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Treatment effects of maternal micronutrient supplementation vary by percentiles of the birth weight distribution in Nepal



Treatment effects of maternal micronutrient supplementation vary by percentiles of the birth weight distribution in Nepal



FASEB Journal 18(4-5): Abst 358 16



We reported antenatal micronutrient supplementation to increase mean birth weight by 40-70 g in a rural population in Nepal (BMJ 2003;326:571-6). The impact was estimated by calculating the mean difference in birth weight between control and treatment groups assuming a constant treatment effect across the distribution of birth weights. We propose an analysis that compares differences (and confidence intervals) in birth weight between treatment and control groups modeled as a non-linear, but smooth function of the percentiles of the birth weights distribution (Wilcox 2001). Supplementation groups were folic acid, folic acid+iron, folic acid+iron+zinc and a multiple micronutrient supplement all with vitamin A compared against the control group (vitamin A alone). Treatment effects of folic acid+iron were observed mainly in the lower and middle parts of the birth weight distribution, while being close to 0 or negative in the upper tail (Figure). In contrast, treatment effects in the multiple micronutrient group (not shown) appeared to be constant across the birth weight distribution. The biologic pathways affecting intrauterine growth may vary by micronutrients such that some (such as iron) may confer a benefit among the most vulnerable infants, whereas others may have a more constant effect across the spectrum of birth weight. Future analytic approaches for estimating benefits of maternal supplementation on birth weight should challenge the assumption of a constant effect across the distribution of birth weight. Funded by USAID, Washington DC and the Bill & Melinda Gates Foundation, Seattle. .

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Accession: 035980139

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