Trial reportThe Journal of nutrition2025
Hemoglobin During Pregnancy Does Not Mediate the Relationship between Nutrition Supplements and Intrauterine Growth: A Secondary Data Analysis of Women First Preconception Nutrition Trial.
Trial report in The Journal of nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01883193 (Women First), which is not on this map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Women First: Preconception Maternal Nutrition
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Authors and funding
22 authors.
Funding
Abstract
backgroundNutrition supplements such as multiple micronutrient-fortified small-quantity lipid-based nutrient supplementation (SQ-LNS) consumed either before or during pregnancy have been shown to improve intrauterine growth, but the mechanisms through which the supplements improve intrauterine growth remain unclear.
objectivesWe examined whether hemoglobin (Hb) during pregnancy could be a potential mechanism through which multiple micronutrient-fortified SQ-LNS improve intrauterine growth.
methodsWe used data collected from women and newborns in a randomized controlled trial conducted in Pakistan, India, the Democratic Republic of the Congo, and Guatemala. Women were randomly assigned to consume multiple micronutrient-fortified SQ-LNS from preconception until birth (arm 1); consume the SQ-LNS from the second trimester of pregnancy until birth (arm 2); or no supplement (arm 3). Intrauterine growth, expressed as birth length, weight, and head circumference Z-scores, was the outcome. The mediator was Hb (g/dL) measured at 12 (n = 2075) and 32 wk of gestation (n = 2157). Causal mediation analysis was employed to estimate direct and indirect effects.
resultsHb levels at 12 or 32 wk of gestation did not mediate the relation between the SQ-LNS and intrauterine growth. Indirect effects of preconception SQ-LNS (arm 1) compared with arm 3, mediated by Hb at 12 wk of gestation, were 0.02 [95% confidence interval (CI): -0.02, 0.01], 0.01 (95% CI: -0.01, 0.02), and 0.01 (95% CI: -0.01, 0.02) for length, weight, and head circumference Z-scores, respectively. The corresponding direct effects (95% CIs), not mediated by Hb, were 0.18 (0.09, 0.33), 0.12 (0.03, 0.23), and 0.06 (-0.03, 0.20), respectively. Site-specific and gestational age-adjusted data analyses at 12 and 32 wk of gestation confirmed the findings of no statistically significant mediated effects of Hb during pregnancy.
conclusionsThe observed main effect of multiple micronutrient-fortified SQ-LNS on intrauterine growth was not mediated by Hb levels at 12 or 32 wk of gestation. The findings suggest exploring other pathways implicated in the association between the SQ-LNS and intrauterine growth. This trial was registered at clinicaltrials.gov as #NCT01883193 (https://clinicaltrials.gov/ct2/show/NCT01883193?term=01883193&rank=1).
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