Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial
Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial
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DOI：
10.1136/bmj.326.7389.571
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发表时间：
2003-03-15
影响因子：
105.7
通讯作者：
West, KP
中科院分区：
文献类型：
--
作者：
Christian, P;Khatry, SK;West, KP
目的探讨孕妇每日补充叶酸、叶酸铁、叶酸-铁-锌或多种微量营养素与维生素A的关系。设计双盲整群随机对照试验，研究对象为尼泊尔东南部农村社区4926名孕妇和4130名活产婴儿。干预426个社区随机分为5组，孕妇每日补充叶酸、叶酸铁、叶酸-铁-锌或多种微量营养素，同时补充维生素A或单独补充维生素A(对照组)。主要指标为出生后72小时内的出生体重、身长、头围和胸围。低出生体重被定义为2500克。结果仅补充母亲叶酸对出生大小没有影响。叶酸铁使平均出生体重增加37克(95%可信区间-16克至90克)，低出生体重儿的百分比(<；2500克)从43%降至34%(16%；相对危险度=0.84，0.72至0.99)。与对照组相比，叶酸-铁-锌对新生儿出生大小没有影响。补充多种微量营养素可增加新生儿出生体重(12g~115g)，降低低出生体重儿百分率14%(0.86，0.74~0.99)。所有的补充剂组合都不能降低早产的发生率。结论产前补充叶酸铁可适度降低低出生体重儿的风险。与叶酸铁相比，多种微量营养素在降低这种风险方面没有额外的好处。
Objective To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women.Design Double blind cluster randomised controlled trial.Setting Rural community in south eastern Nepal.Participants 4926 pregnant women and 4130 live born infants.Interventions 426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control).Main outcome measures Birth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined < 2500 g.Results Supplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval - 16 g to 90 g) and reduced the percentage of low birthweight babies (< 2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length.Conclusions Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk.