부산대학교 도서관

Meta‐analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age (SGA) was considered inconsistent. We conducted meta‐analyses to determine if the effects of MMS on LBW, preterm birth and SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine test and recall of LMP. The effects of MMS versus IFA on birthweight, preterm birth and SGA appeared consistent across subgroups with no evidence of subgroup differences (p > 0.05). When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratios of 0.87 (95% confidence interval [CI] 0.78–0.97) for LBW, 0.90 (95% CI, 0.79–1.03) for preterm birth and 0.9 (95% CI, 0.83–0.99) for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low‐ and middle‐income countries. Key messages: World Health Organization (WHO) has a conditional recommendation for antenatal multiple micronutrient supplementation (MMS) noting ultrasound to assess gestational age should be used in future trials.These meta‐analyses of the 16 trials informing the WHO guidelines showed that the benefits of MMS versus iron and folic acid on low birthweight, preterm birth and small‐for‐gestational‐age were not different in subgroups of trials using different gestational age assessment methods.In trials that performed ultrasounds for gestational age assessment, the benefits of MMS on birth outcomes were demonstrated.These analyses strengthen the evidence for the transition to MMS in antenatal care programmes in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]