Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries

Self Cite

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.

Section: Revisiting the Evidence Base On The Effect Of Multiple‐micromentioning

confidence: 99%

“…Smith et al . obtained IPD from 17 randomized controlled trials—including 112,952 pregnancies—that compared the use of MMS, which included IFA, versus IFA alone . Fifteen of these trials were also included in the 2019 Cochrane Review .…”

Section: Revisiting the Evidence Base On The Effect Of Multiple‐micromentioning

confidence: 99%

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

Bourassa

Osendarp

Adu‐Afarwuah

et al. 2019

Self Cite

“…The task force found from a review of evidence that in women of reproductive age and pregnant women in LMIC, there is a high prevalence of deficiencies of multiple essential micronutrients. It also considered an individual participant data meta‐analysis of multiple micronutrient supplement trials that was published after the WHO antenatal guidelines . This analysis confirmed the findings of the previous meta‐analysis, including the observation that women receiving MMS, compared with those receiving only IFA, had a lower risk of LBW and SGA births.…”

mentioning

confidence: 82%

“…WHO antenatal care guidelines for use of IFA do not specify the number of days that supplementation should be given during pregnancy, but indicate that it should be started as early in pregnancy as possible. The evidence for MMS, showing that women who started before 20 weeks of gestation had a reduction in preterm births compared with no effect in those who started later, suggests that the same advice applies to MMS.…”

mentioning

confidence: 99%

Benefits of supplementation with multiple micronutrients in pregnancy

Black

Dewey

2019

A task force was convened by the New York Academy of Sciences to evaluate new evidence that was not available at the time of, and to help countries interpret, recent World Health Organization guidelines for nutrition interventions in pregnancy as they relate to multiple micronutrient supplementation. The report of the task force is published in a recent special issue of Annals of the New York Academy of Sciences . Here, we provide a short introduction to the special issue.

“…In comparison to current recommendations, there is some variation in the UNIMMAP formulation around 100% of the RDA/AI; however, all values are substantially below ULs. As well, more than 20 randomized controlled trials have been published comparing multiple micronutrient (often, but not always similar to UNIMMAP) to iron and folic acid supplementation in LMIC . Conducting such trials is inherently challenging, and morbidities such as nausea and vomiting were either not collected or have not yet been reported in a way that would allow collective conclusions about the side effects of supplementation …”

Section: Potential For Excess Intake When Taking Daily Unimmapmentioning

confidence: 99%

The upper level: examining the risk of excess micronutrient intake in pregnancy from antenatal supplements

Gernand

2019

Micronutrient deficiencies are prevalent and co‐occurring among pregnant women in low‐ and middle‐income countries (LMIC). To prevent and treat deficiencies, antenatal vitamin and mineral supplements are the most common interventions during gestation. With most micronutrients, there can be health risks when intake regularly exceeds a high amount, and an upper threshold value set by the United States and Canada, the World Health Organization, and other groups is commonly called an upper intake level (UL). This review summarizes what is known about risks in pregnancy when ULs are exceeded and assesses the potential risk of exceeding the UL if a pregnant woman is taking a multiple micronutrient supplement. Overall, there is limited information on pregnancy‐specific risks from excess intake. When assuming high dietary intake plus the amount in a standard multiple micronutrient supplement (with 30 mg of iron), only niacin and iron would be expected to slightly exceed the UL. Known risks for this level intake for each nutrient are transient and mild.