Effect of Maternal Multiple Micronutrients Supplementation on the Apgar Score of Indonesian Neonates

Introduction: Maternal multiple micronutrients (MMN) supplementation as compared to iron-folic acid (IFA) can increase birth weight and decrease infant mortality, but the physiological basis remains unclear. We examined Apgar scores to assess the impact of MMN on the dynamic process of neonatal adaptation after birth. Methods: We selected 3667 singleton live births from the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) of maternal MMN versus IFA (ISRCTN34151616) with Apgar scores at the 1st and 5th minute, after excluding those with midline anomaly, inborn diseases and if not a spontaneous vaginal birth. Mixed effect multiple linear regression models were used to adjust for clustered randomization, covariates and interactions. Results: Overall, there were no significant differences between Apgar scores of children from the MMN and IFA groups at the 1st (adjusted β -0.416, 95% CI -0.339-0.047) or 5th minute (adjusted β 0.077, 95% CI -0.097-0.252), or changes from 1 to 5 minutes (...