Prenatal multiple micronutrient supplements lower risk of small, vulnerable newborns

New research highlights a 27% reduction in adverse birth outcomes with prenatal MMS, supporting a shift in antenatal care guidelines

A new study published in The Lancet Global Health reveals that prenatal multiple micronutrient supplementation (MMS) significantly reduces the risk of giving birth to small, vulnerable newborns—those affected by preterm birth, low birthweight, and small-for-gestational-age birth—marking a critical step toward improving neonatal health in low- and middle-income countries.

Prevalence and risks associated with small, vulnerable newborns

Small, vulnerable newborns are those who are born too soon or too small and are at a higher risk of detrimental health consequences, including mortality. The prevalence of low birthweight (LBW) is relatively high in low- and middle-income countries (LMICs).

In 2020, approximately 19.8 million new-borns worldwide had LBW, and the majority of them belonged to LMICs, including South Asia and sub-Saharan Africa. A newborn’s body weight is dependent on short pregnancy duration (preterm birth) and fetal growth restriction. Fetal growth restriction determines the birth of a newborn, small for its gestational age (SGA).

Small, vulnerable newborn types, such as preterm births, SGA births, and LBW births, exhibit disproportionate burdens of neonatal mortality. In 2020, approximately 26% of live births were small, vulnerable newborns due to preterm or SGA. In the same year, there were 2.4 million neonatal deaths, and the majority of them were classified as preterm newborns who were not SGA. This was followed by term–SGA newborns and preterm–SGA newborns.

Nutritional interventions to prevent the risk of delivering LBW

Multiple studies have shown that antenatal nutritional interventions could prevent giving birth to small, vulnerable newborns. These studies have shown that the use of MMS might also prevent preterm, SGA, and LBW birth risks. Considering the research findings, there is currently a debate about shifting recommendations of the standard of antenatal care from iron and folic acid to MMS.

Prenatal lipid-based nutrient supplements (LNSs), including SQ-LNS are nutritional supplements that offer micronutrients, energy, and essential fatty acids to the consumer. Previous studies have indicated that SQ-LNS increases birthweight and prevents the risk of a newborn being SGA. No studies have evaluated the effect of MMS and SQ-LNS on small, vulnerable newborns.

About the study

The current meta-analysis pooled individual-level data from randomized controlled trials conducted in LMICs to determine how prenatal MMS and SQ-LNS influence the risk of giving birth to small, vulnerable newborns.

All relevant research was obtained from PubMed, Embase, and Web of Science, published between Jan 1, 2000, and Dec 31, 2021. The current meta-analysis excluded research that selected participants based on their pre-existing medical conditions, such as HIV infection, diabetes, and anemia.

Newborns were classified using ten-group and four-group categorization approaches. The former approach grouped newborns based on a combination of three birth outcome dimensions, namely, term-preterm birth, SGA- appropriate for gestational age (AGA), and LBW and non-LBW. The permutations across the three dimensions generated ten exhaustive and mutually exclusive combinations for ten-group categorization.

Study findings

A total of fourteen studies linked to MMS and four studies related to SQ-LNS that offered individual participant data were selected for prenatal analysis. In almost all studies, the control group participants were subjected to iron and folic acid supplementation.

The MMS analysis included 23,292 participants in the control group and 19,326 in the MMS groups. Approximately 51.8% of male neonates and 48.2% of female neonates constituted the cohort. The mean maternal age of the participants belonging to the MMS group was 24.34 years.

The SQ-LNS analysis included 3,832 participants in the control groups and 2,414 participants in the SQ-LNS groups. The mean maternal age of this cohort was 23.32 years, and it included 50.2% male neonates and 49.8% female neonates.

In the ten-group categorization analysis, the term- AGA–non-LBW was found to be the most common newborn type based on the ten-group categorization. In the four-group categorization, term–non-SGA accounted for most of the sample, followed by term–SGA, preterm–non-SGA, and preterm–SGA.

In the ten-group categorization, prenatal MMS significantly reduced the risk of five of nine small, vulnerable newborn types. Similarly, the four-group categorization revealed MMS significantly reduced term–SGA and preterm–SGA births. Prenatal SQ-LNS also reduced the risk of preterm–LGA–non-LBW in the ten-group categorization; however, no significant effect was observed in the four-group categorization. Interestingly, prenatal MMS was associated with higher protective r effects against the risk of giving birth to a preterm neonate–SGA–LBW) or preterm–AGA–LBW.

Conclusions

This study documented varying benefits of prenatal MMS and SQ-LNS in preventing births of small, vulnerable newborn types with high mortality risks. It also highlighted the importance of nutritional supplements in antenatal care, particularly in LMICs.