Shrimpton Roger, Huffman Sandra L, Zehner Elizabeth R, Darnton-Hill Ian, Dalmiya Nita
Institute of Child Health, London, UK.
Food Nutr Bull. 2009 Dec;30(4 Suppl):S556-73. doi: 10.1177/15648265090304S410.
An independent Systematic Review Team performed a meta-analysis of 12 randomized, controlled trials comparing multiple micronutrients with daily iron-folic acid supplementation during pregnancy.
To provide an independent interpretation of the policy and program implications of the results of the meta-analysis.
A group of policy and program experts performed an independent review of the meta-analysis results, analyzing internal and external validity and drawing conclusions on the program implications.
Although iron content was often lower in the multiple micronutrient supplement than in the iron-folic acid supplement, both supplements were equally effective in tackling anemia. Community-based supplementation ensured high adherence, but some mothers still remained anemic, indicating the need to concomitantly treat infections. The small, significant increase in mean birthweight among infants of mothers receiving multiple micronutrients compared with infants of mothers receiving iron-folic acid is of similar magnitude to that produced by food supplementation during pregnancy. Larger micronutrient doses seem to produce greater impact. Meaningful improvements have also been observed in height and cognitive development of the children by 2 years of age. There were no significant differences in the rates of stillbirth, early neonatal death, or neonatal death between the supplemented groups. The nonsignificant trend toward increased early neonatal mortality observed in the groups receiving multiple micronutrients may be related to differences across trials in the rate of adolescent pregnancies, continuing iron deficiency, and/or adequacy of postpartum health care and merits further investigation.
Replacing iron-folic acid supplements with multiple micronutrient supplements in the package of health and nutrition interventions delivered to mothers during pregnancy will improve the impact of supplementation on birthweight and on child growth and development.
一个独立的系统评价团队对12项随机对照试验进行了荟萃分析，比较了孕期补充多种微量营养素与每日补充铁-叶酸的效果。
对该荟萃分析结果的政策和项目意义进行独立解读。
一组政策和项目专家对荟萃分析结果进行了独立审查，分析其内部和外部效度，并就项目意义得出结论。
尽管多种微量营养素补充剂中的铁含量通常低于铁-叶酸补充剂，但两种补充剂在治疗贫血方面同样有效。基于社区的补充剂确保了高依从性，但仍有一些母亲贫血，这表明需要同时治疗感染。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的平均出生体重有小幅但显著的增加，这与孕期补充食物所产生的增加幅度相似。更大剂量的微量营养素似乎产生更大的影响。在2岁儿童的身高和认知发育方面也观察到了有意义的改善。补充剂组之间的死产、早期新生儿死亡或新生儿死亡发生率没有显著差异。在接受多种微量营养素的组中观察到的早期新生儿死亡率增加的不显著趋势可能与各试验中青少年怀孕率、持续缺铁和/或产后医疗保健充足性的差异有关，值得进一步研究。
在孕期提供给母亲的健康和营养干预措施中，用多种微量营养素补充剂替代铁-叶酸补充剂将改善补充剂对出生体重以及儿童生长发育的影响。
