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The impact of prenatal vitamin A and zinc supplementation on growth of children up to 2 years of age in rural Java, Indonesia.
Department of Child Health, Medical School, Gadjah Mada University, Sardjito Hospital, Jalan Kesehatan no. 1, Sekip, Yogyakarta 55284, Indonesia.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-5095-3454
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-8944-2558
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
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2011 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 14, no 12, 2197-2206 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine whether prenatal vitamin A and/or Zn supplementation affects postnatal growth. DESIGN: Follow-up of a randomized controlled trial monitoring growth in children from birth up to 24 months of age. SETTING: Central Java, Indonesia. SUBJECTS: Children (n 343) of mothers participating in a double-blinded, randomized controlled study of vitamin A and/or Zn supplementation during pregnancy. We report the effects of prenatal supplementation on infant growth, measured as weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and weight-for-height Z-scores (WHZ ), from 0 to 24 months, as well as differences in growth faltering among the supplementation groups. RESULTS: For HAZ, the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0·34 sd and 0·37 sd, respectively, and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0·31 sd. Compared with placebo, none of the supplements affected growth. Defining growth faltering as a downward crossing of two or more major percentile lines, 50-75 % of the children were found to be growth faltering within 9 months of age, whereas 17 % and 8 % scored <-2 sd for WAZ and HAZ, respectively. Prenatal supplementation did not reduce the prevalence of growth faltering. CONCLUSIONS: Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of children's length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone, but not compared with placebo. It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering. Future studies should duplicate these findings before recommendations can be made.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2011. Vol. 14, no 12, 2197-2206 p.
Keyword [en]
Vitamin A, Zn, Prenatal micronutrient supplementation, Child growth
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-45726DOI: 10.1017/S1368980011001078PubMedID: 21729462OAI: oai:DiVA.org:umu-45726DiVA: diva2:434373
Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Prenatal zinc and vitamin A supplementation: a study on the impact of prenatal micronutrient supplementation in rural Indonesia
Open this publication in new window or tab >>Prenatal zinc and vitamin A supplementation: a study on the impact of prenatal micronutrient supplementation in rural Indonesia
2012 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To study the effects of prenatal zinc and vitamin A supplementation on birthsize, neonatal morbidity, infant mortality, and growth in children up to two years of age.

Subjects and Methods: From September 1995 to December 1999 pregnant women inPurworejo District, Central Java, Indonesia with gestational age <17 weeks (n=2173) wererecruited to and participated in a community-based, individually randomized, placebo controlled,double blinded study aiming to evaluate the impact of supplementation (vitamin A,zinc, vitamin A + zinc) during pregnancy on maternal morbidity and pregnancy outcomes. Weanalyzed secondary data from that study regarding birth size, neonatal morbidity and infantmortality of the 1956 infants born alive. A subsample of infants (n=343) was followed until 2years of age concerning growth, feeding practices and morbidity. Outcomes were tested usingthe chi-square test, ANOVA, ANCOVA, and Cox’s proportional hazard function.

Results: Birth weights in the zinc [mean ±Standard deviation (SD): 3.16 ± 0.52 kg], vitaminA (3.08 ± 0.46 kg) or the combined vitamin A and zinc (3.10 ± 0.59) groups did not differ fromplacebo (3.09 ± 0.50 kg) after adjustment for maternal pre-pregnancy weight, weight gainduring pregnancy, and parity (P=0.70). Birth lengths of infants born to mothers supplementedwith zinc or vitamin A were in average 0.3 cm and 0.2 cm longer than those in the placebogroup after adjustment for maternal height, pre-pregnancy weight, weight gain during pregnancy,and parity (P=0.04). The impact of prenatal supplementation on infant mortality andneonatal morbidity was not significant. There was a small effect of prenatal vitamin A supplementationon postnatal growth in height-for-age z-score (HAZ). The absolute differencesbetween the vitamin A only and vitamin A + zinc groups at 3 and 9 months were 0.34 SD and0.37 SD, respectively, and the absolute difference between the vitamin A only and zinc onlygroups at 18 months was 0.31 SD. Defining growth faltering as downward crossing of ≥2 majorpercentile lines, 50-75% of the children were faltering within 9 months of age, whereas 17%and 8% were <-2 SD for growth in weight-for-age z-score (WAZ) and HAZ, respectively.Prenatal supplementation did not reduce the prevalence of growth faltering.

Conclusions: Prenatal vitamin A and zinc demonstrates a small but significant impact onbirth length, but it does not have any protective effect on infant mortality and neonatal morbidity.Prenatal vitamin A supplementation had a small but significant effect on postnatallength growth until 18 months of age, but no effect on weight gain, growth rate and it did notreduce the prevalence of growth faltering.

Abstract [id]

Tujuan: meneliti pengaruh suplementasi zink dan vitamin A pada masa prenatal terhadapukuran tubuh bayi baru lahir, morbiditas neonatal, kematian bayi, dan pertumbuhan anaksampai dengan umur dua tahun

Subjek dan Metode: Dari bulan September 1995 sampai dengan Desember 1999 ibu hamildi Kabupaten Purworejo, Jawa Tengah, Indonesia dengan umur kehamilan <17 minggu(n=2173) diikutsertakan ke dalam penelitian berbasis komunitas, teracak, menggunakankontrol plasebo dan buta ganda yang bertujuan mengevaluasi pengaruh suplementasi vitaminA, zink, dan kombinasi vitamin A dan zink selama kehamilan terhadap morbididitas ibu danhasil kehamilan. Kami menganalisis data sekunder dari penelitian ini dan mengevaluasi ukurantubuh bayi waktu lahir, morbiditas neonatal, dan kematian bayi dari 1956 bayi yang lahirhidup. Sebagian dari subjek (n=343) diikuti sampai dengan umur dua tahun untuk mengetahuipertumbuhan, cara pemberian makan, dan morbiditasnya. Data dianalisis dengan chi-squaretest, ANOVA, ANCOVA, dan Cox’s proportional hazard function.

Hasil: Berat badan lahir pada kelompok zink [mean ±standar deviasi (SD): 3.16 ± 0.52 kg],vitamin A (3.08 ± 0.46 kg) atau kombinasi vitamin A dan zink (3.10 ± 0.59) tidak berbedasecara bermakna dibandingkan dengan plasebo (3.09 ± 0.50 kg) setelah dikontrol oleh beratbadan ibu sebelum hamil, pertambahan berat badan selama hamil, dan paritas (P=0,70).Panjang lahir dari kelompok ibu yang disuplementasi dengan vitamin A atau zink 0,2 cm danrata-rata 0,3 cm lebih panjang dibanding kelompok plasebo setelah dikontrol oleh tinggi badanibu, berat badan ibu sebelum hamil, pertambahan berat selama hamil, dan paritas (P=0,04). Pengaruh suplementasi selama masa prenatal terhadap kematian bayi dan morbiditas neonataltidak bermakna. Suplementasi masa prenatal mempunyai efek yang lemah terhadap pertumbuhanyang diukur dengan indikator tinggi badan menurut umur (HAZ). Perbedaan absolutpanjang badan anak antara kelompok vitamin A dan kombinasi vitamin A dan zink pada umur3 dan 9 bulan adalah 0,34 SD dan 0,37 SD; dan perbedaan absolut antara kelompok vitaminA dengan zink pada umur 18 bulan adalah 0,31 SD. Dengan menggunakan kriteria growthfaltering sebagai penurunan garis pertumbuhan memotong ≥ 2 persentil major, 50-75% anakmengalami growth faltering pada umur 9 bulan, dan hanya 17% dan 8% yang terdeksi mengalamigrowth faltering bila digunakan kriteria WAZ dan HAZ <- 2SD. Suplementasi vitaminA dan zink pada masa prenatal tidak menurunkan prevalensi growth faltering.

Kesimpulan: Suplementasi vitamin A dan zink pada masa prenatal menunjukkan adanyapengaruh lemah tetapi bermakna terhadap panjang lahir, tetapi tidak menunjukkan efekprotektif terhadap kematian bayi dan morbiditas neonatal. Suplementasi vitamin A pada masaprenatal mempunyai efek lemah tetapi bermakna terhadap pertumbuhan panjang badansampai dengan umur 18 bulan, tetapi tidak disertai pengaruh terhadap kenaikan berat badan,laju pertumbuhan dan tidak menurunkan prevalensi growth faltering.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2012. 44 p.
Keyword
zinc, vitamin A, prenatal supplementation, birth size, growth, morbidity, mortality, Zink, vitamin A, suplementasi prenatal, ukuran lahir, pertumbuhan, morbiditas, mortalitas
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-52912 (URN)978-91-7459-376-1 (ISBN)
Presentation
2012-03-14, Sal 135, Allmänmedicin, Norrlands universitetssjukhus, By 9 A, ingång X5, Norrlands universitetssjukhus, Umeå, 13:00 (English)
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Available from: 2012-03-13 Created: 2012-03-06 Last updated: 2015-04-29Bibliographically approved

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