Do Multivitamins Reduce Risk for Adverse Birth Outcomes?
BACKGROUND AND PURPOSE:
A change toward poor-quality diet with low nutritional value in high-income countries has led to inadequate vitamin intake during pregnancy
Previous meta-analyses on the benefits of multivitamins and pregnancy outcomes were conducted in low- and middle-income regions and may not be applicable in high-income countries
Wolf et al. (AJOG, 2017) evaluated the link between multivitamin use among women from high-income countries and the risk of adverse birth outcomes
Systematic Review and meta-analysis focusing on high-income countries
Randomized controlled trials and observational studies were evaluated for associations between multivitamins (3 or more vitamins or minerals in tablets or capsules) and adverse birth outcomes
We identified 35 eligible studies including 98,926 women
When comparing the use of multivitamins to those who did not take supplements
No change in risk of preterm birth (relative risk [RR] 0.84; 95% CI 0.69–1.03)
No change in risk for trisomy 21 (RR 0.98; 95% CI, 0.70–1.37)
There were significant decreases in risk for the following outcomes
Small for gestational age (RR 0.77; 95% CI 0.63–0.93)
Neural tube defects (RR 0.67; 95% CI 0.52–0.87)
Cardiovascular defects (RR 0.83; 95% CI 0.70–0.98)
Urinary tract defects (RR 0.60; 95% CI 0.46–0.78)
Limb deficiencies (RR 0.68; 95% CI 0.52-0.89)
Evidence quality was low or very low for all outcomes except for recurrence of neural tube defects (moderate degree)
Routine use of multivitamins in high-income countries can be recommended but authors recommend caution because results are mostly based on low quality evidence
Results do not indicate causality due to large number of observational studies
This study did not confirm the results of previous studies regarding decreased risk of clefting and hydrocephalus, but likely related to differences in search and eligibility criteria
None of the studies compared the use of folic acid and iron vs the use of multivitamins and therefore the authors of this study could not determine if beneficial effects the results of only these two components
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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