The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data
Background Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | Inglés |
| Published: |
Elsevier
2025
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/172863 |
| _version_ | 1855530180054876160 |
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| author | Wang, Dongqing Liu, Enju Perumal, Nandita Partap, Uttara Cliffer, Ilana R. Costa, Janaína Calu Wang, Molin Fawzi, Wafaie W. Adu-Afarwuah, Seth Ashorn, Per Ashorn, Ulla Mridha, Malay Kanti Arifeen, Shams Bhutta, Zulfiqar A. Cheng, Yue Christian, Parul Costello, Anthony M. Dewey, Kathryn G. Friis, Henrik Gomo, Exnevia Grais, Rebecca Guindo, Ousmane Krebs, Nancy F. Huybregts, Lieven Isanaka, Sheila Lachat, Carl Lartey, Anna LeClerq, Steven C. Maleta, Kenneth Manandhar, Dharma S. Martorell, Reynaldo Matias, Susana L. McClure, Elizabeth M. Moore, Sophie E. Osrin, David Urassa, Willy Pembe, Andrea B. Prentice, Andrew M. Ramakrishnan, Usha Rivera, Juan Rizvi, Arjumand Roberfroid, Dominique Shamim, Abu Ahmed Soofi, Sajid Schulze, Kerry West Jr., Keith P. Wu, Lee Zeng, Lingxia Zhu, Zhonghai |
| author_browse | Adu-Afarwuah, Seth Arifeen, Shams Ashorn, Per Ashorn, Ulla Bhutta, Zulfiqar A. Cheng, Yue Christian, Parul Cliffer, Ilana R. Costa, Janaína Calu Costello, Anthony M. Dewey, Kathryn G. Fawzi, Wafaie W. Friis, Henrik Gomo, Exnevia Grais, Rebecca Guindo, Ousmane Huybregts, Lieven Isanaka, Sheila Krebs, Nancy F. Lachat, Carl Lartey, Anna LeClerq, Steven C. Liu, Enju Maleta, Kenneth Manandhar, Dharma S. Martorell, Reynaldo Matias, Susana L. McClure, Elizabeth M. Moore, Sophie E. Mridha, Malay Kanti Osrin, David Partap, Uttara Pembe, Andrea B. Perumal, Nandita Prentice, Andrew M. Ramakrishnan, Usha Rivera, Juan Rizvi, Arjumand Roberfroid, Dominique Schulze, Kerry Shamim, Abu Ahmed Soofi, Sajid Urassa, Willy Wang, Dongqing Wang, Molin West Jr., Keith P. Wu, Lee Zeng, Lingxia Zhu, Zhonghai |
| author_facet | Wang, Dongqing Liu, Enju Perumal, Nandita Partap, Uttara Cliffer, Ilana R. Costa, Janaína Calu Wang, Molin Fawzi, Wafaie W. Adu-Afarwuah, Seth Ashorn, Per Ashorn, Ulla Mridha, Malay Kanti Arifeen, Shams Bhutta, Zulfiqar A. Cheng, Yue Christian, Parul Costello, Anthony M. Dewey, Kathryn G. Friis, Henrik Gomo, Exnevia Grais, Rebecca Guindo, Ousmane Krebs, Nancy F. Huybregts, Lieven Isanaka, Sheila Lachat, Carl Lartey, Anna LeClerq, Steven C. Maleta, Kenneth Manandhar, Dharma S. Martorell, Reynaldo Matias, Susana L. McClure, Elizabeth M. Moore, Sophie E. Osrin, David Urassa, Willy Pembe, Andrea B. Prentice, Andrew M. Ramakrishnan, Usha Rivera, Juan Rizvi, Arjumand Roberfroid, Dominique Shamim, Abu Ahmed Soofi, Sajid Schulze, Kerry West Jr., Keith P. Wu, Lee Zeng, Lingxia Zhu, Zhonghai |
| author_sort | Wang, Dongqing |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background
Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which are currently unknown.
Methods
In this meta-analysis, individual participant data from randomised controlled trials of MMS and randomised controlled trials of SQ-LNS in low-income and middle-income countries were used. We systematically searched the literature using PubMed, Embase, and Web of Science to identify randomised controlled trials of prenatal nutritional supplementation using MMS or SQ-LNS among pregnant people published between Jan 1, 2000, and Dec 31, 2021. Studies were excluded if they were conducted exclusively among participants selected by pre-existing health conditions, such as anaemia status, HIV infection, or diabetes. We contacted the corresponding authors of all identified studies to seek data contribution. As individual participant data became available, we mapped relevant variables and harmonised the data across studies. Iron and folic acid supplementation was the control group in most studies. Newborns were classified into ten groups through the combinations of preterm or term birth, small, appropriate, and large for gestational age, and low birthweight (LBW) or non-LBW. Newborns were also analysed using a four-group categorisation of preterm or term and LBW or non-LBW. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses.
Findings
14 randomised controlled trials of MMS (n=42 618; the mean maternal age at study enrolment was 24·3 years [SD 5.6]; 22 086 [51·8%] male neonates and 20 532 [48·2%] female neonates) and four randomised controlled trials of SQ-LNS (n=6246; the mean maternal age at study enrolment was 23·3 years [SD 5·3]; 3137 [50·2%] male neonates and 3109 [49·8%] female neonates) were used. In the ten-group categorisation of small vulnerable newborns, prenatal MMS reduced the risk of preterm–small for gestational age (SGA)–LBW (RR 0·73, 95% CI 0·64–0·84; p=0·0003); preterm–appropriate for gestational age (AGA)–LBW (0·82, 0·74–0·91; p=0·0010); preterm–AGA–non-LBW (0·89, 0·80–0·98; p=0·019); term–SGA–LBW (0·91, 0·85–0·96; p=0·0046); and term–SGA–non-LBW (0·95, 0·90–1·00; p=0·050). In the four-group categorisation, prenatal MMS reduced the risk of preterm–SGA (0·71, 0·62–0·82; p=0·0002) and term–SGA (0·93, 0·89–0·98; p=0·0066). Prenatal SQ-LNS had no significant effects on the risk of giving birth to small vulnerable newborns except for preterm–large for gestational age–non-LBW in the ten-group categorisation (0·78, 0·65–0·94; p=0·023).
Interpretation
Prenatal MMS and SQ-LNS reduce the risk of giving birth to small vulnerable newborns to varying extents, with the greatest magnitude of effects observed for small vulnerable newborn types that confer the greatest neonatal mortality risk. This study underscores the importance of nutritional supplements in prenatal care. |
| format | Journal Article |
| id | CGSpace172863 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Elsevier |
| publisherStr | Elsevier |
| record_format | dspace |
| spelling | CGSpace1728632025-07-08T20:33:40Z The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data Wang, Dongqing Liu, Enju Perumal, Nandita Partap, Uttara Cliffer, Ilana R. Costa, Janaína Calu Wang, Molin Fawzi, Wafaie W. Adu-Afarwuah, Seth Ashorn, Per Ashorn, Ulla Mridha, Malay Kanti Arifeen, Shams Bhutta, Zulfiqar A. Cheng, Yue Christian, Parul Costello, Anthony M. Dewey, Kathryn G. Friis, Henrik Gomo, Exnevia Grais, Rebecca Guindo, Ousmane Krebs, Nancy F. Huybregts, Lieven Isanaka, Sheila Lachat, Carl Lartey, Anna LeClerq, Steven C. Maleta, Kenneth Manandhar, Dharma S. Martorell, Reynaldo Matias, Susana L. McClure, Elizabeth M. Moore, Sophie E. Osrin, David Urassa, Willy Pembe, Andrea B. Prentice, Andrew M. Ramakrishnan, Usha Rivera, Juan Rizvi, Arjumand Roberfroid, Dominique Shamim, Abu Ahmed Soofi, Sajid Schulze, Kerry West Jr., Keith P. Wu, Lee Zeng, Lingxia Zhu, Zhonghai infants prematurity health perinatal period micronutrient deficiencies nutrition Background Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which are currently unknown. Methods In this meta-analysis, individual participant data from randomised controlled trials of MMS and randomised controlled trials of SQ-LNS in low-income and middle-income countries were used. We systematically searched the literature using PubMed, Embase, and Web of Science to identify randomised controlled trials of prenatal nutritional supplementation using MMS or SQ-LNS among pregnant people published between Jan 1, 2000, and Dec 31, 2021. Studies were excluded if they were conducted exclusively among participants selected by pre-existing health conditions, such as anaemia status, HIV infection, or diabetes. We contacted the corresponding authors of all identified studies to seek data contribution. As individual participant data became available, we mapped relevant variables and harmonised the data across studies. Iron and folic acid supplementation was the control group in most studies. Newborns were classified into ten groups through the combinations of preterm or term birth, small, appropriate, and large for gestational age, and low birthweight (LBW) or non-LBW. Newborns were also analysed using a four-group categorisation of preterm or term and LBW or non-LBW. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses. Findings 14 randomised controlled trials of MMS (n=42 618; the mean maternal age at study enrolment was 24·3 years [SD 5.6]; 22 086 [51·8%] male neonates and 20 532 [48·2%] female neonates) and four randomised controlled trials of SQ-LNS (n=6246; the mean maternal age at study enrolment was 23·3 years [SD 5·3]; 3137 [50·2%] male neonates and 3109 [49·8%] female neonates) were used. In the ten-group categorisation of small vulnerable newborns, prenatal MMS reduced the risk of preterm–small for gestational age (SGA)–LBW (RR 0·73, 95% CI 0·64–0·84; p=0·0003); preterm–appropriate for gestational age (AGA)–LBW (0·82, 0·74–0·91; p=0·0010); preterm–AGA–non-LBW (0·89, 0·80–0·98; p=0·019); term–SGA–LBW (0·91, 0·85–0·96; p=0·0046); and term–SGA–non-LBW (0·95, 0·90–1·00; p=0·050). In the four-group categorisation, prenatal MMS reduced the risk of preterm–SGA (0·71, 0·62–0·82; p=0·0002) and term–SGA (0·93, 0·89–0·98; p=0·0066). Prenatal SQ-LNS had no significant effects on the risk of giving birth to small vulnerable newborns except for preterm–large for gestational age–non-LBW in the ten-group categorisation (0·78, 0·65–0·94; p=0·023). Interpretation Prenatal MMS and SQ-LNS reduce the risk of giving birth to small vulnerable newborns to varying extents, with the greatest magnitude of effects observed for small vulnerable newborn types that confer the greatest neonatal mortality risk. This study underscores the importance of nutritional supplements in prenatal care. 2025-02 2025-02-06T13:48:34Z 2025-02-06T13:48:34Z Journal Article https://hdl.handle.net/10568/172863 en Open Access Elsevier Wang, Dongqing; Liu, Enju; Perumal, Nandita; Partap, Uttara; Cliffer, Ilana R.; Costa, Janaína Calu; Wang, Molin; Fawzi, Wafaie W.; and the Gestational Weight Gain Pooling Project Consortium. 2025. The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data. Lancet Global Health 13(2): e298-e308. https://doi.org/10.1016/S2214-109X(24)00449-2 |
| spellingShingle | infants prematurity health perinatal period micronutrient deficiencies nutrition Wang, Dongqing Liu, Enju Perumal, Nandita Partap, Uttara Cliffer, Ilana R. Costa, Janaína Calu Wang, Molin Fawzi, Wafaie W. Adu-Afarwuah, Seth Ashorn, Per Ashorn, Ulla Mridha, Malay Kanti Arifeen, Shams Bhutta, Zulfiqar A. Cheng, Yue Christian, Parul Costello, Anthony M. Dewey, Kathryn G. Friis, Henrik Gomo, Exnevia Grais, Rebecca Guindo, Ousmane Krebs, Nancy F. Huybregts, Lieven Isanaka, Sheila Lachat, Carl Lartey, Anna LeClerq, Steven C. Maleta, Kenneth Manandhar, Dharma S. Martorell, Reynaldo Matias, Susana L. McClure, Elizabeth M. Moore, Sophie E. Osrin, David Urassa, Willy Pembe, Andrea B. Prentice, Andrew M. Ramakrishnan, Usha Rivera, Juan Rizvi, Arjumand Roberfroid, Dominique Shamim, Abu Ahmed Soofi, Sajid Schulze, Kerry West Jr., Keith P. Wu, Lee Zeng, Lingxia Zhu, Zhonghai The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title | The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title_full | The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title_fullStr | The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title_full_unstemmed | The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title_short | The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: A meta-analysis of individual participant data |
| title_sort | effects of prenatal multiple micronutrient supplementation and small quantity lipid based nutrient supplementation on small vulnerable newborn types in low income and middle income countries a meta analysis of individual participant data |
| topic | infants prematurity health perinatal period micronutrient deficiencies nutrition |
| url | https://hdl.handle.net/10568/172863 |
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effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT graisrebecca effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT guindoousmane effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT krebsnancyf effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT huybregtslieven effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT isanakasheila effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT lachatcarl effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT larteyanna effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT leclerqstevenc effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT maletakenneth effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT manandhardharmas effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT martorellreynaldo effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT matiassusanal effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT mcclureelizabethm effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT mooresophiee effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT osrindavid effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT urassawilly effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT pembeandreab effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT prenticeandrewm effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT ramakrishnanusha effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT riverajuan effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT rizviarjumand effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT roberfroiddominique effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT shamimabuahmed effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT soofisajid effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT schulzekerry effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT westjrkeithp effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT wulee effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT zenglingxia effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata AT zhuzhonghai effectsofprenatalmultiplemicronutrientsupplementationandsmallquantitylipidbasednutrientsupplementationonsmallvulnerablenewborntypesinlowincomeandmiddleincomecountriesametaanalysisofindividualparticipantdata |