual Patient Data from 17 Randomised Trials in Low-Income and Middle-Income Countries.” The Lancet Global Health 5 (11) (November): e1090–e1100. doi:10.1016/s2214-109x(17)30371-6.
Full Text & Related Files:
Abstract: Abstract

Objective To identify individual-level effect modifiers of the effect of multiple micronutrient supplementation (MMS) containing iron and folic acid (IFA) during pregnancy, compared to IFA alone, on the risk of stillbirth, infant mortality, and birth outcomes.

Methods We performed an individual patient data meta-analysis. Study-specific estimates were generated, and we pooled subgroup estimates using fixed effects models.

Findings We included 17 randomized controlled trials (including 112,953 pregnancies). MMS resulted in greater reductions in low birthweight (RR 0.81; 95% CI: 0.74–0.89), small-for-gestational age births (RR 0.91; 95% CI: 0.87–0.96), and six-month mortality (RR: 0.71; 95% CI: 0.60–0.86) among anemic (hemoglobin <110g/L) as compared with non-anemic pregnant women. MMS had a greater impact on preterm birth among underweight pregnant women (body mass index <18.5kg/m2) (RR: 0.84; 95% CI: 0.78–0.90) compared to those with BMI ≥18.5 (RR: 0.94; 95% CI 0.90–0.98) (p value heterogeneity 0.01). MMS provided significantly greater reductions in infant mortality for female (RR: 0.87; 95% CI: 0.77–0.99) as compared to male infants (RR: 1.05; 95% CI: 0.93–1.18) (p value heterogeneity 0.04). In general, the survival and birth outcome effects of MMS were greater with high adherence (≥95%) to supplementation.

Conclusion MMS produced greater birth outcome benefits for pregnant women with indicators of nutritional deficiency and improved survival for female infants.
Published Version: doi:10.1016/S2214-109X(17)30371-6
Terms of Use: This article is made available under the terms and conditions applicable to Open Access Policy Articles, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#OAP
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:34216385
Downloads of this work:

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters