Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation.
Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation.
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DOI：
10.1177/15648265090304s408
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发表时间：
2009-12
影响因子：
1.9
通讯作者：
Maternal Micronutrient Supplementation Study Group
中科院分区：
文献类型：
--
作者：
Fall CH;Fisher DJ;Osmond C;Margetts BM;Maternal Micronutrient Supplementation Study Group
多种微量营养素缺乏在低收入国家的妇女中很常见，可能会对妊娠结局产生不利影响。这项荟萃分析报告了在最近的随机对照试验中，主要与怀孕期间补充铁加叶酸相比，补充多种微量营养素对新生儿体型和妊娠持续时间的影响。纳入了来自孟加拉国、布基纳法索、中国、几内亚比绍、印度尼西亚、墨西哥、尼泊尔、尼日尔、巴基斯坦和津巴布韦的 12 项随机对照试验的原始数据，所有这些试验均向假定的 HIV 阴性女性提供大约 1 种多种微量营养素的推荐膳食摄入量 (RDA)。结果包括出生体重、其他出生测量数据、妊娠以及低出生体重（LBW）（< 2,500 g）、小于胎龄出生（SGA，出生体重低于每个人群内第 10 个百分位）、大于胎龄出生（LGA，出生体重高于每个人群内第 90 个百分位）和早产（< 37 周）的发生率。与对照补充（主要是铁叶酸）相比，补充多种微量营养素与平均出生体重增加（汇总估计值：+22.4 g [95% CI，8.3 至 36.4 g]；p = 0.002）、LBW 患病率降低（汇总 OR = 0.89 [95% CI，0.81 至 0.97]；p = 0.01）和 SGA 相关。出生率（汇总 OR = 0.90 [95% CI，0.82 至 0.99]；p = .03），以及 LGA 出生率的增加（汇总 OR = 1.13 [95% CI，1.00 至 1.28]；p = .04）。在大多数研究中，体重指数 (BMI) 较高的母亲对出生体重的影响更大。在汇总分析中，母亲 BMI 每增加一个单位，多种微量营养素对出生体重的积极影响就会增加 7.6 克（95% CI，1.9 至 13.3 克）（交互作用 p = 0.009）。 BMI 20 kg/m2 或以上的母亲相对于对照组的干预效果为 + 39.0 g（95% CI，+22.0 至 +56.1 g），而 BMI 低于 20 kg/m2 的母亲则为 –6.0 g（95% CI，–8.8 至 +16.8 g）。补充多种微量营养素对出生身长或头围以及妊娠持续时间没有显着影响（汇总效应：+0.17 天 [95% CI，–0.35 至 +0.70 天]；p = .51）或早产发生率（汇总 OR = 1.00 [95% CI，0.93 至 1.09]；p = .92）。与单独补充铁叶酸相比，低收入国家孕期补充多种微量营养素可导致出生体重小幅增加，低出生体重患病率降低约 10%。对于体重指数较高的女性来说，这种影响更大。
Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes. This meta-analysis reports the effects on newborn size and duration of gestation of multiple micronutrient supplementation mainly compared with iron plus folic acid during pregnancy in recent randomized, controlled trials. Original data from 12 randomized, controlled trials in Bangladesh, Burkina Faso, China, Guinea-Bissau, Indonesia, Mexico, Nepal, Niger, Pakistan, and Zimbabwe, all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients to presumed HIV-negative women, were included. Outcomes included birthweight, other birth measurements, gestation, and incidence of low birthweight (LBW) (< 2,500 g), small-for-gestational age birth (SGA, birthweight below the within-each-population 10th percentile), large-for-gestational age birth (LGA, birthweight above the within-each-population 90th percentile), and preterm delivery (< 37 weeks). Compared with control supplementation (mainly with iron–folic acid), multiple micronutrient supplementation was associated with an increase in mean birthweight (pooled estimate: +22.4 g [95% CI, 8.3 to 36.4 g]; p = .002), a reduction in the prevalence of LBW (pooled OR = 0.89 [95% CI, 0.81 to 0.97]; p = .01) and SGA birth (pooled OR = 0.90 [95% CI, 0.82 to 0.99]; p = .03), and an increase in the prevalence of LGA birth (pooled OR = 1.13 [95% CI, 1.00 to 1.28]; p = .04). In most studies, the effects on birthweight were greater in mothers with higher body mass index (BMI). In the pooled analysis, the positive effect of multiple micronutrients on birthweight increased by 7.6 g (95% CI, 1.9 to 13.3 g) per unit increase in maternal BMI (p for interaction = .009). The intervention effect relative to the control group was + 39.0 g (95% CI, +22.0 to +56.1 g) in mothers with BMI of 20 kg/m2 or higher compared with –6.0 g (95% CI, –8.8 to +16.8 g) in mothers with BMI under 20 kg/m2. There were no significant effects of multiple micronutrient supplementation on birth length or head circumference nor on the duration of gestation (pooled effect: +0.17 day [95% CI, –0.35 to +0.70 day]; p = .51) or the incidence of preterm birth (pooled OR = 1.00 [95% CI, 0.93 to 1.09]; p = .92). Compared with iron–folic acid supplementation alone, maternal supplementation with multiple micronutrients during pregnancy in low-income countries resulted in a small increase in birthweight and a reduction in the prevalence of LBW of about 10%. The effect was greater among women with higher BMI.