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Previous Volume 356:1423-1431 April 5, 2007 Number 14 Next

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ABSTRACT

Background Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes.

Methods In a double-blind trial in Dar es Salaam, Tanzania, we randomly assigned 8468 pregnant women (gestational age of fetus, 12 to 27 weeks) who were negative for human immunodeficiency virus infection to receive daily multivitamins (including multiples of the recommended dietary allowance) or placebo. All the women received prenatal supplemental iron and folic acid. The primary outcomes were low birth weight (<2500 g), prematurity, and fetal death.

Results The incidence of low birth weight was 7.8% among the infants in the multivitamin group and 9.4% among those in the placebo group (relative risk, 0.82; 95% confidence interval [CI], 0.70 to 0.95; P=0.01). The mean difference in birth weight between the groups was modest (67 g, P<0.001). The rates of prematurity were 16.9% in the multivitamin group and 16.7% in the placebo group (relative risk, 1.01; 95% CI, 0.91 to 1.11; P=0.87), and the rates of fetal death were 4.3% and 5.0%, respectively (relative risk, 0.87; 95% CI, 0.72 to 1.05; P=0.15). Supplementation reduced both the risk of a birth size that was small for gestational age (<10th percentile; 10.7% in the multivitamin group vs. 13.6% in the placebo group; relative risk, 0.77; 95% CI, 0.68 to 0.87; P<0.001) and the risk of maternal anemia (hemoglobin level, <11 g per deciliter; relative risk, 0.88; 95% CI, 0.80 to 0.97; P=0.01), although the difference in the mean hemoglobin levels between the groups was small (0.2 g per deciliter, P<0.001).

Conclusions Multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death. Multivitamins should be considered for all pregnant women in developing countries. (ClinicalTrials.gov number, NCT00197548 [ClinicalTrials.gov] .)

Source Information

From the Departments of Nutrition (W.W.F., P.P., W.C.W.), Epidemiology (W.W.F., E.H., W.C.W., D.S.), and Biostatistics (D.S.), Harvard School of Public Health, Boston; and the Departments of Community Health (G.I.M.) and Microbiology and Immunology (W.U.), Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.

Address reprint requests to Dr. Fawzi at the Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at mina{at}hsph.harvard.edu.

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• Nilsen, R. M., Vollset, S. E., Rasmussen, S. A., Ueland, P. M., Daltveit, A. K. (2008). Folic Acid and Multivitamin Supplement Use and Risk of Placental Abruption: A Population-based Registry Study. Am J Epidemiol 167: 867-874 [Abstract] [Full Text]