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Review
. 2015 Feb 2;2015(2):CD000230.
doi: 10.1002/14651858.CD000230.pub5.

Zinc supplementation for improving pregnancy and infant outcome

Erika Ota  1 , Rintaro Mori, Philippa Middleton, Ruoyan Tobe-Gai, Kassam Mahomed, Celine Miyazaki, Zulfiqar A Bhutta
Affiliations
Review

Zinc supplementation for improving pregnancy and infant outcome

Erika Ota et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: It has been suggested that low serum zinc levels may be associated with suboptimal outcomes of pregnancy such as prolonged labour, atonic postpartum haemorrhage, pregnancy-induced hypertension, preterm labour and post-term pregnancies, although many of these associations have not yet been established.

Objectives: To assess the effects of zinc supplementation in pregnancy on maternal, fetal, neonatal and infant outcomes.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014) and reference lists of retrieved studies.

Selection criteria: Randomised trials of zinc supplementation in pregnancy. We excluded quasi-randomised controlled trials.

Data collection and analysis: Three review authors applied the study selection criteria, assessed trial quality and extracted data. When necessary, we contacted study authors for additional information. The quality of the evidence was assessed using GRADE.

Main results: We included 21 randomised controlled trials (RCTs) reported in 54 papers involving over 17,000 women and their babies. One trial did not contribute data. Trials were generally at low risk of bias. Zinc supplementation resulted in a small reduction in preterm birth (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.76 to 0.97 in 16 RCTs; 16 trials of 7637 women). This was not accompanied by a similar reduction in numbers of babies with low birthweight (RR 0.93, 95% CI 0.78 to 1.12; 14 trials of 5643 women). No clear differences were seen between the zinc and no zinc groups for any of the other primary maternal or neonatal outcomes, except for induction of labour in a single trial. No differing patterns were evident in the subgroups of women with low versus normal zinc and nutrition levels or in women who complied with their treatment versus those who did not. The GRADE quality of the evidence was moderate for preterm birth, small-for-gestational age, and low birthweight, and low for stillbirth or neonatal death and birthweight.

Authors' conclusions: The evidence for a 14% relative reduction in preterm birth for zinc compared with placebo was primarily represented by trials involving women of low income and this has some relevance in areas of high perinatal mortality. There was no convincing evidence that zinc supplementation during pregnancy results in other useful and important benefits. Since the preterm association could well reflect poor nutrition, studies to address ways of improving the overall nutritional status of populations in impoverished areas, rather than focusing on micronutrient and or zinc supplementation in isolation, should be an urgent priority.

PubMed Disclaimer

Conflict of interest statement

Kassam Mahomed was principal investigator in a trial included in this review and was not involved in its assessment or data extraction.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 1 Zinc supplementation versus no zinc (with or without placebo), outcome: 1.1 Preterm birth.
4
4
Funnel plot of comparison: 1 Zinc supplementation versus no zinc (with or without placebo), outcome: 1.3 Birthweight.
5
5
Funnel plot of comparison: 1 Zinc supplementation versus no zinc (with or without placebo), outcome: 1.5 Low birthweight.
1.1
1.1. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 1 Preterm birth.
1.2
1.2. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 2 Stillbirth or neonatal death.
1.3
1.3. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 3 Birthweight.
1.4
1.4. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 4 Small‐for‐gestational age.
1.5
1.5. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 5 Low birthweight.
1.6
1.6. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 6 Antepartum haemorrhage.
1.7
1.7. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 7 Pregnancy hypertension or pre‐eclampsia.
1.8
1.8. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 8 Prelabour rupture of membranes.
1.9
1.9. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 9 Post‐term birth.
1.10
1.10. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 10 Induction of labour.
1.11
1.11. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 11 Any maternal infection.
1.12
1.12. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 12 Meconium in liquor.
1.13
1.13. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 13 Caesarean section.
1.14
1.14. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 14 Instrumental vaginal birth.
1.15
1.15. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 15 Retention of placenta.
1.16
1.16. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 16 Postpartum haemorrhage.
1.17
1.17. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 17 Smell dysfunction.
1.18
1.18. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 18 Taste dysfunction.
1.19
1.19. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 19 Fetal heart rate (beats/minute).
1.20
1.20. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 20 Fetal heart rate variability (beats/minute).
1.21
1.21. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 21 Number of fetal accelerations.
1.22
1.22. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 22 Number of fetal movement bouts.
1.23
1.23. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 23 Fetal activity level.
1.24
1.24. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 24 Fetal movement amplitude.
1.25
1.25. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 25 Gestational age at birth.
1.26
1.26. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 26 High birthweight.
1.27
1.27. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 27 Five‐minute Apgar score less than 5.
1.28
1.28. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 28 Infant head circumference (cm).
1.29
1.29. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 29 Blue or floppy (neonatal hypoxia).
1.30
1.30. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 30 Neonatal sepsis.
1.31
1.31. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 31 Neonatal jaundice.
1.32
1.32. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 32 Respiratory distress syndrome.
1.33
1.33. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 33 Neonatal intraventricular haemorrhage.
1.34
1.34. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 34 Necrotising enterocolitis.
1.35
1.35. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 35 Neonatal hospital stay.
1.36
1.36. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 36 Congenital malformation.
1.37
1.37. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 37 Diarrhoea (episodes/infant over 6 months).
1.38
1.38. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 38 Dysentery (episodes/infant over 6 months).
1.39
1.39. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 39 Cough (episodes/infant over 6 months).
1.40
1.40. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 40 Acute lower respiratory infection (episodes/infant over 6 months).
1.41
1.41. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 41 Impetigo (episodes/infant over 6 months).
1.42
1.42. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 42 Infant weight‐for‐age (Z‐score).
1.43
1.43. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 43 Infant weight‐for‐height (Z‐score).
1.44
1.44. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 44 Infant mid‐upper arm circumference (mm).
1.45
1.45. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 45 Infant mental development index.
1.46
1.46. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 46 Infant psychomotor development index.
1.47
1.47. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 47 Infant approach.
1.48
1.48. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 48 Infant emotional tone.
1.49
1.49. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 49 Infant activity.
1.50
1.50. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 50 Infant co‐operation.
1.51
1.51. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 51 Infant vocalisation.
1.52
1.52. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 52 Differential abilities score at 5 years.
1.53
1.53. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 53 Visual sequential memory score.
1.54
1.54. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 54 Auditory sequential memory score.
1.55
1.55. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 55 Knox cube score.
1.56
1.56. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 56 Gross motor scale score.
1.57
1.57. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 57 Grooved pegboard score.
1.58
1.58. Analysis
Comparison 1 Zinc supplementation versus no zinc (with or without placebo), Outcome 58 Intelligence quotient of infants at 54 months.
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References to ongoing studies

Zahiri 2010 {published data only}
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