Menten J and Kolsteren P. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso

Background: Intrauterine growth retardation is a major predictor of child health in developing countries. Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient prepara-tion (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates. Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed. Results: Pregnancy outcome was known in 96.3 % of the partici-pants. After adjustment for gestational age at delivery, both birth weight (52 g; 95 % CI: 4, 100; P 0.035) and birth length (3.6 mm; 95 % CI: 0.8, 6.3; P 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percen-tiles of birth weight and length distributions: the risk of large-for-gestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95 % CI: 1.04, 2.38; P 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMA