Antenatal Micronutrient Supplementation and Infant Survival

Maternal deficiency in multiple essential micronutrients is likely to be a major public
health problem in low-income countries. Supplementing mothers with certain individual
micronutrients has been shown to confer health benefits, although the evidence is not clear
for multiple micronutrients. We aim to test, in a cluster-randomized, double-masked,
controlled trial whether giving a daily multiple micronutrient supplement (similar in
composition to the UNICEF antenatal supplement) will enhance infant survival and birth
outcomes such as birth weight and gestational duration in a rural population in Bangladesh.
Over the duration of 2-3 years a community-surveillance in the northwestern, rural Districts
of Gaibandha and Southern Rangpur, the trial plans to identify and recruit 36,000 pregnant
women based on 5-weekly histories of amenorrhea confirmed by urine-testing, and supplement
them with either a multiple micronutrient supplement or an iron-folic acid supplement (as
the standard of care control for pregnancy) and monitor pregnancy health, birth outcomes and
vital status and health of liveborn infants through 6 months of age. In a ~3% sub-sample of
mothers, additional measures of nutritional and health status will be evaluated in the 1st
and 3rd trimesters of pregnancy, and at 3 months postpartum (with infants), that include
anthropometric and body composition (bioelectrical impedance) assessment, collection of
biospecimens (eg, phlebotomy and breast milk sampling for micronutrient and other analyte
concentration determinations), and other clinical assessments. The trial will generate
evidence from which to examine the safety and efficacy of an antenatal through postnatal
maternal micronutrient supplement intervention in order to inform and guide antenatal
nutrition policies and programs in South Asia.