• Parul Christian, Subarna K Khatry, Joanne Katz, Elizabeth K Pradhan, Steven C LeClerq, Sharada Ram Shrestha, Ramesh K Adhikari, Alfred Sommer, and Keith P West.
• Division of Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. pchristi@jhsph.edu
• BMJ. 2003 Mar 15;326(7389):571.

ObjectiveTo assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women.DesignDouble blind cluster randomised controlled trial.SettingRural community in south eastern Nepal.Participants4926 pregnant women and 4130 live born infants.Interventions426 communities were randomised to five regimens in which pregnant women received daily supplements of folic acid, folic acid-iron, folic acid-iron-zinc, or multiple micronutrients all given with vitamin A, or vitamin A alone (control).Main Outcome MeasuresBirth weight, length, and head and chest circumference assessed within 72 hours of birth. Low birth weight was defined <2500 g.ResultsSupplementation with maternal folic acid alone had no effect on birth size. Folic acid-iron increased mean birth weight by 37 g (95% confidence interval -16 g to 90 g) and reduced the percentage of low birthweight babies (<2500 g) from 43% to 34% (16%; relative risk=0.84, 0.72 to 0.99). Folic acid-iron-zinc had no effect on birth size compared with controls. Multiple micronutrient supplementation increased birth weight by 64 g (12 g to 115 g) and reduced the percentage of low birthweight babies by 14% (0.86, 0.74 to 0.99). None of the supplement combinations reduced the incidence of preterm births. Folic acid-iron and multiple micronutrients increased head and chest circumference of babies, but not length.ConclusionsAntenatal folic acid-iron supplements modestly reduce the risk of low birth weight. Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk.

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