Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal

Delan Devakumar; Janet Stocks; Jon G Ayres; Jane Kirby; Sushil K  Yadav; Naomi M  Saville; Graham Devereux; Jonathan C K Wells; Dharma S Manandhar; Anthony Costello; David Osrin

doi:10.1183/09031936.00188914

Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal

Delan Devakumar, Janet Stocks, Jon G Ayres, Jane Kirby, Sushil K Yadav, Naomi M Saville, Graham Devereux, Jonathan C K Wells, Dharma S Manandhar, Anthony Costello, David Osrin

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Abstract

A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at two years of age in offspring, compared with those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function, by measuring spirometry at 7-9 years of age in children born in the trial.
841 children (80% of the cohort) were seen at mean (SD) 8.5 (0.4) years. Technically successful spirometry results were obtained in 793 children (94.3%), 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry and exposures were similar in the two allocation groups. Lung function was also similar, mean (95%CI) difference in z-scores (supplementation – control) being -0.08 (-0.19, 0.04) for FEV1; -0.05 (-0.17, 0.06) for FVC and -0.04 (-0.15, 0.07) for FEV1/FVC. Compared with healthy White children, FEV1 and FVC in the ‘healthy’ Nepalese children were ~1 z-score (~13%) lower, with no difference in FEV1/FVC.
We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age.

Original language	English
Pages (from-to)	1566-1575
Number of pages	10
Journal	European Respiratory Journal
Volume	45
Issue number	6
Early online date	31 May 2015
DOIs	https://doi.org/10.1183/09031936.00188914
Publication status	Published - 1 Jun 2015

Bibliographical note

Date of Acceptance: 12/12/2014

Support statement: This study was funded by the Wellcome Trust (Ref 092121/Z/10/Z), who played no role in its conception, methods, analysis or interpretation. Funding information for this article has been deposited with FundRef.

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This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.
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Devakumar, D., Stocks, J., Ayres, J. G., Kirby, J., Yadav, S. K., Saville, N. M., Devereux, G., Wells, J. C. K., Manandhar, D. S., Costello, A., & Osrin, D. (2015). Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal. European Respiratory Journal, 45(6), 1566-1575. https://doi.org/10.1183/09031936.00188914

Devakumar, D, Stocks, J, Ayres, JG, Kirby, J, Yadav, SK, Saville, NM, Devereux, G, Wells, JCK, Manandhar, DS, Costello, A & Osrin, D 2015, 'Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal', European Respiratory Journal, vol. 45, no. 6, pp. 1566-1575. https://doi.org/10.1183/09031936.00188914

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title = "Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal",

abstract = "A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at two years of age in offspring, compared with those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function, by measuring spirometry at 7-9 years of age in children born in the trial. 841 children (80% of the cohort) were seen at mean (SD) 8.5 (0.4) years. Technically successful spirometry results were obtained in 793 children (94.3%), 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry and exposures were similar in the two allocation groups. Lung function was also similar, mean (95%CI) difference in z-scores (supplementation – control) being -0.08 (-0.19, 0.04) for FEV1; -0.05 (-0.17, 0.06) for FVC and -0.04 (-0.15, 0.07) for FEV1/FVC. Compared with healthy White children, FEV1 and FVC in the {\textquoteleft}healthy{\textquoteright} Nepalese children were ~1 z-score (~13%) lower, with no difference in FEV1/FVC. We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age. ",

author = "Delan Devakumar and Janet Stocks and Ayres, {Jon G} and Jane Kirby and Yadav, {Sushil K} and Saville, {Naomi M} and Graham Devereux and Wells, {Jonathan C K} and Manandhar, {Dharma S} and Anthony Costello and David Osrin",

note = "Date of Acceptance: 12/12/2014 Support statement: This study was funded by the Wellcome Trust (Ref 092121/Z/10/Z), who played no role in its conception, methods, analysis or interpretation. Funding information for this article has been deposited with FundRef.",

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AU - Devakumar, Delan

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AU - Kirby, Jane

AU - Yadav, Sushil K

AU - Saville, Naomi M

AU - Devereux, Graham

AU - Wells, Jonathan C K

AU - Manandhar, Dharma S

AU - Costello, Anthony

AU - Osrin, David

N1 - Date of Acceptance: 12/12/2014 Support statement: This study was funded by the Wellcome Trust (Ref 092121/Z/10/Z), who played no role in its conception, methods, analysis or interpretation. Funding information for this article has been deposited with FundRef.

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N2 - A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at two years of age in offspring, compared with those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function, by measuring spirometry at 7-9 years of age in children born in the trial. 841 children (80% of the cohort) were seen at mean (SD) 8.5 (0.4) years. Technically successful spirometry results were obtained in 793 children (94.3%), 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry and exposures were similar in the two allocation groups. Lung function was also similar, mean (95%CI) difference in z-scores (supplementation – control) being -0.08 (-0.19, 0.04) for FEV1; -0.05 (-0.17, 0.06) for FVC and -0.04 (-0.15, 0.07) for FEV1/FVC. Compared with healthy White children, FEV1 and FVC in the ‘healthy’ Nepalese children were ~1 z-score (~13%) lower, with no difference in FEV1/FVC. We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age.

AB - A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at two years of age in offspring, compared with those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function, by measuring spirometry at 7-9 years of age in children born in the trial. 841 children (80% of the cohort) were seen at mean (SD) 8.5 (0.4) years. Technically successful spirometry results were obtained in 793 children (94.3%), 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry and exposures were similar in the two allocation groups. Lung function was also similar, mean (95%CI) difference in z-scores (supplementation – control) being -0.08 (-0.19, 0.04) for FEV1; -0.05 (-0.17, 0.06) for FVC and -0.04 (-0.15, 0.07) for FEV1/FVC. Compared with healthy White children, FEV1 and FVC in the ‘healthy’ Nepalese children were ~1 z-score (~13%) lower, with no difference in FEV1/FVC. We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age.

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DO - 10.1183/09031936.00188914

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JF - European Respiratory Journal

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ER -

Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal

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