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American Journal of Epidemiology Advance Access originally published online on September 24, 2009
American Journal of Epidemiology 2009 170(9):1127-1136; doi:10.1093/aje/kwp253
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Antenatal and Postnatal Iron Supplementation and Childhood Mortality in Rural Nepal: A Prospective Follow-up in a Randomized, Controlled Community Trial

Parul Christian, Christine P. Stewart, Steven C. LeClerq, Lee Wu, Joanne Katz, Keith P. West, Jr and Subarna K. Khatry

Correspondence to Dr. Parul Christian, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, W2041, Baltimore, MD 21205 (e-mail: pchristi{at}jhsph.edu).

Received for publication March 23, 2009. Accepted for publication July 22, 2009.

The long-term benefits of antenatal iron supplementation in child survival are not known. In 1999–2001, 4,926 pregnant women in rural Nepal participated in a cluster-randomized, double-masked, controlled trial involving 4 alternative combinations of micronutrient supplements, each containing vitamin A. The authors examined the impact on birth weight and early infant mortality in comparison with controls, who received vitamin A only. They followed the surviving offspring of these women at approximately age 7 years to study effects of in utero supplementation on survival. Of 4,130 livebirths, 209 infants died in the first 3 months and 8 were lost to follow-up. Of those remaining, 3,761 were followed, 150 died between ages 3 months and 7 years, and 152 were lost to follow-up. Mortality rates per 1,000 child-years from birth to age 7 years differed by maternal supplementation group, as follows: folic acid, 13.4; folic acid-iron, 10.3; folic acid-iron-zinc, 12.0; multiple micronutrients; 14.0; and controls, 15.2. Hazard ratios were 0.90 (95% confidence interval (CI): 0.65, 1.22), 0.69 (95% CI: 0.49, 0.99), 0.80 (95% CI: 0.58, 1.11), and 0.93 (95% CI: 0.66, 1.31), respectively, in the 4 supplementation groups. Maternal iron-folic acid supplementation reduced mortality among these children by 31% between birth and age 7 years. These results provide additional motivation for strengthening antenatal iron-folic acid programs.

child; dietary supplements; folic acid; iron; micronutrients; pregnancy; prenatal care; survival

Abbreviations: CI, confidence interval; RR, relative risk


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