Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso
Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso
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DOI：
10.3945/ajcn.2008.26296
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发表时间：
2008-11-01
影响因子：
7.1
通讯作者：
Kolsteren, Patrick
中科院分区：
文献类型：
--
作者：
Roberfroid, Dominique;Huybregts, Lieven;Kolsteren, Patrick
背景：宫内发育迟缓是发展中国家儿童健康的一个主要预测指标。目的：我们测试是否给孕妇提供联合国儿童基金会/世界卫生组织/联合国大学国际多种微量营养素制剂(UNIMMAP)，而不是仅提供铁和叶酸，改善胎儿生长及其相关性。设计：在布基纳法索农村地区进行了一项意向治疗、双盲、随机对照试验，包括1426例孕妇。结果：96.3%的受试者知道妊娠结局。在调整分娩时胎龄后，UNIMMAP组的出生体重(52g；95%CI：4100；P=0.035)和出生长度(3.6 mm；95%CI：0.8，6.3；P=0.012)均显著高于对照组。UNIMMAP对出生体重和身长分布的百分位数有不同的影响：UNIMMAP组出生大胎龄儿的风险较高(OR：1.58；95%CI：1.04，2.38；P=0.03)，尽管低出生体重的风险保持不变。UNIMMAP对出生大小的影响在登记时通过母亲的体重指数进行了修正，在经产妇女和服用磺胺多辛-乙胺的妇女中可能更加重要。UNIMMAP组围产儿死亡风险略有增加(OR：1.78；95%CI：0.95，3.32；P=0.07)，这似乎主要影响初产妇女(OR：3.44；95%CI：1.1，10.7；交互作用=0.11)。需要评估由此产生的对婴儿生长和存活的益处。初产妇女可能缺乏益处和潜在危害，应进一步调查。这项试验已在临床试验中登记。GOV AS NCT00642408。AM J Clin Nutr 2008；88：1330-40。
Background: Intrauterine growth retardation is a major predictor of child health in developing countries.Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates.Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed.Results: Pregnancy outcome was known in 96.3% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMAP group (OR: 1.78; 95% CI: 0.95, 3.32; P = 0.07), and this seemed to affect mainly primiparous women (OR: 3.44; 95% CI: 1.1, 10.7; P for interaction = 0.11).Conclusions: Maternal UNIMMAP modestly but significantly increased fetal growth. The resulting benefit on infant growth and survival needs to be assessed. The possible lack of benefit and potential harm in primiparous women should be further investigated. This trial was registered at clinicaltrials. gov as NCT00642408. Am J Clin Nutr 2008; 88: 1330-40.