Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial

Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial

The long-term benefits of antenatal iron supplementation in child survival are not known.

In 1999-2001, 4,926 pregnant women in rural Nepal participated in a cluster-randomized, double-masked, controlled trial involving 4 alternative combinations of micronutrient supplements, each containing vitamin A.
The authors of this paper examined the impact on birth weight and early infant mortality in comparison with controls, who received vitamin A only. They followed the surviving offspring of these women at approximately age 7 years to study effects of in utero supplementation on survival.

Key findings include:

  • Of 4,130 livebirths, 209 infants died in the first 3 months and 8 were lost to follow-up.
  • Of those remaining, 3,761 were followed, 150 died between ages 3 months and 7 years, and 152 were lost to follow-up.
  • Mortality rates per 1,000 child-years from birth to age 7 years differed by maternal supplementation group, as follows: folic acid, 13.4; folic acid-iron, 10.3; folic acid-iron-zinc, 12.0; multiple micronutrients; 14.0; and controls, 15.2.
  • Hazard ratios were 0.90, 0.69, 0.80, and 0.93, respectively, in the 4 supplementation groups.
  • Maternal iron-folic acid supplementation reduced mortality among these children by 31% between birth and age 7 years.
These results provide additional motivation for strengthening antenatal iron-folic acid programmes.
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