JAMA：孟加拉产前微量营养素和食物补充可减少儿童死亡率

芝加哥-据5月16日刊《美国医学会杂志》JAMA上的一项研究披露，与那些在标准计划中的接受包括通常的食品补充剂的妇女相比，那些在孟加拉的贫困社区中接受包括结合了早期食品补充剂的铁和叶酸的多种微营养素的孕妇大大提高了她们的新生儿的存活率；该期杂志是有关全球卫生的专刊。

瑞典乌普萨拉市乌普萨拉大学的Lars Ake Persson， M.D.， Ph.D.及其同事开展了一项研究（MINIMat试验），旨在检查一种产前多种微营养素补充剂（MMS），以及早期邀请进入一个日常食物补充计划是否会增加妊娠30周时的母体血红蛋白水平、新生儿出生体重和婴儿的存活率以及这些干预措施（早期邀请接受MMS）的组合是否会进一步地改善这些结果。

研究人员得出结论：“科学家和决策者已经建议在发送给孕妇以提高婴儿出生时大小及孩子生长和发育的健康及营养干预包中用MMS来取代目前的铁-叶酸补充剂。其它的研究质疑这种建立于有限的出生体重的功效规模以及缺失对胎儿和新生儿存活的正面功效之上的观点。该MINIMat试验为如果将多种微营养素与一种在妊娠早期开始摄取的平衡的蛋白-能量补充剂相结合则可降低后代的死亡率提供了证据。”

doi:10.1001/jama.2012.4061
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Effects of Prenatal Micronutrient and Early Food Supplementation on Maternal Hemoglobin, Birth Weight, and Infant Mortality Among Children in Bangladesh:

Lars Åke Persson, MD, PhD; Shams Arifeen, MD, PhD; Eva-Charlotte Ekström, PhD; Kathleen M. Rasmussen, ScD; Edward A. Frongillo, PhD; Md Yunus, MD; for the MINIMat Study Team

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.