The Modifying Effects of Maternal Nutritional Status on the Impact of Maternal Multiple Micronutrient Supplementation on Birth Outcomes and Early Infant Mortality in Indonesia

Background:This thesis aims to assess the modifying effect of maternal nutritional status on maternal supplementation with multiple micronutrients (MMN) compared to iron and folic acid (IFA). Method:Data from the Supplementation with Multiple Micronutrient Intervention Trial (SUMMIT), a cluster randomized controlled trial in Lombok, Indonesia was used for analysis. Mortality outcomes were analysed by Cox proportional hazard models, mean birthweight by linear regression and LBW, SGA, and preterm by logistic regression. All analyses were adjusted for clustering. Results:For women with Mid-upper-arm-circumference (MUAC)≥23.5cm, MMN increased birthweight by 33g and significantly reduced LBW by 21%. In anaemic women MMN significantly improved birthweight by 37g, reduced LBW by 17%, reduced preterm-LBW by 40%, increased haemoglobin in anaemic women by 0.28g/dl and significantly reduced early infant mortality (the first 90 days) by 39% in infants of anaemic mothers. Around 22% and 74% of MMN impact on survival was mediated by birthweight and preterm-LBW. Conclusion:MMN compared to IFA improves birthweight and survival with greater impact in anaemic women. MMN improves birthweight, reduce LBW, and SGA greater in high MUAC women without impact modification of MUAC seen for survival. There might be different etiology between micronutrient and macronutrient status in which MMN improves fetal growth and survival.