Pregnancy is an exciting time for many women, but it is also a time of increased nutritional needs as the body works to support the growing fetus. Unfortunately, many women in low- and middle-income countries (LMICs) struggle to meet these needs, leading to micronutrient deficiencies that can have serious consequences for both mother and baby.
A recent study conducted by the Multiple Micronutrient Supplementation in Pregnancy Technical Advisory Group (MMS TAG) found that taking multiple micronutrient supplementation (MMS), also known as prenatal vitamins in some regions of the world, during pregnancy is better than only taking iron-folic acid (IFA) supplements.1 These findings provide strong support for the use of MMS during pregnancy to reduce the risk of adverse birth outcomes.
Micronutrient deficiencies are a common problem among women of reproductive age, affecting two-thirds of women worldwide.2 Pregnant women in LMICs are particularly vulnerable due to nutrient-poor diets and increased nutritional requirements. Anemia during pregnancy, for example, increases the risk of poor outcomes for both the mother and baby, including a higher risk of maternal and perinatal death, premature birth, and low birth weight.
To address this problem many LMICs have added IFA to their nutrition programs. However, IFA alone may not be enough to meet all the nutritional needs of pregnant women, as deficiencies in other micronutrients like vitamin A and zinc are also common and can affect fetal growth and development.
This is where MMS come in—they contain more vitamins and minerals than IFA alone and have been shown to significantly improve maternal health and reduce the risk of adverse birth outcomes. These supplements, such as the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation, include 13 vitamins and minerals in addition to IFA.
The study, published in the Maternal & Child Nutrition journal, analyzed data from 16 studies to determine whether the effects of MMS or IFA were different for three birth outcomes of interest (on low birth weight, being born too small or too early) depending on how pregnancy length was determined. The findings showed that MMS improved birth outcomes compared to IFA, regardless of the method used to determine pregnancy length (e.g., based on ultrasound, date of last menstrual period, or other method). MMS showed even more pronounced benefits when ultrasound was used, which is considered the gold standard for dating pregnancy.
In 2020, the World Health Organization (WHO) updated its recommendations for pregnant women and adolescent girls to improve the quality of their routine health care during pregnancy to include MMS.3 But the WHO’s recommendation on MMS was conditional, calling for further research to fully understand its effects on things like premature birth and low birth weight.
This study complements previous findings that demonstrated MMS were just as good as IFA for preventing anemia during pregnancy, even when the MMS contained less iron than IFA.4
“Our study provides additional support for the transition from IFA to MMS in LMICs and challenges the need for new efficacy trials using ultrasound for gestational age assessment. We hope that the WHO Guideline Development Group will consider these important findings when reviewing the evidence for the recommendation of MMS during pregnancy.”
– Filomena Gomes, PhD, Coordinator for the MMS TAG.
Implementing MMS in antenatal care programs in LMICs is a critical step in achieving global health and nutrition development goals. By providing pregnant women with the essential micronutrients they need, women can give their babies the best possible start in life while improving their own health outcomes.
- Gomes, F., Askari, S., Black, R. E., Christian, P., Dewey, K. G., Mwangi, M. N., Rana, Z., Reed, S., Shankar, A. H., Smith, E. R., & Tumilowicz, A. (2023). Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method. Maternal & Child Nutrition, e13509. https://doi.org/10.1111/mcn.13509
- Stevens, G. A., Beal, T., Mbuya, M. N. N., Luo, H., Neufeld, L. M., & Global Micronutrient Deficiencies Research Group. (2022). Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: A pooled analysis of individual-level data from population-representative surveys. The Lancet Global Health, 10(11), e1590– e1599. https://doi.org/10.1016/S2214-109X(22)00367-9
- World Health Organization (WHO). (2020). WHO antenatal care recommendations for a positive pregnancy experience. Nutritional interventions update: Multiple micronutrient supplements during pregnancy. https://www.who.int/publications/i/item/9789240007789
- Gomes, F., Agustina, R., Black, R. E., Christian, P., Dewey, K. G., Kraemer, K., Shankar, A. H., Smith, E. R., Thorne‐Lyman, A., Tumilowicz, A., & Bourassa, M. W. (2022). Multiple micronutrient supplements versus iron‐folic acid supplements and maternal anemia outcomes: An iron dose analysis. Annals of the New York Academy of Sciences, 1512(1), 114–125. https://doi.org/10.1111/nyas.14756.