Review of the use of antenatal multiple micronutrient supplementation in low- and middle-income countries
Research snapshot1
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 increased adverse pregnancy and birth outcomes. Supplementation with multiple micronutrient supplements (MMS) that include iron and folic acid (IFA) during pregnancy is practiced in some countries. The World Health Organization (WHO) antenatal care guidelines do not recommend that MMS replace IFA as routine standard of care, due to some evidence of risk and gaps in evidence, although the guidelines suggest that policymakers in populations with a high prevalence of nutritional deficiencies consider giving MMS that include IFA when the benefits outweigh the disadvantages. However, no further guidance is provided regarding the contexts where MMS may be warranted. A task force comprising 33 members from a variety of organisations was convened to reassess the evidence base for antenatal MMS to support policymakers in the implementation of the guidelines.
The task force identified new evidence that shows that, despite the variability in prevalence of micronutrient deficiencies among women of reproductive age and a general lack of data on dietary intake and micronutrient status among pregnant women in most LMICs, there is clear and consistent evidence from trial data that MMS is beneficial where micronutrient deficiencies are relatively common and where it would reduce the risk for preterm birth, small for gestational age, and low birth weight, in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anaemic and underweight women and female infants. The additional mortality and birth outcome benefits associated with the more expensive multiple micronutrient tablets should result in favourable cost-effectiveness values when compared with other programmes aimed at reducing mortality and undesirable birth outcomes. The task force also identified little risk of exceeding the upper limit of micronutrients, even when combined with adequate dietary intake. The task force concludes that MMS is likely to lead to additional benefits compared to IFA supplementation alone and could be included as part of routine antenatal care to improve maternal micronutrient status.
Endnotes
1Bourassa, M.W. et al (2019) (2019) Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries. Annals of the New York Academy of Sciences, 1444 (1). pp. 6-21. ISSN 0077-8923 DOI: https://doi.org/10.1111/nyas.14121