Christian Parul, West Keith P, Khatry Subarna K, Leclerq Steven C, Pradhan Elizabeth K, Katz Joanne, Shrestha Sharada Ram, Sommer Alfred
Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room 2041, Baltimore, MD 21205-2179, USA.
Am J Clin Nutr. 2003 Dec;78(6):1194-202. doi: 10.1093/ajcn/78.6.1194.
We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by approximately 15%.
We examined the effect of daily maternal micronutrient supplementation on fetal loss and infant mortality.
The study was a double-blind, cluster-randomized, controlled trial among 4926 pregnant women and their 4130 infants in rural Nepal. In addition to vitamin A (1000 microg retinol equivalents), the intervention groups received either folic acid (FA; 400 microg), FA + iron (60 mg), FA + iron + zinc (30 mg), or multiple micronutrients (MNs; the foregoing plus 10 microg vitamin D, 10 mg vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 2.2 mg vitamin B-6, 2.6 microg vitamin B-12, 100 mg vitamin C, 64 microg vitamin K, 20 mg niacin, 2 mg Cu, and 100 mg Mg). The control group received vitamin A only.
None of the supplements reduced fetal loss. Compared with control infants, infants whose mothers received FA alone or with iron or iron + zinc had a consistent pattern of 15-20% lower 3-mo mortality; this pattern was not observed with MNs. The effect on mortality was restricted to preterm infants, among whom the relative risks (RRs) were 0.36 (95% CI: 0.18, 0.75) for FA, 0.53 (0.30, 0.92) for FA + iron, 0.77 (0.45, 1.32) for FA + iron + zinc, and 0.70 (0.41, 1.17) for MNs. Among term infants, the RR for mortality was close to 1 for all supplements except MNs (RR: 1.74; 95% CI: 1.00, 3.04).
Maternal micronutrient supplementation failed to reduce overall fetal loss or early infant mortality. Among preterm infants, FA alone or with iron reduced mortality in the first 3 mo of life. MNs may increase mortality risk among term infants, but this effect needs further evaluation.
我们之前报道过，尼泊尔农村地区孕妇补充微量营养素可使低出生体重发生率降低约15%。
我们研究了孕妇每日补充微量营养素对胎儿丢失和婴儿死亡率的影响。
该研究是一项在尼泊尔农村地区针对4926名孕妇及其4130名婴儿开展的双盲、整群随机对照试验。除了维生素A（1000微克视黄醇当量）外，干预组分别接受叶酸（FA；400微克）、FA+铁（60毫克）、FA+铁+锌（30毫克）或多种微量营养素（MNs；上述营养素加10微克维生素D、10毫克维生素E、1.6毫克硫胺素、1.8毫克核黄素、2.2毫克维生素B-6、2.6微克维生素B-12、100毫克维生素C、64微克维生素K、20毫克烟酸、2毫克铜和100毫克镁）。对照组仅接受维生素A。
没有一种补充剂能降低胎儿丢失率。与对照组婴儿相比，母亲单独或与铁或铁+锌一起接受FA的婴儿，其3个月死亡率始终低15%-20%；MNs未观察到此种情况。对死亡率的影响仅限于早产儿，其中FA的相对风险（RR）为0.36（95%CI：0.18，0.75），FA+铁为0.53（0.30，0.92），FA+铁+锌为0.77（0.45，1.32），MNs为0.70（0.41，1.17）。在足月儿中，除MNs外，所有补充剂的死亡率RR均接近1（RR：1.74；95%CI：1.00，3.04）。
孕妇补充微量营养素未能降低总体胎儿丢失率或早期婴儿死亡率。在早产儿中，单独使用FA或与铁一起使用可降低出生后前3个月的死亡率。MNs可能会增加足月儿的死亡风险，但这种影响需要进一步评估。
