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.

In a randomized, placebo-controlled, double-blind effectiveness trial among antenatal care attendees in Harare, Zimbabwe, pregnant women were randomly allocated to receive a multimicronutrient or placebo supplement daily until delivery. Supplementation with iron and folic acid (IFA) was part of antenatal care (ANC). Multimicronutrient supplementation (MMS) was associated with tendencies for increased gestational length, birth weight, and head circumference but was not associated with low birth weight (LBW). The effect of MMS on birth weight was not significantly different between HIV-uninfected and HIV-infected women.

In a double-blind trial in Dar es Salaam, Tanzania,  8468 pregnant women, who were negative for human immunodeficiency virus infection (HIV-negative), were randomly assigned to receive daily multivitamins (including multiples of the recommended dietary allowance) or placebo. All the women received prenatal supplemental iron and folic acid (IFA). The incidence of low birth weight (LBW) was significantly lower (7.8%) among the infants in the multivitamin group compared to those in the placebo group (9.4%). The mean difference in birth weight between the groups was modest but statistically significant. Supplementation reduced both the risk of a birth size that was small for gestational age (SGA) (10.7%) in the multivitamin group vs. 13.6% in the placebo group and the risk of maternal anemia although the difference in the mean hemoglobin levels between the groups was small. Multivitamin supplementation had no significant effects on prematurity or fetal death.

In Tanzania, 1075 HIV-1-infected pregnant women received either no micronutrients, vitamin A, multivitamins excluding vitamin A or multivitamins including vitamin A in a randomized, double-blind, placebo-controlled trial. Among women assigned multivitamins, 30 fetal deaths occurred compared with 49 among those not on multivitamins. Multivitamin supplementation decreased the risk of low birth weight (LBW) by 44%, severe preterm birth by 39%, and small size for gestational age (SGA) at birth by 43%. Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts. The results suggested that multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. 

This study examined the effect of daily maternal micronutrient supplementation (MMS) on fetal loss and infant mortality in rural Nepal.  Pregnant women received either vitamin A only, or in addition to Vitamin A, folic acid only,  iron-folic acid (IFA), IFA, and zinc or multiple micronutrients. Results showed that MMS failed to reduce overall fetal loss or early infant mortality. Among preterm infants, folic acid alone or with iron reduced mortality in the first 3 months of life. Multiple micronutrients may increase mortality risk among term infants, but this effect needs further evaluation.

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.

This study examined the effects of home fortification of pregnant women’s diets with small-quantity lipid-based nutrient supplement (SQ-LNS) on the birth size of newborns in an African community in Malawi. The women were provided with one daily iron-folic acid (IFA) capsule, one capsule containing multiple micronutrients (MMNs), or one 20-g sachet of SQ-LNS (LNS, containing 118 kcal, protein, carbohydrates, essential fatty acids, and 21 micronutrients). The study findings do not support a hypothesis that the provision of SQ-LNS to all pregnant women would increase the mean birth size in rural Malawi.

The International Lipid-Based Nutrient Supplements Project has developed a small-quantity (20 g/d) lipid-based nutrient supplement (LNS) for pregnant and lactating women. This study evaluated the effects of prenatal LNS supplementation on fetal growth. In a community-based, partially double-blind, individually randomized controlled trial, 1320 pregnant women received iron-folic acid (IFA), or 1–2 Recommended Dietary Allowances of 18 micronutrients, including iron (MMN), or LNS with the same micronutrients as the MMN group, plus 4 minerals and macronutrients contributing 118 kcal (LNS) daily until delivery. Fetal growth was compared across groups by using intention-to-treat analysis. Among primiparous women the LNS group had greater mean birth length than did the IFA group; similar differences were found when comparing the LNS and MMN groups. Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana, particularly primiparous women.

This study estimated the impact of scaling up iron-folic acid (IFA), calcium, multiple micronutrients (MMS), and balanced energy protein (BEP) supplementation for pregnant women, on human capital outcomes in low- and middle-income countries (LMIC). Results showed that across 132 LMIC, scaling up prenatal nutrition interventions to 90% coverage was estimated to increase school years and lifetime income per birth cohort by: 2.28 million y and $8.26 billion for IFA; 4.08 million y  and $18.9 billion for calcium; 5.02 million y and $18.1 billion for MMS; and 0.53 million y and $1.34 billion for BEP supplementation. Therefore, increasing coverage of prenatal nutrition interventions in LMIC may lead to substantial gains in schooling and lifetime income, particularly for MMS compared to IFA.

Supplementary Data

As a global community, we have a unique opportunity to elevate women – their voices, their empowerment, and their nutrition – within global and national efforts taking place in preparations towards and beyond the U.N. Food Systems Summit. This Guide details narratives, opportunities, and information on Summit architecture that to draw from towards advocacy efforts.