Effect of multimicronutrient supplementation on gestational length and birth size: a randomized, placebo-controlled, double-blind effectiveness trial in Zimbabwe

Abstract

Background: Multiple micronutrient deficiencies may contribute to low birth weight, which is a major global determinant of mortality. Objective: We assessed the effect of prenatal multimicronutrient supplementation on gestational length and birth size. Design: We conducted a randomized, placebo-controlled, double-blind effectiveness trial among antenatal care attendees in Harare, Zimbabwe. Pregnant women (22–35 wk of gestation) were randomly allocated to receive a multimicronutrient or placebo supplement daily until delivery. Supplementation with iron and folic acid was part of antenatal care. Results: Of 1669 women, birth data were available from 1106 (66%), of whom 360 (33%) had HIV infection. The mean gestational length was 39.1 wk, and 16.6% of the women had a gestational length < 37 wk. The mean birth weight was 3030 g, and 10.5% of the infants had a birth weight < 2500 g. Multimicronutrient supplementation was associated with tendencies for increased gestational length (0.3 wk; 95% CI: −0.04, 0.6 wk; P = 0.06), birth weight (49 g; −6, 104 g; P = 0.08), and head circumference (0.2 cm; −0.02, 0.4 cm; P = 0.07) but was not associated with low birth weight (birth weight < 2500 g) (relative risk: 0.84; 0.59, 1.18; P = 0.31). The effect of multimicronutrient supplementation on birth weight was not significantly different between HIV-uninfected (26 g; −38, 91 g) and HIV-infected (101 g; −3, 205 g) subjects (interaction, P > 0.10). Conclusion: Antenatal multimicronutrient supplementation may be one strategy to increase birth size.