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The article discusses the results of a study that examines the effects of prenatal multiple micronutrient supplementation (MMS) and early food supplementation on the level of maternal hemoglobin, birth weight and infant mortality among children in Matlab, Bangladesh. The study shows that the level of mean maternal hemoglobin was lower in the early group than in the usual invitation group. Those in the MMS group had the highest incidence of spontaneous abortion and infant mortality rate. The study concludes that decreased childhood mortality were experienced by pregnant women treated with multiple micronutrients, including a combination of iron and folic acid and early food supplementation.

The article discusses the reduced childhood mortality in Bangladesh due to multiple micronutrient supplementation (MMS) combined with early pregnancy protein-energy supplementation compared with folic acid supplements. This evidence is provided by the maternal and infant nutrition interventions in matlab (MINIMat) clinical trial. The MINIMat trial included the meta-analysis of 12 trials of stillbirth and early and late neonatal mortality comparing antenatal MMS with folic acid supplements.

Context: Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences.Objectives: To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes.Design, Setting, and Participants: A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009.Interventions: Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation).Main Outcome Measures: Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed.Results: Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, -0.9 g/L; 95% CI, -1.7 to -0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births (54 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid; HR, 0.34; 95% CI, 0.18-0.65). Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate.Conclusion: Among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including iron and folic acid combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality.Trial Registration: isrctn.org Identifier: ISRCTN16581394. [ABSTRACT FROM AUTHOR]