1 Total fetal loss (including miscarriages or combined miscarriages and stillbirths) Show forest plot

13

33943

Relative risk (Fixed, 95% CI)

1.04 [0.95, 1.14]

1.1 Trial entry before pregnancy

5

25182

Relative risk (Fixed, 95% CI)

1.06 [0.96, 1.17]

1.2 Trial entry < 12 weeks' gestation

1

406

Relative risk (Fixed, 95% CI)

1.32 [0.63, 2.77]

1.3 Trial entry >= 12 weeks' and < 20 weeks' gestation

1

739

Relative risk (Fixed, 95% CI)

0.84 [0.38, 1.85]

1.4 Trial entry 'mixed' both < 20 and >= 20 weeks' gestation

6

7616

Relative risk (Fixed, 95% CI)

0.89 [0.66, 1.20]

2 Early or late miscarriage Show forest plot

10

11266

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.95, 1.25]

2.1 Trial entry before pregnancy

4

7809

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.93, 1.24]

2.2 Trial entry < 12 weeks' gestation

1

406

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.63, 2.77]

2.3 Trial entry >= 12 weeks but < 20 weeks' gestation

1

739

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.30, 5.87]

2.4 Trial entry 'mixed' both < 20 and >= 20 weeks' gestation

4

2312

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.63, 2.24]

3 Placental abruption Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Placental abruption

4

4264

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.34, 1.30]

3.2 Antepartum haemorrhage including placental abruption

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

7.0 [0.88, 55.86]

4 Psychological effects (anxiety and depression)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pre‐eclampsia Show forest plot

7

9561

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.70, 1.09]

6 Stillbirth Show forest plot

9

15980

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.65, 1.13]

6.1 Trial entry before pregnancy

3

7785

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.48, 1.85]

6.2 Trial entry < 12 weeks' gestation

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Trial entry >= 12 weeks' but < 20 weeks' gestation

1

739

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.27, 1.80]

6.4 Trial entry 'mixed' both < 20 and >= 20 weeks' gestation

5

7456

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.63, 1.19]

7 Perinatal death Show forest plot

4

4313

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.62, 1.11]

8 Neonatal death Show forest plot

6

27657

Relative risk (Fixed, 95% CI)

1.11 [0.94, 1.31]

9 Preterm birth Show forest plot

8

27414

Relative risk (Fixed, 95% CI)

1.02 [0.94, 1.10]

10 Very preterm birth Show forest plot

4

4181

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.75, 1.15]

11 Birthweight Show forest plot

5

7497

Mean Difference (IV, Random, 95% CI)

16.99 [‐37.66, 71.64]

12 Small‐for‐gestational age Show forest plot

7

9356

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.84, 1.08]

12.1 Birthweight less than 10th centile or birthweight < 2500 g

7

9356

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.84, 1.08]

13 Congenital malformations Show forest plot

4

8933

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.90, 2.40]

14 Multiple pregnancy Show forest plot

3

20986

Relative risk (Fixed, 95% CI)

1.38 [1.12, 1.70]

15 Apgar score less than seven at five minutes Show forest plot

1

700

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.27, 1.60]

16 Use of blood transfusion for the mother

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 Anaemia (maternal) Show forest plot

2

1190

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.46, 1.73]

18 Anaemia (infant) Show forest plot

1

836

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.98, 1.12]

19 Placental weight Show forest plot

1

29

Mean Difference (IV, Fixed, 95% CI)

96.0 [30.73, 161.27]

20 Method of feeding Show forest plot

1

4878

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.96, 1.01]

20.1 Breastfeeding

1

4878

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.96, 1.01]

20.2 Formula

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.3 Breastfeeding and formula

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Subsequent fertility

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

22 Poor growth at childhood follow‐up

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

23 Disability at childhood follow‐up

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

24 Any adverse effects of vitamin supplementation sufficient to stop supplementation Show forest plot

1

739

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.39, 3.41]

25 Maternal views of care

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

26 Gynaecological hospital admission Show forest plot

1

1365

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.69]

26.1 Any maternal admission to ICU

1

1365

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.69]

27 Admission to neonatal intensive care unit Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

27.1 Any admission to NICU

1

1515

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.11]

27.2 > 4 days of NICU care

1

1853

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.27, 1.37]

27.3 > 7 days in NICU

1

1515

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.54, 1.39]

28 Healthcare costs

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

29 Duration of admission to the neonatal intensive care unit Show forest plot

1

181

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐0.28, 2.88]

30 Side effects Show forest plot

1

1734

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.12, 2.36]

30.1 Abdominal pain

1

1734

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.12, 2.36]

1 Total fetal loss (including miscarriage or combined miscarriages and stillbirths) Show forest plot

5

Relative risk (Fixed, 95% CI)

0.97 [0.84, 1.12]

1.1 Allocation concealment is adequate

5

Relative risk (Fixed, 95% CI)

0.97 [0.84, 1.12]

2 Early or late miscarriage Show forest plot

4

4633

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.71, 1.27]

2.1 Allocation concealment is adequate

4

4633

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.71, 1.27]

3 Stillbirth Show forest plot

5

4916

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.47, 1.53]

3.1 Allocation concealment is adequate

5

4916

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.47, 1.53]

1 Total fetal loss Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Vitamin C + multivitamins versus placebo plus multivitamins

1

406

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.63, 2.77]

1.2 Vitamin C and vitamin E versus placebo

3

2899

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.48, 1.42]

1.3 Vitamin C versus no supplement/placebo

2

224

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.58, 2.83]

2 Early or late miscarriage Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Vitamin C + multivitamins versus placebo plus multivitamins

1

406

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.63, 2.77]

2.2 Vitamin C and vitamin E versus placebo

2

2616

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.27, 1.84]

2.3 Vitamin C versus no supplement/placebo

2

224

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.52, 2.65]

3 Antepartum haemorrhage and placental abruption Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Vitamin C and vitamin E versus placebo ‐ placental abruption only

4

4264

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.34, 1.30]

3.2 Vitamin C versus placebo ‐ antepartum haemorrhage including placental abruption

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

7.0 [0.88, 55.86]

4 Pre‐eclampsia Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Vitamin C and vitamin E versus placebo

4

4264

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.72, 1.22]

4.2 Vitamin C versus placebo

1

200

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.21, 4.84]

5 Stillbirth Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Vitamin C and vitamin E versus placebo

3

2899

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.46, 1.73]

5.2 Vitamin C versus placebo

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.12, 72.77]

6 Perinatal death Show forest plot

4

4313

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.62, 1.11]

6.1 Vitamin C versus placebo

1

182

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.05, 5.54]

6.2 Vitamin C and vitamin E versus placebo

3

4131

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.63, 1.12]

7 Neonatal death Show forest plot

3

2717

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.30, 1.61]

7.1 Vitamin C versus placebo

1

181

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.12, 4.03]

7.2 Vitamin C and E versus placebo

2

2536

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.27, 1.81]

8 Preterm birth Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Vitamin C and vitamin E versus placebo

4

4264

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.85, 1.10]

8.2 Vitamin C versus placebo

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.43 [1.03, 1.99]

9 Very preterm birth Show forest plot

4

4181

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.75, 1.15]

9.1 Vitamin C versus placebo

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.3 [0.78, 2.17]

9.2 Vitamin C and vitamin E versus placebo

3

3981

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.70, 1.10]

10 Small‐for‐gestational age Show forest plot

4

4233

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.78, 1.04]

10.1 Vitamin C and vitamin E versus placebo

4

4233

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.78, 1.04]

11 Birthweight Show forest plot

2

2561

Mean Difference (IV, Fixed, 95% CI)

1.25 [‐47.45, 49.95]

11.1 Vitamin C and vitamin E versus placebo

2

2561

Mean Difference (IV, Fixed, 95% CI)

1.25 [‐47.45, 49.95]

12 Congenital malformations Show forest plot

2

2254

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.84]

12.1 Vitamin C and vitamin E versus placebo

2

2254

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.84]

13 Apgar score less than seven at five minutes Show forest plot

1

700

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.27, 1.60]

13.1 Vitamin C and vitamin E versus placebo

1

700

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.27, 1.60]

14 Any adverse effects of vitamin supplementation sufficient to stop supplementation Show forest plot

1

739

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.39, 3.41]

14.1 Vitamin C and vitamin E versus placebo

1

739

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.39, 3.41]

15 Gynaecological hospital admission Show forest plot

1

1365

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.69]

15.1 Vitamin C and vitamin E versus placebo: Any maternal admission to ICU

1

1365

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.69]

16 Admission to neonatal intensive care unit Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

16.1 Vitamin C and vitamin E versus placebo: Any admission to NICU

1

1515

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.11]

16.2 Vitamin C and vitamin E versus placebo: > 4 days of NICU care

1

1853

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.27, 1.37]

16.3 Vitamin C and vitamin E versus placebo: > 7 days of NICU care

1

1515

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.54, 1.39]

17 Side effects Show forest plot

1

1734

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.12, 2.36]

17.1 Vitamin C and vitamin E versus placebo: Abdominal pain

1

1734

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [1.12, 2.36]

1 Total fetal loss (including miscarriages or combined miscarriages and stillbirths) Show forest plot

5

Relative risk (Fixed, 95% CI)

Subtotals only

1.1 Vitamin A versus placebo

1

11723

Relative risk (Fixed, 95% CI)

1.04 [0.92, 1.17]

1.2 B‐carotene versus placebo

1

11303

Relative risk (Fixed, 95% CI)

1.03 [0.91, 1.16]

1.3 Vitamin A versus B‐carotene

1

11720

Relative risk (Fixed, 95% CI)

1.01 [0.90, 1.14]

1.4 Vitamin A or B‐carotene versus placebo

1

17373

Relative risk (Fixed, 95% CI)

1.05 [0.91, 1.21]

1.5 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1074

Relative risk (Fixed, 95% CI)

0.80 [0.53, 1.21]

1.6 Vitamin A + iron + folate versus iron + folate

3

1640

Relative risk (Fixed, 95% CI)

1.01 [0.61, 1.66]

2 Early or late miscarriage Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.37, 1.55]

2.2 Vitamin A + iron + folate versus iron + folate

2

1397

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.47, 1.63]

3 Stillbirth Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.60, 1.79]

3.2 Vitamin A + iron + folate versus iron + folate

3

1640

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.57, 2.91]

4 Neonatal death Show forest plot

1

Relative risk (Fixed, 95% CI)

Subtotals only

4.1 Vitamin A versus placebo

1

10214

Relative risk (Fixed, 95% CI)

1.09 [0.92, 1.30]

4.2 B‐carotene versus placebo

1

9788

Relative risk (Fixed, 95% CI)

1.09 [0.91, 1.30]

4.3 Vitamin A versus B‐carotene

1

10228

Relative risk (Fixed, 95% CI)

1.0 [0.85, 1.18]

4.4 Vitamin A or B‐carotene versus placebo

1

15115

Relative risk (Fixed, 95% CI)

1.09 [0.91, 1.30]

5 Preterm birth Show forest plot

3

Relative risk (Fixed, 95% CI)

Subtotals only

5.1 Vitamin A versus placebo

1

11723

Relative risk (Fixed, 95% CI)

1.04 [0.89, 1.21]

5.2 B‐carotene versus placebo

1

11303

Relative risk (Fixed, 95% CI)

1.01 [0.86, 1.18]

5.3 Vitamin A versus B‐carotene

1

11720

Relative risk (Fixed, 95% CI)

1.03 [0.88, 1.20]

5.4 Vitamin A or B‐carotene versus placebo

1

17373

Relative risk (Fixed, 95% CI)

1.02 [0.89, 1.17]

5.5 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1075

Relative risk (Fixed, 95% CI)

1.07 [0.84, 1.37]

5.6 Vitamin A + iron + folate versus iron + folate

1

700

Relative risk (Fixed, 95% CI)

1.11 [0.59, 2.09]

6 Birthweight Show forest plot

1

594

Mean Difference (IV, Fixed, 95% CI)

90.0 [2.68, 177.32]

6.1 Vitamin A + iron + folate versus iron + folate

1

594

Mean Difference (IV, Fixed, 95% CI)

90.0 [2.68, 177.32]

7 Small‐for‐gestational age Show forest plot

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.58, 1.21]

7.1 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.58, 1.21]

8 Multiple pregnancy Show forest plot

1

Relative risk (Fixed, 95% CI)

Subtotals only

8.1 Vitamin A versus placebo

1

10697

Relative risk (Fixed, 95% CI)

1.35 [0.99, 1.85]

8.2 B‐carotene versus placebo

1

10294

Relative risk (Fixed, 95% CI)

1.37 [1.00, 1.88]

8.3 Vitamin A versus B‐carotene

1

10699

Relative risk (Fixed, 95% CI)

1.03 [0.77, 1.37]

8.4 Vitamin A or B‐carotene versus placebo

1

15845

Relative risk (Fixed, 95% CI)

1.39 [1.05, 1.84]

9 Very preterm birth Show forest plot

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.71, 1.74]

9.1 Vitamin A (with/without multivitamins) versus multivitamins or placebo

1

1075

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.71, 1.74]

10 Maternal anaemia Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Vitamin A + beta‐carotene with or without multivitamin versus placebo

1

807

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.60, 1.24]

10.2 Vitamin A + beta‐carotene versus placebo

1

539

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.60, 1.38]

10.3 Vitamin A + iron and folic acid versus iron and folic acid

1

700

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.82, 1.12]

11 Infant anaemia Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Infant anaemia at 6 weeks' of age ‐ vitamin A + iron + folate versus iron + folate

1

562

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.45, 0.75]

11.2 Infant anaemia at 12 months ‐ vitamin A + iron + folate versus iron + folate

1

478

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.88, 1.20]

11.3 Infant anaemia ‐ vitamin A + beta‐carotene with or without multivitamins versus placebo

1

625

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.92, 1.06]

11.4 Infant anaemia ‐ vitamin A + beta‐carotene versus placebo

1

406

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.92, 1.08]

12 Poor growth at childhood follow up Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 Weight (g) at 6 weeks: vitamin A + iron + folate versus iron + folate

1

546

Mean Difference (IV, Fixed, 95% CI)

169.0 [16.55, 321.45]

12.2 Length (cm) at 6 weeks: vitamin A + iron + folate versus iron + folate

1

546

Mean Difference (IV, Fixed, 95% CI)

0.70 [0.15, 1.25]

12.3 Weight (g) at 4 months: vitamin A + iron + folate versus iron + folate

1

148

Mean Difference (IV, Fixed, 95% CI)

‐100.0 [‐377.14, 177.14]

12.4 Length (cm) at 4 months: vitamin A + iron + folate versus iron + folate

1

148

Mean Difference (IV, Fixed, 95% CI)

‐0.5 [‐1.33, 0.33]

1 Total fetal loss (including miscarriages or combined miscarriages and stillbirths) Show forest plot

12

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Multivitamin + folic acid versus no multivitamin/folic acid

3

6883

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.75, 1.34]

1.2 Multivitamin without folic acid versus no multivitamin/folic acid

1

907

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.56, 1.25]

1.3 Multivitamins with/without folic acid versus no multivitamins/folic acid

1

1368

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.27]

1.4 Multivitamin + folic acid versus folic acid

2

1096

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.72, 1.48]

1.5 Multivitamin without folic acid versus folic acid

2

1090

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.62, 1.30]

1.6 Multivitamin with/without folic acid versus folic acid

2

1644

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.69, 1.30]

1.7 Multivitamin with/without vitamin A versus vitamin A or placebo

1

1074

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.39, 0.91]

1.8 Multivitamins versus control

1

5021

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.58, 1.17]

1.9 Multivitamin + vitamin E versus multivitamin without vitamin E or controls

1

823

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.46, 1.83]

1.10 Multivitamins + iron + folic acid versus iron + folic acid

5

42404

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.75, 1.09]

2 Early or late miscarriage Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Multivitamin + folic acid versus no multivitamin/folic acid

3

6883

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.72, 1.38]

2.2 Multivitamin without folic acid versus no multivitamin/folic acid

1

907

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.59, 1.34]

2.3 Multivitamin with/without folic acid versus no multivitamin/folic acid

1

1368

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.67, 1.34]

2.4 Multivitamin + folic acid versus folic acid

2

1096

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.72, 1.49]

2.5 Multivitamin without folic acid versus folic acid

2

1090

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.61, 1.31]

2.6 Multivitamin with/without folic acid versus folic acid

2

1644

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.70, 1.33]

2.7 Multivitamin + vitamin E versus multivitamin without vitamin E or controls

1

823

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.26, 4.13]

2.8 Multivitamin + iron + folic acid versus iron + folic acid

5

42404

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.73, 1.11]

3 Placental abruption Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Multivitamins + iron + folic acid versus iron + folic acid

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Pre‐eclampsia Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Multivitamin versus control

1

5021

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.55, 0.90]

4.2 Multivitamin + iron + folic acid versus iron + folic acid

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.06, 1.01]

5 Stillbirth Show forest plot

11

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Multivitamin + folic acid versus no multivitamin/folic acid

3

6883

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.51, 2.10]

5.2 Multivitamin without folic acid versus no multivitamin/folic acid

1

907

Risk Ratio (M‐H, Random, 95% CI)

0.14 [0.01, 2.76]

5.3 Multivitamin with/without folic acid versus no multivitamin/folic acid

1

1368

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.06, 1.97]

5.4 Multivitamin + folic acid versus folic acid

2

1096

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.14, 6.88]

5.5 Multivitamin without folic acid versus folic acid

2

1090

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.04, 22.88]

5.6 Multivitamin with/without folic acid versus folic acid

2

1644

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.15, 4.10]

5.7 Multivitamin versus control

1

5021

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.58, 1.17]

5.8 Multivitamin + vitamin E versus multivitamin without vitamin E or controls

1

823

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.39, 1.98]

5.9 Multivitamin + iron + folic acid versus iron + folic acid

5

42404

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.75, 1.07]

6 Perinatal death Show forest plot

5

Relative risk (Random, 95% CI)

Subtotals only

6.1 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

4308

Relative risk (Random, 95% CI)

1.11 [0.98, 1.26]

6.2 Multivitamin + iron + folic acid versus iron + folic acid

4

42344

Relative risk (Random, 95% CI)

0.99 [0.80, 1.21]

7 Neonatal death Show forest plot

8

Relative risk (Fixed, 95% CI)

Subtotals only

7.1 Multivitamin + folic acid versus no multivitamin/folic acid

1

4930

Relative risk (Fixed, 95% CI)

1.59 [0.30, 8.30]

7.2 Multivitamin + vitamin E versus multivitamin without vitamin E or controls

1

787

Relative risk (Fixed, 95% CI)

1.44 [0.91, 2.27]

7.3 Multivitamin versus control

1

4895

Relative risk (Fixed, 95% CI)

1.0 [0.75, 1.34]

7.4 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

4122

Relative risk (Fixed, 95% CI)

1.15 [0.97, 1.36]

7.5 Multivitamin + iron + folic acid versus iron + folic acid

4

40706

Relative risk (Fixed, 95% CI)

0.91 [0.80, 1.03]

8 Preterm birth Show forest plot

8

Relative risk (Fixed, 95% CI)

Subtotals only

8.1 Multivitamin + folic acid versus no multivitamin/folic acid

1

5502

Relative risk (Fixed, 95% CI)

1.01 [0.91, 1.12]

8.2 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

3320

Relative risk (Fixed, 95% CI)

0.98 [0.90, 1.07]

8.3 Multivitamin + vitamin E versus multivitamin without vitamin E or controls

1

814

Relative risk (Fixed, 95% CI)

0.99 [0.85, 1.15]

8.4 Multivitamin + iron + folic acid versus iron + folic acid

5

39540

Relative risk (Fixed, 95% CI)

1.00 [0.96, 1.04]

9 Very preterm birth Show forest plot

1

8428

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.73, 1.06]

9.1 Multivitamin + iron + folic acid versus iron + folic acid

1

8428

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.73, 1.06]

10 Birthweight Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 Multivitamin + folic acid versus no multivitamin/folic acid

1

4862

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐24.15, 30.15]

10.2 Multivitamin + iron + folic acid versus iron + folic acid

3

10241

Mean Difference (IV, Fixed, 95% CI)

61.61 [37.32, 85.91]

11 Small‐for‐gestational age (birthweight less than the 10th percentile or < 2500 g Show forest plot

8

Relative risk (Random, 95% CI)

Subtotals only

11.1 Multivitamin + folic acid versus no multivitamin/folic acid

1

4862

Relative risk (Random, 95% CI)

1.09 [0.94, 1.26]

11.2 Multivitamin + folic acid versus no multivitamin/folic acid (birthweight < 2500 g)

1

186

Relative risk (Random, 95% CI)

0.91 [0.63, 1.32]

11.3 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

3320

Relative risk (Random, 95% CI)

0.98 [0.95, 1.02]

11.4 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A (birthweight < 2500 g)

1

3325

Relative risk (Random, 95% CI)

0.95 [0.90, 1.00]

11.5 Multivitamins + iron + folic acid versus iron + folic acid

5

21434

Relative risk (Random, 95% CI)

0.93 [0.77, 1.12]

12 Congenital malformations Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Multivitamin + folic acid versus no multivitamin/folic acid

2

5777

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [0.81, 3.53]

12.2 Multivitamin without folic acid without versus no multivitamin/folic acid

1

907

Risk Ratio (M‐H, Fixed, 95% CI)

1.60 [0.53, 4.86]

12.3 Multivitamin with/without folic acid versus no multivitamin/folic acid

1

1368

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [0.75, 5.26]

12.4 Multivitamin + folic acid versus folic acid

2

1096

Risk Ratio (M‐H, Fixed, 95% CI)

1.71 [0.72, 4.04]

12.5 Multivitamin without folic acid versus folic acid

2

1090

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [0.67, 3.85]

12.6 Multivitamin with/without folic acid versus folic acid

2

1644

Risk Ratio (M‐H, Fixed, 95% CI)

1.66 [0.76, 3.63]

12.7 Multivitamin + iron + folic acid versus iron + folic acid

1

1200

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 7.08]

13 Multiple pregnancy Show forest plot

2

5141

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [1.00, 1.85]

13.1 Multivitamin + folic acid versus no multivitamin/folic acid

2

5141

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [1.00, 1.85]

14 Maternal anaemia Show forest plot

4

Relative risk (Fixed, 95% CI)

Subtotals only

14.1 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A (any anaemia)

1

813

Relative risk (Fixed, 95% CI)

0.92 [0.83, 1.03]

14.2 Multivitamin + folic acid + iron + zinc+vitamin A versus folic acid + iron + zinc + vitamin A (severe anaemia)

1

813

Relative risk (Fixed, 95% CI)

0.82 [0.53, 1.27]

14.3 Multivitamins versus placebo

1

538

Relative risk (Fixed, 95% CI)

0.78 [0.50, 1.22]

14.4 Multivitamins + vitamin A + beta‐carotene versus placebo

1

535

Relative risk (Fixed, 95% CI)

0.82 [0.53, 1.26]

14.5 Multivitamins + iron + folic acid versus iron + folic acid

2

2278

Relative risk (Fixed, 95% CI)

0.88 [0.81, 0.96]

15 Breastfeeding Show forest plot

1

4878

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.96, 1.01]

15.1 Multivitamin versus control

1

4878

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.96, 1.01]

16 Poor growth at childhood follow up: Underweight in childhood (6‐8 years of age) Show forest plot

1

3356

Risk Ratio (Fixed, 95% CI)

1.05 [0.97, 1.13]

16.1 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

3356

Risk Ratio (Fixed, 95% CI)

1.05 [0.97, 1.13]

17 Poor growth at childhood follow up: Stunting in childhood (6‐8 years of age) Show forest plot

1

3356

Risk Ratio (Fixed, 95% CI)

1.09 [1.00, 1.19]

17.1 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

3356

Risk Ratio (Fixed, 95% CI)

1.09 [1.00, 1.19]

18 Additional outcomes ‐ infant death Show forest plot

1

4122

Relative risk (Fixed, 95% CI)

1.10 [0.94, 1.29]

18.1 Multivitamin + folic acid + iron + zinc + vitamin A versus folic acid + iron + zinc + vitamin A

1

4122

Relative risk (Fixed, 95% CI)

1.10 [0.94, 1.29]

1 Total fetal loss (including miscarriages or combined miscarriages and stillbirths) Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Folic acid + multivitamin versus no folic acid/multivitamin

3

6883

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.95, 1.25]

1.2 Folic acid without multivitamin versus no folic acid/multivitamin

1

903

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.64, 1.40]

1.3 Folic acid with/without multivitamin versus no folic acid/multivitamin

1

1364

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.69, 1.35]

1.4 Folic acid + multivitamin versus multivitamin

2

1102

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.80, 1.67]

1.5 Folic acid without multivitamin versus multivitamin

2

1090

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.77, 1.62]

1.6 Folic acid with or without multivitamin versus multivitamin

2

1644

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.82, 1.57]

1.7 Folic acid + iron versus iron

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.23 [0.01, 4.59]

1.8 Folic acid + iron + antimalarials versus iron + antimalarials

1

160

Risk Ratio (M‐H, Fixed, 95% CI)

13.0 [0.74, 226.98]

2 Early or late miscarriage Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Folic acid + multivitamin versus no folic acid/multivitamin

3

6883

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.72, 1.38]

2.2 Folic acid without multivitamins versus no folic acid/multivitamin

1

903

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.65, 1.44]

2.3 Folic acid with/without multivitamin versus no folic acid/multivitamin

1

1364

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.70, 1.39]

2.4 Folic acid + multivitamin versus multivitamin

2

1102

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.80, 1.69]

2.5 Folic acid without multivitamin versus multivitamin

2

1090

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.77, 1.64]

2.6 Folic acid with/without multivitamin versus multivitamin

2

1642

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.79, 1.51]

2.7 Folic acid + iron versus iron

1

75

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.02, 9.03]

2.8 Folic acid + iron + antimalarials versus iron + antimalarials

1

160

Risk Ratio (M‐H, Random, 95% CI)

13.0 [0.74, 226.98]

3 Pre‐eclampsia Show forest plot

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.17, 7.69]

3.1 Folic acid + iron versus iron

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.17, 7.69]

4 Stillbirth Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Folic acid + multivitamin versus no folic acid/multivitamin

3

6883

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.51, 2.09]

4.2 Folic acid without multivitamin versus no folic acid/multivitamin

1

903

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.11, 4.02]

4.3 Folic acid with/without multivitamin versus no folic acid/multivitamin

1

1364

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.15, 2.96]

4.4 Folic acid + multivitamin versus multivitamin

2

1102

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.20, 4.99]

4.5 Folic acid without multivitamin versus multivitamin

2

1090

Risk Ratio (M‐H, Fixed, 95% CI)

4.97 [0.58, 42.29]

4.6 Folic acid with/without multivitamin versus multivitamin

2

1644

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.20, 3.53]

4.7 Folic acid + iron versus iron

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.02, 9.03]

5 Perinatal death Show forest plot

1

4308

Relative risk (Fixed, 95% CI)

0.97 [0.85, 1.11]

5.1 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A

1

4308

Relative risk (Fixed, 95% CI)

0.97 [0.85, 1.11]

6 Neonatal death Show forest plot

2

Relative risk (Fixed, 95% CI)

Subtotals only

6.1 Folic acid + multivitamin versus no folic acid/multivitamin

1

4930

Relative risk (Fixed, 95% CI)

1.59 [0.30, 8.28]

6.2 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A

1

4122

Relative risk (Fixed, 95% CI)

0.96 [0.80, 1.14]

7 Preterm birth Show forest plot

3

Relative risk (Fixed, 95% CI)

Subtotals only

7.1 Folic acid + multivitamin versus no folic acid/multivitamin

1

5502

Relative risk (Fixed, 95% CI)

1.01 [0.91, 1.12]

7.2 Folic acid + multivitamin versus no folic acid/multivitamin

1

75

Relative risk (Fixed, 95% CI)

1.01 [0.65, 1.56]

7.3 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A

1

3320

Relative risk (Fixed, 95% CI)

1.02 [0.94, 1.11]

8 Birthweight Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Folic acid + multivitamin versus no folic acid/multivitamin

1

4862

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐24.15, 30.15]

8.2 Folic acid versus placebo

1

29

Mean Difference (IV, Fixed, 95% CI)

312.0 [108.52, 515.48]

8.3 Folic + iron versus control

1

45

Mean Difference (IV, Fixed, 95% CI)

‐32.0 [‐213.62, 149.62]

9 Small‐for‐gestational age Show forest plot

4

Relative risk (Fixed, 95% CI)

Subtotals only

9.1 Folic acid + multivitamin versus no folic acid/multivitamin

1

4862

Relative risk (Fixed, 95% CI)

1.09 [0.94, 1.26]

9.2 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A

1

3320

Relative risk (Fixed, 95% CI)

0.97 [0.92, 1.03]

9.3 Folic acid + iron versus iron (birthweight < 2500 g)

1

75

Relative risk (Fixed, 95% CI)

1.06 [0.48, 2.33]

9.4 Folic acid + multivitamin versus no folic acid/multivitamin (birthweight < 2500 g)

1

186

Relative risk (Fixed, 95% CI)

0.91 [0.63, 1.32]

9.5 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A (birthweight < 2500 g)

1

3325

Relative risk (Fixed, 95% CI)

0.94 [0.90, 0.99]

10 Congenital malformations Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Folic acid + multivitamin versus no folic acid/multivitamin

2

5777

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [0.81, 3.53]

10.2 Folic acid without multivitamin versus no folic acid/multivitamin

1

903

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [0.45, 4.43]

10.3 Folic acid with/without multivitamin versus no folic acid/multivitamin

1

1364

Risk Ratio (M‐H, Fixed, 95% CI)

1.90 [0.71, 5.04]

10.4 Folic acid + multivitamin versus multivitamin

2

1102

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.51, 2.26]

10.5 Folic acid without multivitamin versus multivitamin

2

1090

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.26, 1.49]

10.6 Folic acid with or without multvitamin versus multivitamin

2

1644

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.43, 1.67]

11 Multiple pregnancy Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Folic acid + multivitamin versus no folic acid/multivitamin

2

5141

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [1.00, 1.85]

12 Maternal anaemia Show forest plot

3

Relative risk (Fixed, 95% CI)

Subtotals only

12.1 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A (any anaemia)

1

813

Relative risk (Fixed, 95% CI)

0.83 [0.77, 0.91]

12.2 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A (severe anaemia)

1

813

Relative risk (Fixed, 95% CI)

0.82 [0.59, 1.16]

12.3 Folic acid + iron versus iron (severe anaemia)

1

85

Relative risk (Fixed, 95% CI)

1.06 [0.25, 4.42]

12.4 Folic acid + iron versus no folic acid or iron

1

89

Relative risk (Fixed, 95% CI)

1.53 [0.79, 2.95]

13 Poor growth in childhood: Stunting in childhood (6‐8 years of age) Show forest plot

1

3356

Risk Ratio (Fixed, 95% CI)

0.93 [0.86, 1.00]

13.1 Folic acid + iron + zinc + vitamin A versus multivitamin + vitamin A

1

3356

Risk Ratio (Fixed, 95% CI)

0.93 [0.86, 1.00]

14 Poor growth in childhood: Underweight in childhood (6‐8 years of age) Show forest plot

1

3356

Risk Ratio (Fixed, 95% CI)

0.97 [0.91, 1.04]

14.1 Folic acid + iron + zinc + vitamin A versus multivitamin + vitamin A

1

3356

Risk Ratio (Fixed, 95% CI)

0.97 [0.91, 1.04]

15 Placental weight Show forest plot

1

29

Mean Difference (IV, Fixed, 95% CI)

96.0 [30.73, 161.27]

15.1 Folic acid versus placebo

1

29

Mean Difference (IV, Fixed, 95% CI)

96.0 [30.73, 161.27]

16 Additional outcomes ‐ infant death Show forest plot

1

4122

Relative risk (Fixed, 95% CI)

0.95 [0.81, 1.11]

16.1 Folic acid + iron + zinc + multivitamin + vitamin A versus vitamin A

1

4122

Relative risk (Fixed, 95% CI)

0.95 [0.81, 1.11]