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Maternal anemia modifies the effect of multiple micronutrient supplements on birth weight and infant mortality in Indonesia
Author(s) -
Sebayang Susy Katikana,
Pierce Marcella,
Harefa Benyamin,
Aditiawarman Aditiawarman,
Apriatni Mandri S.,
Shankar Anita V.,
Dibley Michael,
Kelly Patrick J.,
Tjiong Roy,
Anwar Khaerul,
Shankar Anuraj H.
Publication year - 2013
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.27.1_supplement.358.7
Subject(s) - medicine , micronutrient , anemia , low birth weight , birth weight , gestational age , obstetrics , pregnancy , pediatrics , biology , pathology , genetics
Objective To assess effects of maternal anemia on the impact of maternal multiple micronutrient (MMN) supplementation compared to iron & folic acid (IFA) in a double blind RCT in Indonesia ( ISRCTN34151616 ). Methods We analyzed 14611 singleton births with data on maternal hemoglobin (Hb), height, parity, education, gestational age at birth, sex, season of birth & household wealth. Mortality was analyzed with Cox proportional hazards models; birth weight (BW) & maternal Hb with linear models; low birth weight (LBW), small for gestational age (SGA) & preterm‐LBW with logistic models. Results In anemic women MMN reduced early infant mortality (< 90 days of birth) by 39% [Adj HR 0.61; 95%CI 0.49–0.78 p<0.001; interaction (int) p=0.04] and neonatal mortality by 36% (Adj HR 0.64; CI=0.47–0.86 p=0.003; int p=0.18). MMN improved BW by 37g (CI −1 to 74 p=0.056; int p=0.01), and reduced LBW by 17% (aRR 0.83; CI 0.66–1.05 p=0.11; int p=0.04) and preterm‐LBW by 40% (aRR 0.60; CI 0.42–0.87 p=0.007; int p=0.002), and improved Hb by 0.28g/dl (CI −0.031 to 0.59 p=0.08) in anemic women. Conclusions Maternal MMN supplements, as compared to IFA, have greater benefits on infant survival and birth weight in anemic than in non‐anemic women. Funding: Turner Foundation, UNICEF, CHHD, USAID Indonesia grant # 497G00010000100. AusAID supported SKS's PhD at U of Sydney.