In this issue of JAMA, Persson et al1 describe the effects of early (approximately 9 weeks) vs usual (approximately 20 weeks) food supplementation alone or in combination with multiple micronutrient supplementation (MMS) vs iron-folic acid (using 60-mg and 30-mg iron formulations) during pregnancy on outcomes of maternal anemia, birth size, gestational age, and infant mortality, using a 3×2 factorial experimental design. The main, rather complex, findings were that there was no effect of either early food supplementation or MMS interventions on birth size or gestational duration at birth. Instead, both a positive and negative interaction between food supplementation and MMS were observed related to the outcome of offspring mortality. Early food supplementation combined with MMS significantly reduced the outcomes of neonatal, infant, and under 5-year child mortality compared with the standard of care of antenatal iron (60 mg) and folic acid supplements with a food supplement starting midgestation. Neither intervention nor their combination reduced stillbirth or perinatal mortality.
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