Prenatal Micronutrient and Early Pregnancy Food Supplementation in Bangladesh

To the Editor: The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) trial¹ provided evidence that prenatal multiple micronutrient supplementation (MMS) combined with early pregnancy protein-energy supplementation reduced childhood mortality compared with standard of care antenatal iron (60 mg) and folic acid supplements with the food supplementation commencing mid-gestation.

Data from the MINIMat trial were included in an earlier meta-analysis² of 12 trials of stillbirth and early and late neonatal mortality comparing antenatal MMS with iron and folic acid supplements alone. The portion of the MINIMat trial data included in this meta-analysis compared the MMS and 30-mg iron treatment groups, but only used singleton births in the analysis. The number of multiple births in the MINIMat trial varied across treatment groups, with 24 in the 30-mg iron group and 22 in the MMS group (Table 4 in article). Including multiple births in the trial resulted in 30 early neonatal deaths in the 30-mg iron treatment group (10 more than in the meta-analysis) and 25 in the MMS group (1 more than in the meta-analysis). In addition, there were 7 late neonatal deaths in the MMS group, which was 2 more than in the meta-analysis, suggesting very different neonatal mortality for multiple births by treatment group.