Devakumar Delan, Fall Caroline H D, Sachdev Harshpal Singh, Margetts Barrie M, Osmond Clive, Wells Jonathan C K, Costello Anthony, Osrin David
Institute for Global Health, University College London, 30 Guilford St, London, UK.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
BMC Med. 2016 Jun 16;14:90. doi: 10.1186/s12916-016-0633-3.
Multiple micronutrient supplementation for pregnant women reduces low birth weight and has been recommended in low- and middle-income countries (LMICs) to improve child survival, growth and health. We aimed to review the evidence from long-term follow-up studies of multiple micronutrient supplementation beginning in the later first or second trimester.
We searched systematically for follow-up reports from all trials in a 2015 Cochrane review of multiple micronutrient supplementation in pregnancy. The intervention comprised three or more micronutrients and the comparison group received iron (60 mg) and folic acid (400 μg), where possible. Median gestation of commencement varied from 9 to 23 weeks. Primary outcomes were offspring mortality, height, weight and head circumference, presented as unadjusted differences in means or proportions (intervention minus control). Secondary outcomes included other anthropometry, body composition, blood pressure, and cognitive and lung function.
We found 20 follow-up reports from nine trials (including 88,057 women recruited), six of which used the UNIMMAP supplement designed to provide recommended daily allowances. The age of follow-up ranged from 0 to 9 years. Data for mortality estimates were available from all trials. Meta-analysis showed no difference in mortality (risk difference -0.05 per 1000 livebirths; 95 % CI, -5.25 to 5.15). Six trials investigated anthropometry and found no difference at follow-up in weight-for-age z score (0.02; 95 % CI, -0.03 to 0.07), height-for-age z score (0.01; 95 % CI, -0.04 to 0.06), or head circumference (0.11 cm; 95 % CI, -0.03 to 0.26). No differences were seen in body composition, blood pressure, or respiratory outcomes. No consistent differences were seen in cognitive function scores.
There is currently no evidence that, compared with iron and folic acid supplementation, routine maternal antenatal multiple micronutrient supplementation improves childhood survival, growth, body composition, blood pressure, respiratory or cognitive outcomes.
孕妇补充多种微量营养素可降低低体重儿出生率，低收入和中等收入国家（LMICs）已推荐采用该方法来改善儿童生存、生长和健康状况。我们旨在回顾从孕早期晚期或孕中期开始补充多种微量营养素的长期随访研究证据。
我们系统检索了2015年Cochrane关于孕期补充多种微量营养素的综述中所有试验的随访报告。干预措施包括三种或更多种微量营养素，对照组尽可能接受铁（60毫克）和叶酸（400微克）。开始补充的中位孕周为9至23周。主要结局为子代死亡率、身高、体重和头围，以均值或比例的未调整差异表示（干预组减去对照组）。次要结局包括其他人体测量指标、身体成分、血压以及认知和肺功能。
我们从9项试验中找到了20份随访报告（包括招募的88,057名女性），其中6项试验使用了旨在提供推荐每日摄入量的UNIMMAP补充剂。随访年龄范围为0至9岁。所有试验均有死亡率估计数据。荟萃分析显示死亡率无差异（风险差异为每1000例活产儿-0.05；95%可信区间，-5.25至5.15）。6项试验研究了人体测量指标，发现随访时年龄别体重Z评分（0.02；95%可信区间，-0.03至0.07）、年龄别身高Z评分（0.01；95%可信区间，-0.04至0.06）或头围（0.11厘米；95%可信区间，-0.03至0.26）均无差异。身体成分、血压或呼吸结局方面未见差异。认知功能评分方面未见一致差异。
目前没有证据表明，与补充铁和叶酸相比，常规孕期母亲补充多种微量营养素可改善儿童生存、生长、身体成分、血压、呼吸或认知结局。
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