Osrin David, Vaidya Anjana, Shrestha Yagya, Baniya Ram Bahadur, Manandhar Dharma S, Adhikari Ramesh K, Filteau Suzanne, Tomkins Andrew, Costello Anthony M de L
International Perinatal Care Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
Lancet. 2005;365(9463):955-62. doi: 10.1016/S0140-6736(05)71084-9.
Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years, and low birthweight is a crucial underlying factor. We tested the hypotheses that antenatal multiple micronutrient supplementation would increase infant birthweight and gestational duration.
We did a double-blind, randomised controlled trial in Dhanusha district, Nepal. Women attending for antenatal care with singleton pregnancies at up to 20 weeks' gestation were invited to participate. Participants were randomly allocated either routine iron and folic acid supplements (control; n=600) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals (intervention; n=600). Supplementation began at a minimum of 12 weeks' gestation and continued until delivery. Primary outcome measures were birthweight and gestational duration. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN88625934.
Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group. Mean birthweight was 2733 g (SD 422) in the control group and 2810 g (453) in the intervention group, representing a mean difference of 77 g (95% CI 24-130; p=0.004) and a relative fall in the proportion of low birthweight by 25%. No difference was recorded in the duration of gestation (0.2 weeks [-0.1 to 0.4]; p=0.12), infant length (0.3 cm [-0.1 to 0.6]; p=0.16), or head circumference (0.2 cm [-0.1 to 0.4]; p=0.18).
In a poor community in Nepal, consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a standard iron and folic acid preparation. The effects on perinatal morbidity and mortality need further comparisons between studies. Published online March 3, 2005 http://image.thelancet.com/extras/04art11045web.pdf.
新生儿死亡率是全球5岁以下儿童死亡的最大原因，低出生体重是一个关键的潜在因素。我们检验了产前补充多种微量营养素会增加婴儿出生体重和孕周的假设。
我们在尼泊尔的达努沙区进行了一项双盲随机对照试验。邀请妊娠20周以内的单胎妊娠且前来接受产前护理的妇女参与。参与者被随机分配接受常规铁和叶酸补充剂（对照组；n = 600）或提供15种维生素和矿物质推荐每日摄入量的多种微量营养素补充剂（干预组；n = 600）。补充从妊娠至少12周开始，持续至分娩。主要结局指标是出生体重和孕周。分析采用意向性分析。该研究注册为国际标准随机对照试验，编号为ISRCTN88625934。
对照组600名婴儿中有523名的出生体重数据可得，干预组600名中有529名。对照组的平均出生体重为2733 g（标准差422），干预组为2810 g（453），平均差异为77 g（95%置信区间24 - 130；p = 0.004）且低出生体重比例相对下降25%。孕周（0.2周[-0.1至0.4]；p = 0.12）、婴儿身长（0.3 cm[-0.1至0.6]；p = 0.16）或头围（0.2 cm[-0.1至0.4]；p = 0.18）均未记录到差异。
在尼泊尔的一个贫困社区，与标准铁和叶酸制剂相比，在妊娠中期和晚期每日食用含15种微量营养素推荐每日摄入量的补充剂与出生体重增加有关。对围产期发病率和死亡率的影响需要在不同研究间进一步比较。2005年3月3日在线发表http://image.thelancet.com/extras/04art11045web.pdf 。
