This presentation provides an overview of the scientific evidence on multiple micronutrient supplements (MMS).

 This brief provides interim programmatic guidance on actions to protect the diets and nutrition services and practices of pregnant women and breastfeeding mothers during the mitigation phase of the COVID-19 response. Disseminating this guidance and documenting emerging evidence and lessons learned will be key to implementing the most appropriate and effective responses in the face of this pandemic. 

This is a comprehensive presentation on research studies on preconception care in Indonesia to improve maternal and newborn health with a special focus on the benefits of multiple micronutrient supplements (MMS) on maternal and newborn health outcomes compared to iron-folic acid (IFA).

The presentation provides a brief introduction to multiple micronutrient supplementation (MMS), its efficacy, use during COVID-19, and global commitments to scale up MMS.

This report presents cost-benefit analyses for two promising interventions within Malawi’s Ante-natal Care (ANC) system to improve maternal and newborn health. The first is BEmONC5, a compacted set of five specific interventions taken from within the conventional basic emergency obstetric and newborn care package and the second is multiple micronutrients supplementation (MMS). Additional interventions considered in the main analysis include the conventional 15-intervention package of basic emergency obstetric and newborn care (BEmONC) interventions and calcium supplementation in pregnancy, which were not found to be as cost-effective as the first two. According to this report, replacing the existing IFA supplements with MMS for pregnant women would lead to 1300 to 1600 averted stillbirths and neonatal deaths per year. Scaled up to full coverage across Malawi, this program would require an investment of MWK 1.5 – 2.5 billion (USD 2.0m – 3.4m) annually over the next 10 years.

In this study, villages in northwest China were randomized for all pregnant women to take either daily folic acid (control), iron with folic acid (IFA), or multiple micronutrient supplements (MMS) with a recommended allowance of 15 vitamins and minerals. Birth weight was 42 g higher in the MMS group compared with the folic acid group. IFA was associated with a significantly reduced risk of early preterm delivery. There was a significant increase in haemoglobin concentration in both IFA and MMS groups compared with folic acid alone. There were no significant differences for perinatal mortality, but IFA was associated with a significantly reduced early neonatal mortality by 54%.

This study assessed the effects of prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation on maternal hemoglobin level, birth weight, and infant mortality in Bangladesh. Pregnant women were randomized into 6 groups; iron-folic acid (IFA) with 30 mg of iron and 400 μg of folic acid, IFA with 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, combined with food supplementation (608 kcal 6 days per week) either by early invitation (9 weeks’ gestation) or usual invitation (20 weeks’ gestation). The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with IFA with 60 mg of iron and 400 μg of folic acid. Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births compared to 54 per 1000 live births for usual invitation with IFA with 60 mg of iron and 400 μg of folic acid. Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate. Results showed that among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including IFA combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality.

This study was a randomized, double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient supplements (MMS) with those of iron supplements during pregnancy on birth size. Pregnant women received supplements, 6 days a week at home, as well as routine antenatal care, until delivery. Both supplements contained Iron but the MMS group also received 1–1.5 times the recommended dietary allowances of several micronutrients. Both groups did not differ significantly in terms of the birth size of newborns. The results suggest that MMS during pregnancy does not lead to greater infant birth size than does iron-only supplementation.

This study assessed the effects of antenatal multiple micronutrients vs iron-folic acid (IFA) supplementation on 6-month infant mortality and adverse birth outcomes in Bangladesh. Women were provided supplements containing 15 micronutrients or IFA alone, taken daily from early pregnancy to 12 weeks postpartum. Results showed that antenatal multiple micronutrient supplements (MMS) compared with IFA supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non–statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight.

This randomized, double-blind, placebo-controlled trial evaluated the effect of multimicronutrient supplementation (MMS) for undernourished pregnant women in Delhi, India, on the birth size of their offspring, the incidence of low-birth-weight (LBW) infants, and early neonatal morbidity. The intervention group received a multimicronutrient supplement (MMS) containing 29 vitamins and minerals once a day, from enrollment until delivery. The comparison group received a placebo for 52  days, with 85% compliance. All participants also received iron and folic acid (IFA) supplements. Infants in the micronutrient group were heavier by 98 g and measured 0.80 cm longer and 0.20 cm larger in midarm circumference compared with the placebo group. Incidence of low birth weight declined from 43.1% to 16.2% with multimicronutrient supplementation and that of early neonatal morbidity declined from 28.0% to 14.8%. Therefore, compared with IFA supplementation, MMS given to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity.