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Session: Micronutrients Supplementation and Human Health (Oral 11)

(OR11-02-24) The Effects of Prenatal Nutritional Supplements on Small Vulnerable Newborn Types in Low- and Middle-Income Countries: A Meta-Analysis of Individual Participant Data

Sunday, June 30, 2024
10:00 AM – 10:12 AM CT
Location:  W183
ECRAC

    Presenting Author(s)

  • Dongqing Wang, PhD, MPH (he/him/his)

    Assistant Professor
    George Mason University
    Fairfax, Virginia, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • EL

    Enju Liu, PhD, MD

    Assistant Professor
    Boston Children’s Hospital
    Boston, Massachusetts, United States

  • NP

    Nandita Perumal

    University of South Carolina, South Carolina, United States

  • UP

    Uttara Partap, PhD

    Postdoctoral Research Fellow
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • Ilana R. Cliffer, PhD

    Food systems scientist
    World Vegetable Center
    Boston, Massachusetts, United States

  • JC

    Janaína C. Costa

    Harvard T.H. Chan School of Public Health, Massachusetts, United States

  • MW

    Molin Wang, PhD

    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • WF

    Wafaie W. Fawzi, DrPH, MS, MPH

    Professor
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

Objectives: Small vulnerable newborn (SVN) types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. This individual participant data meta-analysis of randomized controlled trials aimed to examine the effects of prenatal multiple micronutrient supplement (MMS) and small-quantity lipid-based nutrient supplement (SQ-LNS) on SVNs.

Methods: Individual participant data from 14 randomized controlled trials of MMS (N = 42,618<) and four randomized controlled trials of SQ-LNS (N = 6,246) in low- and middle-income countries were used. Newborns were classified into ten groups through the combinations of preterm birth, small for gestational age (SGA) and large for gestational age (LGA) birth, and low birthweight (LBW). Newborns were also analyzed using a four-group categorization excluding the LBW element. Log-binomial models were used to estimate study-specific risk ratios (RRs) of the effects of prenatal MMS or SQ-LNS on SVNs, which were pooled using meta-analyses.

Results: Prenatal MMS reduced the risk of six out of nine SVN types in the ten-group categorization (RRs ranging from 0.73 to 0.95) and all three types in the four-group categorization (RRs ranging from 0.71 to 0.93). Prenatal MMS had the greatest protective effects against preterm-LGA-LBW (RR: 0.73; 95% CI: 0.54, 1.00), preterm-SGA-LBW (RR: 0.79; 95% CI: 0.68, 0.91), preterm-AGA-LBW (RR: 0.82; 95% CI: 0.75, 0.90), and preterm-SGA (RR: 0.71; 95% CI: 0.63, 0.80). Prenatal SQ-LNS reduced the risk of three SVN types in the ten-group categorization (RRs ranging from 19% to 22%) and two types in the four-group categorization (RRs ranging from 10% to 14%).

Conclusions: Prenatal MMS and SQ-LNS reduced the risk of SVN types, particularly the ones conferring the greatest risk of neonatal mortality. This work underscores the important promise of MMS and SQ-LNS in prenatal care in low- and middle-income countries.

Funding Sources: Bill and Melinda Gates Foundation (INV-007640 and INV-016436)