Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi.

A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 µg/d folic acid (IFA) or 18 vitamins and minerals including 250 µg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient supplements (SQ-LNS) with similar nutrient contents as MMN group, plus macronutrients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (µg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150–249, 250–499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively.

Mangochi District, Malawi.

Women ≤20 weeks pregnant.

Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above requirements. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes.

In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women’s UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.

To assess under real community settings the effectiveness of the WHO strategy of home fortification of foods (HFF) with multiple-micronutrient powders on Hb change, anaemia and weight in children.

A pragmatic cluster-randomized controlled trial.

Forty villages in the Nioro Circle in Mali and 722 children aged 6–23 months were randomized to the intervention or control group. The intervention consisted of a daily dose of multiple-micronutrient powder for 3 months; in the control group, no supplement was given. In both groups, mothers received group education on child complementary feeding. Changes in weight, Hb concentration and anaemia were assessed as primary outcomes at baseline and 3 months. The HFF effect was determined using regression analyses and quantile regression with standard errors taking account of the cluster design.

Children aged 6–23 months.

Overall prevalence of anaemia in the sample was high: 90 %. HFF provided a modest but statistically significant Hb change v. no intervention (0·50 v. 0·09 g/dl, P=0·023). Prevalence of anaemia changed little: 91·3–85·8 % (P=0·04) in the intervention group v. 88·1–87·5 % % (P=0·86) in the control group. Proportion of severe anaemia was reduced by 84 % (from 9·8 to 1·6 %) in the intervention group, but increased in the control group (from 8·5 to 10·8 %). No effect was observed on weight.

The WHO HFF strategy to fight anaemia showed a modest change on Hb concentration and significantly reduced the rate of severe anaemia.

To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients (MM) on Hb concentration of young children.

In a nutrition centre that we opened in their villages, children received either MM supplement (containing iron, zinc, vitamin A, vitamin C and iodine) with the improved gruel (MMGG) or the improved gruel only (GG), twice daily, 6 d/week, for 6 months. We assessed baseline and endpoint Hb concentration and anthropometric indices.

Kongoussi, a rural and poor district of Burkina Faso.

In a community-based trial, we randomly assigned 131 children aged 6–23 months with Hb concentrations in the range of 80–109 g/l into two groups.

The groups did not differ significantly at baseline. Mean baseline Hb concentration was 89·2 (sd 6·5) g/l and 90·3 (sd 8·4) g/l in the GG and the MMGG, respectively (P = 0·42). It increased to 104·1 (sd 11·4) g/l in the GG (P < 0·001) and 107·6 (sd 14·7) g/l in the MMGG (P < 0·001). The between-group difference of 3·5 (95 % CI −1·0, 8·1) g/l in mean (sd) endpoint Hb concentration was not significant (P = 0·13). The endpoint anthropometric indices were not different between the groups.

This MM supplement had no additional effect on Hb concentration. Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine.

To test the hypothesis that maternal food fortification with omega-3 fattyacids and multiple micronutrients increases birth weight and gestationduration, as primary outcomes.

Non-blinded, randomised controlled study.

Pregnant women received powdered milk during their health check-ups at 19antenatal clinics and delivered at two maternity hospitals in Santiago,Chile.

Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified withmultiple micronutrients and omega-3 fatty acids (n = 495).

Intention-to-treat analysis showed that mean birth weight was higher in theintervention group than in controls (65.4 g difference, 95% confidenceinterval (CI) 5–126 g; P =0.03) and the incidence of very preterm birth (<34 weeks) waslower (0.4% vs. 2.1%; P = 0.03).On-treatment analysis showed a mean birth weight difference of 118 g (95% CI47–190 g; P = 0.001) and arelative fall in both the proportion of birth weight ≤3000 g(P = 0.015) and the incidence ofpre-eclampsia (P = 0.015). Compliancewith the experimental product was apparent from a haematological study ofred-blood-cell folate at the end of pregnancy, which was performed in asub-sample. In both types of analyses, positive differences were alsopresent for mean gestation duration, birth length and head circumference.Nevertheless, the relatively small sample sizes allowed a statistical powerof >0.80 just for mean birth weight and birth length in theon-treatment analysis; birth length in that analysis had a difference of0.57 cm (95% CI 0.19–0.96 cm; P = 0.003).

The new intervention resulted in increased mean birth weight. Associationswith gestation duration and most secondary outcomes need a larger samplesize for confirmation.