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Folic Acid, Protein Energy and Multiple Micronutrient Supplements on Stillbirths

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More Intervention Effect Estimate Summaries

Reference
Imdad A, Yakoob MY, Bhutta ZA.  The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths.  BMC Public Health. 2011; 11 (Suppl 3): S4.

Background

  • A woman’s nutritional status before and during pregnancy is important for a healthy pregnancy outcome. (1)  Pregnancy is a state of increased requirement of macro and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes (2, 3)
  • At least 3.2 million stillbirths occur annually (4), with 98% of these occurring in the developing world (5).
  • Poor maternal nutritional status is one of the five factors significantly associated with stillbirths. (6)

Intervention Effects

Peri-conceptional Folic Acid Fortification on Stillbirths due to Neural Tube Defects (NTDs) 

  • 41% reduction (RR: 0.59; 95% CI 0.52-0.68) in primary incidence of NTDs – 11 fortification studies (moderate quality of evidence)
  • This estimate has been recommended for inclusion in LiST as a proxy for reduction in stillbirths

Balanced Protein Energy Supplementation during Pregnancy on Stillbirths

  • 45% reduction (RR: 0.55; 95% CI 0.31-0.97) in all-cause stillbirths - 3 low-quality studies
  • Insufficient data to recommend inclusion in LiST

Multiple Micronutrient Supplementation during Pregnancy on Stillbirths

  • No significant effect on reducing stillbirths (RR: 0.98; 95% CI 0.88-1.10) or perinatal mortality (RR: 1.07; 95% CI 0.92-1.25) when compared to iron folate supplementation – 13 studies


Intervention Recommendation

  • Folic acid fortification reduces incidence of NTDs and may also have an effect on stillbirths.  The estimate of 41% reduction has been recommended as a proxy for reduction in stillbirths due to NTDs.
  • While promising, there is need of more operations research before we can recommend balanced protein energy supplementation as an intervention on large scale for reducing stillbirths.
  • There is no evidence of effect of multiple micronutrients supplementation on reducing stillbirths.


References from Imdad Paper Cited Here

  1. Maternal anthropometry and pregnancy outcomes. A WHO Collaborative Study: Introduction. Bull World Health Organ. 1995;73(Suppl):1–6.
  2. de Onis M, Villar J, Gulmezoglu M. Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998;52(Suppl 1):S83–93.
  3. Abu-Saad K, Fraser D. Maternal Nutrition and Birth Outcomes. Epidemiol Rev. 2010.
  4. Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA. 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth. 2009;9(Suppl 1):S2. 
  5. Smith GC. Predicting antepartum stillbirth. Curr Opin Obstet Gynecol. 2006;18(6):625–630. 
  6. Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis. 2007;34(7 Suppl):S11–21.



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