Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low‐ and middle‐income countries

Abstract

Inadequate micronutrient intakes are relatively common in low‐ and middle‐income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost‐effectiveness of MMS compared with IFA. Recent meta‐analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual‐participant data meta‐analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost‐effective method to reduce the risk of adverse birth outcomes.

Setting research priorities on multiple micronutrient supplementation in pregnancy

“…Prenatal multiple micronutrient supplementation (MMS) provides a good solution to supply those essential nutrients. A series of publications recently put forward by the New York Academy of Sciences (NYAS) presented evidence of the benefits of MMS on maternal and perinatal outcomes (i.e., significant risk reduction of LBW, SGA, preterm birth, and stillbirth), in addition to those provided by iron and folic acid . These publications identify populations in low‐ and middle‐income countries (LMIC), where a switch to MMS would be justified, consistent with the WHO Antenatal Care Guidelines, and would be highly cost‐effective .…”

“…Many micronutrients have critical roles during this life stage (especially vitamins A, B 6 , B 9 , B 12 , C, D, and E, and minerals iron, zinc, iodine, copper, and selenium) for which the recommended intakes may increase by up to 50% to accommodate the higher maternal, placental, and fetal demands. These increased nutritional demands of pregnancy, in combination with the preexisting nutritional deficiencies among undernourished (and/or the even higher nutritional demands for adolescent) pregnant women, may put their health and that of their offspring at risk . Maternal micronutrient malnutrition is associated with low birth weight (LBW) (<2500 g), preterm birth (<37 weeks), being born small‐for‐gestational‐age (SGA), and perinatal and maternal mortality, among other pregnancy‐related adverse outcomes …”

“…Anemia affects 31.6% of pregnant women in LMIC; globally, 63.2% of WRA are vitamin D deficient, 41.4% are zinc deficient, 22.7% are folate deficient, and 15.9% are vitamin A deficient…”

“…– SGA: 19.3% (23.3 million) of all live births in LMIC (28% in South Asia); 606,500 neonatal deaths attributable to SGA…”

“…– Preterm births: 10.6% (14.84 million) of live births globally; >80% from Asia and Sub‐Saharan Africa…”