Systematic review: Multiple-micronutrient supplementation for women during pregnancy

In low- and middle-income countries, many women have poor diets and are deficient in nutrients and micronutrients which are required for good health. Micronutrients are vitamins and minerals that are needed by the body in very small quantities but are important for normal functioning, growth and development. During pregnancy, these women often become more deficient, with the need to provide nutrition for the baby too, and this can impact on their health and that of their babies. Combining multiple micronutrients has been suggested as a cost-effective way to achieve multiple benefits for women during pregnancy. Micronutrient deficiencies are known to interact and a greater effect may be achieved by multiple supplementation rather than single-nutrient supplementation, although interactions may also lead to poor absorption of some of the nutrients. High doses of some nutrients may also cause harm to the mother or her baby. This systematic review included 19 trials involving 138,538 women, but only 17 trials involving 137,791 women contributed data. The included trials compared pregnant women who supplemented their diets with multiple micronutrients with pregnant women who received a placebo or supplementation with iron, with or without folic acid. Overall, pregnant women who received multiple-micronutrient supplementation had fewer low birthweight babies, small-for-gestational-age babies, and stillbirths than pregnant women who received only iron, with or without folic acid. The evidence for the main outcomes was found to be of high quality. These findings, consistently observed in several other systematic reviews of evidence, provide a strong basis to guide the replacement of iron and folic acid with multiple-micronutrient supplements for pregnant women in low- and middle-income countries countries where multiple-micronutrient deficiencies are prevalent among women.

Multiple-micronutrient supplementation for women during pregnancy

Batool A Haider, Zulfiqar A Bhutta

Best wishes, Neil

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