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Modifying effect of maternal nutritional status on the impact of maternal multiple micronutrient supplementation on birthweight in Indonesia

European Journal of Clinical Nutrition volume 65, pages 1110–1117 (2011)Cite this article

Subjects

Abstract

Background/Objective:

Low birthweight (LBW) and intrauterine growth restriction are linked with maternal nutritional status during pregnancy, and maternal supplementation with multiple micronutrients (MMNs) is reported to increase birthweight. Responses to MMN, however, might be modified by maternal nutrition.

Subjects/Methods:

To examine the differential effects of maternal nutritional status on birthweight responses to prenatal MMN supplementation, data from the Supplementation with Multiple Micronutrient Intervention Trial, a cluster-randomized trial in Indonesia was analyzed. Birthweight outcomes of 7001 infants whose mothers received iron/folic acid were compared with 7292 infants whose mothers received MMN. The modifying effects of maternal short-term nutritional status (mid-upper arm circumference (MUAC) and long-term nutritional status (height) on the birthweight response to MMN supplementation were assessed.

Results:

For women with higher MUAC (⩾23.5 cm), MMN increased mean birthweight by 33 g (95% confidence interval (CI): −1 to 66, P=0.06) and significantly reduced LBW by 21% (relative risk: 0.79, 95% CI: 0.64–0.99, P=0.04). The modifying effect of MUAC on mean birthweight, LBW and small for gestational age was significant. There was no evidence of a modifying effect of maternal height on the response to MMN.

Conclusions:

Supplementation with MMN in pregnancy increased birthweight, but maternal nutritional status modified this response, with infants born to women with better short-term nutrition having greater birthweight response.

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Acknowledgements

The SUMMIT was supported by funds from the Turner Foundation, the United Nations International Children's Emergency Fund, the Centre for Health and Human Development, and the United States Agency for International Development-Indonesia (Grant no. 497-G-00-01-00001-00). SKS PhD program is supported by the Australian Leadership Awards provided by the Australian Agency for International Development.

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Authors and Affiliations

  1. SUMMIT Institute of Development, Gedung Pusat Penelitian Bahasa dan Kebudayaan, University of Mataram, Mataram, Indonesia

    S K Sebayang

  2. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia

    M J Dibley & P Kelly

  3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    A V Shankar

  4. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    A H Shankar

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  1. S K Sebayang
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Correspondence to S K Sebayang.

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Sebayang, S., Dibley, M., Kelly, P. et al. Modifying effect of maternal nutritional status on the impact of maternal multiple micronutrient supplementation on birthweight in Indonesia. Eur J Clin Nutr 65, 1110–1117 (2011). https://doi.org/10.1038/ejcn.2011.97

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