This study evaluated the acceptability of multiple micronutrient supplementation (MMS) and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh, Pakistan through a cluster-randomized design. Pregnant women received either iron-folic acid (IFA) or MMS. The data suggest that MMS are well tolerated during pregnancy, but the effect on birthweight is modest. The observed effect of MMS on early neonatal mortality, though not statistically significant, suggests the need for further studies and careful assessment of the intervention in health system settings.