ABSTRACT
OBJECTIVE:
Antenatal multiple
micronutrient supplements (MMS) are a
cost-effective intervention to reduce adverse
pregnancy and
birth outcomes. However, the current
WHO recommendation on the use of antenatal MMS is conditional, partly due to concerns about the effect on
neonatal mortality in a subgroup of studies comparing MMS with
iron and
folic acid supplements (IFA) containing 60 mg of
iron. We aimed to assess the effect of MMS vs IFA on
neonatal mortality stratified by
iron dose in each supplement.
METHODS:
We updated the
neonatal mortality analysis of the 2020
WHO guidelines using the generic inverse variance
method and applied the random effects model to calculate the effect estimates of MMS vs. IFA on
neonatal mortality in subgroups of trials (n=13) providing the same or different amounts of
iron, i.e. MMS with 60 mg of
iron vs IFA with 60 mg of
iron; MMS with 30 mg of
iron vs IFA with 30 mg of
iron; MMS with 30 mg of
iron vs IFA with 60 mg of
iron; and MMS with 20 mg of
iron vs IFA with 60 mg of
iron.
RESULTS:
There were no statistically significant differences in
neonatal mortality between MMS and IFA within any of the subgroups of trials.
Analysis of MMS with 30 mg vs IFA with 60 mg of
iron (7 trials, 14,114 participants), yielded a nonsignificant
Risk Ratio (RR) of 1.12 (95% CI 0.83 to 1.50).
CONCLUSION:
Neonatal mortality did not differ between MMS and IFA regardless of
iron dose in either supplement.