Bhutta Zulfiqar A, Rizvi Arjumand, Raza Farrukh, Hotwani Sunil, Zaidi Shujaat, Moazzam Hossain S, Soofi Sajid, Bhutta Shereen
The Aga Khan University, Karachi, Pakistan.
Food Nutr Bull. 2009 Dec;30(4 Suppl):S496-505. doi: 10.1177/15648265090304S404.
Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation. Intervention strategies largely consist of administration of iron-folic acid supplements during pregnancy.
We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-randomized design.
We randomly assigned 2378 pregnant women to receive either iron-folic acid or multiple micronutrient supplements. The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers.
The women in both groups consumed about 75% of the supplements provided, and few reported adverse effects such as vomiting, abdominal pain, etc. There was a small (70 g) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron-folic acid supplements (2.95 +/- 0.6 vs. 2.88 +/- 0.5 kg, p = .01). This translated into a 10% reduction (p < 0.17) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients. Although stillbirth rates were comparable in the two groups, the early neonatal mortality rate in the group receiving multiple micronutrients was higher, although not significantly, than that in the group receiving iron-folic acid (43.2 vs. 23.5 deaths per 1000 live births; RR = 1.64; 95% CI, 0.94 to 2.87). Comparable reductions in anemia (hemoglobin < 11 g/dL) were observed, although the proportion with low iron stores (assessed by serum ferritin) was lower in the iron-folic acid group in the postnatal period. Although the proportion of women with subclinical vitamin A deficiency after supplementation did not differ between the two groups, the iron-folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period.
These data suggest that multiple micronutrient supplements are well tolerated during pregnancy, but the effect on birthweight is modest. The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system settings.
孕产妇微量营养素缺乏在巴基斯坦普遍存在，可能与孕产妇营养不足和宫内生长迟缓有关。干预策略主要包括孕期补充铁叶酸。
我们通过整群随机设计，评估了在信德省农村和城市的一组孕妇中补充多种微量营养素的可接受性及其对妊娠结局和孕产妇微量营养素状况的潜在益处。
我们将2378名孕妇随机分为两组，分别接受铁叶酸或多种微量营养素补充剂。社区卫生工作者每两周进行一次家访，发放补充剂，评估耐受性并观察母亲情况。
两组妇女服用了约75%提供的补充剂，很少有人报告有呕吐、腹痛等不良反应。与接受铁叶酸补充剂的母亲所生婴儿相比，接受多种微量营养素的母亲所生婴儿出生体重有小幅（70克）但显著增加（2.95±0.6 vs. 2.88±0.5千克，p = 0.01）。这使得接受多种微量营养素的母亲所生婴儿中低出生体重婴儿的比例降低了10%（p < 0.17）。尽管两组死产率相当，但接受多种微量营养素的组早期新生儿死亡率高于接受铁叶酸的组，虽不显著（每1000例活产中分别为43.2例和23.5例死亡；RR = 1.64；95%CI，0.94至2.87）。观察到贫血（血红蛋白<11克/分升）有类似程度的降低，尽管产后铁储备低（通过血清铁蛋白评估）的比例在铁叶酸组较低。尽管补充后两组亚临床维生素A缺乏妇女的比例没有差异，但产后即刻铁叶酸组血清锌水平较低的妇女比例较高。
这些数据表明，孕期补充多种微量营养素耐受性良好，但对出生体重的影响不大。观察到的对早期新生儿死亡率的影响表明需要进一步研究，并在卫生系统环境中对该干预措施进行仔细评估。
