Multiple Micronutrient Supplementation During Pregnancy: Evidence Review (P10-092-19).

Abstract

Objectives\nInsufficient pre-pregnancy intakes of micronutrients, combined with increased nutrient demands during pregnancy often result in maternal micronutrient deficiencies that affect the health of the mother and the development of the fetus. WHO currently recommends iron and folic acid (IFA) supplementation as standard of care for pregnant women, but recognizes that multiple micronutrient supplementation (MMS) may improve pregnancy outcomes under given conditions. New evidence on the effect of MMS compared to IFA during pregnancy was reviewed to develop guidance for countries that may want to consider providing MMS to pregnant women.\n\n\nMethods\nAn expert task force was assembled by the Sackler Institute to assess the data from trials comparing MMS to IFA, the risks of reaching the upper intake levels with MMS, the risk of harm to pregnant women or their infants, and to do a cost-effectiveness analysis (CEA) of MMS compared to IFA. Recent data from a Cochrane review (CR) and an Individual Patient Data meta-analysis (IDP) were assessed.\n\n\nResults\nBoth reviews, predominantly using data from low and middle income countries (LMIC), demonstrated improved pregnancy and birth outcomes among women receiving MMS instead of IFA, including a lower risk of low birth weight (RR 0.88 (95% CI 0.85-0.91) in the CR; RR 0.88 (95% CI 0.85-0.90) in the IPD) and of small for gestational age births (RR 0.92 (95% CI 0.86-0.98) in the CR and RR 0.97 (95% CI 0.96-0.99) in the IDP). The IDP identified further beneficial effects of MMS vs. IFA on preterm birth (RR 0.92 (95% CI 0.88-0.95)) and stillbirth (RR 0.92 (95% CI 0.86-0.99)). Larger protective effects of MMS were observed in subgroups of anemic and underweight women, two prevalent conditions in LMIC. The CEA also supported the transition from IFA to MMS.\n\n\nConclusions\nPregnant women in LMICs and their infants could benefit from MMS over IFA during pregnancy, as a cost-effective intervention. This presentation will discuss the approach used by the expert task force, its conclusions, as well as a framework to help LMIC decide on which program to support, and ongoing efforts to pilot the adoption of MMS in sample countries.\n\n\nFunding Sources\nBill & Melinda Gates Foundation.