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Review
. 2019 May;1444(1):6-21.
doi: 10.1111/nyas.14121. Epub 2019 May 27.

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

Megan W Bourassa  1 , Saskia J M Osendarp  2   3 , Seth Adu-Afarwuah  4 , Saima Ahmed  1 , Clayton Ajello  5 , Gilles Bergeron  1 , Robert Black  6 , Parul Christian  6   7 , Simon Cousens  8 , Saskia de Pee  3   9   10 , Kathryn G Dewey  11 , Shams El Arifeen  12 , Reina Engle-Stone  11 , Alison Fleet  13 , Alison D Gernand  14 , John Hoddinott  15 , Rolf Klemm  5   16 , Klaus Kraemer  17 , Roland Kupka  18 , Erin McLean  18 , Sophie E Moore  19 , Lynnette M Neufeld  20 , Lars-Åke Persson  21 , Kathleen M Rasmussen  15 , Anuraj H Shankar  22   23 , Emily Smith  7   22 , Christopher R Sudfeld  22 , Emorn Udomkesmalee  24 , Stephen A Vosti  11
Affiliations
Review

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

Megan W Bourassa et al. Ann N Y Acad Sci. 2019 May.

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.

Keywords: LMICs; micronutrient; pregnancy; supplements.

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Figures

Figure 1
Figure 1
Regional estimates of micronutrient deficiencies and anemia as reported in women of reproductive age. Black circles are not representative (<3 countries). Data calculated from 52 national and regional surveys, published between 2013 and July 2017.66 Missing bars means no data were found for that micronutrient in the specific region.
Figure 2
Figure 2
Prevalence of anemia (Hb < 120 g/L) by country among women of reproductive age in LMICs. Data calculated from 52 national and regional surveys, published between 2013 and July 2017.66
Figure 3
Figure 3
Prevalence of anemia (Hb < 120 g/L) by country among pregnant women in LMICs. Data calculated from 21 national and regional surveys and studies, from 2013 to July 2017.66
Figure 4
Figure 4
Forest plot for the effect of MMS versus IFA (with 60 mg of iron and any dose of folic acid) in the control group on neonatal mortality. This includes all available trials that included a 60 mg iron control group. Reproduced from Sudfeld and Smith.44
See this image and copyright information in PMC

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