This study examined the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient. Results showed that in total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. Folic acid and calcium were the primarily used micronutrient supplements; few participants used multiple micronutrient supplements (MMS) or iron. Adherence to supplementation of all micronutrients was low and well below standards recommended by the Chinese guidelines or WHO. Higher educational levels, higher income levels, urban residence, and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.

This double-blind randomized controlled trial in rural Vietnam assessed individual, household, and programmatic predictors of supplement adherence before conception for iron, iron-folic acid (IFA), and micronutrient supplements and during pregnancy for IFA. Key determinants of adherence included socio-economic status (SES), ethnicity, occupation (farmer), and parity which may be helpful for targeting women for counseling on supplement adherence. Increased contact with village health workers was positively associated with adherence to micronutrient supplementation both before conception and during pregnancy indicating the need for resources to support community outreach to women of reproductive age.

This review identifies key barriers and facilitators to the uptake (or not) of antenatal care (ANC) services by pregnant women and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities.

This technical brief examined the implementation approaches that could be used to enhance the delivery of antenatal care (ANC) nutrition services and introduce antenatal multiple micronutrient supplementation (MMS) to replace iron-folic acid (IFA) for pregnant women in Pakistan. It also examined if the implementation of the enhanced approaches increased pregnant women’s adherence to MMS.

This review studied the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. Balanced energy protein (BEP) supplementation studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies, and increased birth weight. Food distribution programs (FDPs) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention showed reductions in birth weight. Data from this review support the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking.

This study provides a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children using standard methods to assess emerging new evidence for delivery platforms. This analysis suggests that the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodized salt can alleviate iodine deficiency and improve health outcomes. The estimated total additional annual cost involved in scaling up access to these ten direct nutrition interventions in the 34 countries that have 90% of the world’s children with stunted growth is Int$9·6 billion per year. If this improved access is linked to nutrition-sensitive approaches—ie, women’s empowerment, agriculture, food systems, education, employment, social protection, and safety nets—they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.

This Comment, in response to a publication by Caniglia et al. in Lancet Global Health, raises various concerns regarding the programmatic possibility of introducing multiple micronutrient supplements (MMS), which include iron and folic acid, for routine antenatal care in low-income and middle-income countries and argues for precision in nutrition prescription, based on accurate micronutrient deficiency biomarkers.

This correspondence is in response to a Comment by Anura V Kurpad and Harshpal Singh Sachdev (June, 2022) in Lancet Global Health, which addresses various concerns raised by them and argues that multiple micronutrient supplementation (MMS) is an urgent, important, cost-effective, and complementary intervention to improve pregnancy and birth outcomes.

Using nationally representative estimates from the 2017 Global Burden of Disease study, this study conducted an individual-based dynamic microsimulation of population cohorts from birth to 2 years of age in India, Pakistan, Mali, and Tanzania. The effect of maternal nutritional supplementation on infant birth weight, stunting, and wasting was modeled using effect sizes from Cochrane systematic reviews and published literature. The study compared disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs) in a baseline scenario with existing antenatal iron folic acid (IFA) coverage with scenarios where 90% of antenatal care (ANC) attendees receive either universal multiple micronutrient supplementation (MMS), universal Balanced energy-protein (BEP), or MMS and targeted BEP. Results showed that MMS and targeted BEP averts more DALYs and remains cost-effective compared to universal MMS. As countries consider using MMS in alignment with recent WHO guidelines, offering targeted BEP is a cost-effective strategy that can be considered concurrently to maximize benefits and synergize program implementation.

Alive and Thrive (A&T) provided technical assistance to the Government of Ethiopia (GOE) to strengthen the delivery and uptake of antenatal care (ANC) services and immediate postnatal care (PNC) services while carrying out implementation research between 2019 and 2021 to better understand how to effectively integrate proven maternal nutrition interventions into Ethiopia’s existing package of maternal nutrition interventions (National Nutrition Program – NNPII). To strengthen the evidence base for maternal nutrition programs and policies, A&T developed and tested the integration of an intensive package of maternal nutrition interventions into existing ANC services delivered through government health facilities that will align with the latest global evidence and the NNPIl.