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Br J Nutr. 2017 Sep;118(6):431-440. doi: 10.1017/S000711451700229X.

Multi-micronutrient supplementation during pregnancy for prevention of maternal anaemia and adverse birth outcomes in a high-altitude area: a prospective cohort study in rural Tibet of China.

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1School of Public Health,Xi'an Jiaotong University Health Science Center,Xi'an,Shaanxi, 710061,People's Republic of China.
2Department of Clinical Sciences,Liverpool School of Tropical Medicine,Pembroke Place,Liverpool L3 5QA,UK.
3The Primary Health and Maternal and Child Health Division of Health Bureau of Tibet Autonomous Region,Lhasa,Tibet Autonomous Region, 850000,People's Republic of China.
4School of Medicine,Tibet University,Lhasa,Tibet Autonomous Region, 850000,People's Republic of China.


Anaemia during pregnancy, characterised by Hb <110 g/l, is a specific risk factor for adverse maternal and perinatal outcomes in developing countries. The objective of this study was to determine the effectiveness of daily antenatal supplementation with multiple micronutrients (MMN) compared with folic acid (FA) on the occurrence of anaemia among pregnant women and their infants' health in a high-altitude area. A prospective cohort study was carried out in two rural counties in Tibet from 2007 to 2012. A total of 1149 eligible pregnant women were allocated daily supplementation with FA in one county and MMN containing a recommended allowance of twenty-three vitamins and minerals in another county starting ≤24 weeks of gestation and continuing until delivery. Compared with the FA group, prenatal supplementation with MMN was significantly associated with reduced odds of anaemia in the third trimester. This was demonstrated in the primary outcome, with an adjusted OR (AOR) of 0·63; 95 % CI 0·45, 0·88 and P=0·007 and also reduced odds of preterm delivery (AOR: 0·31; 95 % CI 0·15, 0·61; P=0·001). There was no difference between MMN and FA groups in mean birth weight (adjusted mean difference: 36·78; 95 % CI -19·42, 92·98 g; P=0·200), whereas MMN supplementation significantly reduced the odds of low-birth weight (LBW) babies (AOR: 0·58; 95 % CI 0·36, 0·91; P=0·019). In conclusion, the antenatal MMN supplementation in rural Tibet is associated with a reduction of maternal anaemia in the third trimester, and may potentially decrease the risk of preterm delivery and LBW babies.


AOR adjusted OR; FA folic acid; GEE generalised estimating equation; LBW low birth weight; MMN multiple micronutrients; Anaemia; Low birth weight; Multiple micronutrient supplementation; Preterm delivery; Rural Tibet

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