Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Am J Clin Nutr. 2021 Nov 8;114(5):1708-1718. doi: 10.1093/ajcn/nqab234.
Prenatal nutrition interventions can lead to improved birth outcomes, which in turn are associated with better education and human capital outcomes later in life.
We estimated the impact of scaling up iron-folic acid (IFA), calcium, multiple micronutrient (MMS), and balanced energy protein (BEP) supplementation for pregnant women, on human capital outcomes in low- and middle-income countries (LMIC).
We used mathematical modeling with proportional reductions in adverse birth outcomes to estimate the potential gains in school years and lifetime income due to scaling up each prenatal nutrition intervention. Estimates of intervention effects on birth outcomes were derived from meta-analyses of randomized trials. Estimates of the associations between birth outcomes and schooling and lifetime income were derived from de novo meta-analyses of observational studies.
Across 132 LMIC, scaling up prenatal nutrition interventions to 90% coverage was estimated to increase school years and lifetime income per birth cohort by: 2.28 million y (95% uncertainty intervals (UI): -0.44, 6.26) and $8.26 billion (95% UI: -1.60, 22.4) for IFA; 4.08 million y (95% UI: 0.12, 9.68) and $18.9 billion (95% UI: 0.59, 44.6) for calcium; 5.02 million y (95% UI: 1.07, 11.0) and $18.1 billion (95% UI: 3.88, 39.1) for MMS; and 0.53 million y (95% UI: -0.49, 1.70) and $1.34 billion (95% UI: -1.10, 3.10 billion) for BEP supplementation. South Asia and Sub-Saharan Africa tended to have the largest estimated regional gains in school years for scaling up each intervention due to the large population size and high burden of poor birth outcomes. Absolute income benefits for each intervention were estimated to be the largest in Latin America, where returns to education and incomes are higher relative to other regions.
Increasing coverage of prenatal nutrition interventions in LMIC may lead to substantial gains in schooling and lifetime income. Decision makers should consider the potential long-term human capital returns of investments in maternal nutrition.
产前营养干预可改善出生结局，而出生结局的改善又与儿童后期的受教育程度和人力资本状况相关。
我们旨在评估扩大铁叶酸（IFA）、钙、多种微量营养素（MMS）和均衡能量蛋白质（BEP）补充剂在中低收入国家（LMIC）中用于孕妇的规模，对人力资本结局的影响。
我们使用比例减少不良出生结局的数学模型，来估计扩大每种产前营养干预措施可获得的在校年限和终生收入的增加量。干预措施对出生结局的影响估计值源自随机试验的荟萃分析。出生结局与受教育程度和终生收入之间的关联估计值源自观察性研究的全新荟萃分析。
在 132 个 LMIC 中，估计扩大产前营养干预措施至 90%的覆盖率，将使每个出生队列的在校年限和终生收入增加：IFA 为 228 万 y（95%不确定性区间（UI）：-0.44，6.26）和 82.6 亿美元（95% UI：-16.0，224.0）；钙为 408 万 y（95% UI：0.12，9.68）和 189 亿美元（95% UI：0.59，446.0）；MMS 为 502 万 y（95% UI：1.07，11.0）和 181 亿美元（95% UI：3.88，391.0）；BEP 补充剂为 53 万 y（95% UI：-0.49，170.0）和 13.4 亿美元（95% UI：-11.0，310.0）。由于人口规模大和不良出生结局负担重，扩大每个干预措施在南亚和撒哈拉以南非洲的地区预计会获得最大的在校年限增加。估计每个干预措施的绝对收入收益在拉丁美洲最大，因为与其他地区相比，教育和收入的回报更高。
扩大 LMIC 中产前营养干预措施的覆盖率，可能会使受教育程度和终生收入获得大幅提高。决策者应考虑对孕产妇营养投资的潜在长期人力资本回报。
