Multiple-micronutrient supplementation for women during pregnancy

Area of Science:

• Maternal and Fetal Health
• Nutritional Epidemiology
• Public Health Interventions

Background:

• Multiple-micronutrient (MMN) deficiencies are prevalent in women of reproductive age in low- to middle-income countries.
• Pregnancy exacerbates these deficiencies, posing risks to both mother and fetus.
• While MMN supplementation is recommended, consensus on replacing iron and folic acid (IFA) with MMNs is lacking.

Purpose of the Study:

• To evaluate the benefits of oral MMN supplementation during pregnancy.
• To assess impacts on maternal, fetal, and infant health outcomes.
• To inform policy regarding MMN supplementation in pregnancy.

Main Methods:

• Systematic review and meta-analysis of prospective randomized controlled trials.
• Searched Cochrane Pregnancy and Childbirth Group's Trials Register and other sources.
• Assessed trial eligibility, risk of bias, and data extraction using the GRADE approach.

Main Results:

• Fifteen trials (137,791 women) compared MMN+IFA vs. IFA, showing reduced low birthweight (LBW) and small-for-gestational-age (SGA) infants, and fewer stillbirths (high-quality evidence).
• No significant differences observed for preterm birth, maternal anemia, miscarriage, or mortality.
• Two trials comparing MMN vs. placebo in the UK found no clear differences for key outcomes.

Conclusions:

• MMN supplements with iron and folic acid improve birth outcomes, including reducing LBW and stillbirths.
• Evidence supports replacing standard iron and folic acid with MMN supplements in developing countries.
• Integration into maternal nutrition and antenatal care programs is recommended.