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      Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis

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          Abstract

          Background

          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.

          Methods

          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.

          Results

          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.

          Conclusions

          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.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12916-016-0633-3) contains supplementary material, which is available to authorized users.

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          Most cited references 72

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          Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

          The Lancet, 382(9890), 452-477
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            Standardisation of spirometry.

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              Fetal origins of coronary heart disease.

              The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.
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                Author and article information

                Contributors
                +44 (0)20 7905 2122 , +44 (0)20 7404 2062 , d.devakumar@ucl.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                16 June 2016
                16 June 2016
                2016
                : 14
                Affiliations
                [ ]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
                [ ]Pediatrics and Clinical Epidemiology at Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi, India
                [ ]Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
                [ ]Childhood Nutrition Research Centre, Institute of Child Health, University College London, 30 Guilford St, London, UK
                Article
                633
                10.1186/s12916-016-0633-3
                4910255
                27306908
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Wellcome Trust (GB)
                Award ID: 091561/Z/10/Z
                Award Recipient :
                Funded by: Sitaram Bhartia Institute of Science and Research
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100000659, Research Trainees Coordinating Centre;
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100000278, Department for International Development;
                Funded by: Medical Research Council (GB)
                Funded by: Department for International Development (GB)
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine

                child, micronutrients, prenatal exposure delayed effects

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