This special report, prepared by a task force convened by the New York Academy of Sciences,  evaluates the latest evidence to help countries interpret the World Health Organization guidelines for nutrition interventions in pregnancy as they relate to multiple micronutrient supplementation.

Vitamin Angels has created resources for Program Partners to use when educating service providers, stakeholders, and beneficiaries about the benefits of prenatal multivitamins or multiple micronutrients supplements (MMS) and how to best distribute them. Resources include instruction sheets, posters and brochures aimed at beneficiaries, factsheets and FAQ for service providers and are available in English, French, Spanish and other languages. The instruction sheets provide a basic overview of the benefits of vitamin A supplements, deworming, and prenatal multivitamins with visual cues for dosing instructions. The posters are designed to be displayed at distribution sites to provide caregivers and families with nutrition information. The brochure for beneficiaries outlines the importance of good nutrition during pregnancy. It also provides a calendar to help women keep track of taking their daily multivitamin. The fact sheet summarizes the research on multiple micronutrient supplements (MMS) for pregnant women as well as addresses frequently asked questions for potential program partners.  The FAQ sheet is meant to counsel pregnant women during antenatal care and to guide the program.

The objectives of the review are to (1) review the evidence on the burden of micronutrient deficiencies in women of reproductive age (WRA) and associated adverse pregnancy outcomes; (2) update the evidence base on the effects of Multiple Micronutrient Supplements (MMS) on pregnancy outcomes; (3) assess the costs and cost‐effectiveness of shifting from Iron Folic Acid (IFA) to MMS during pregnancy; and (4) provide indicators based on the updated evidence base that might be considered by governments deciding whether IFA or MMS is the most appropriate supplement for their contexts.

To make decisions about switching from iron folic acid (IFA) to multiple micronutrient supplementation (MMS), policymakers must consider not only the health benefits of such a policy change, but also the costs. To help guide the decisions, the objective of this analysis was to estimate the effectiveness and cost‐effectiveness of hypothetically replacing IFA supplements with MMS for 1 year in the context of an ongoing program to deliver supplements to pregnant women in Bangladesh and Burkina Faso.

The aim of this technical workshop was to propose the composition of a multi-micronutrient supplement (MuMS) for pregnant women from developing countries to be used in effectiveness trials in pilot countries. A secondary issue for consideration at the workshop was the suitability of such a supplement for other groups at risk. This report is commonly used as the basis for the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation. 

This study uses the most detailed approach to analysing existing trial data on multiple micronutrient supplements (MMS). Previous meta-analyses identified overall benefits of multiple micronutrient supplements in terms of birth size, but our findings show that specific subgroups experience mortality benefits, notably female neonates. Women with indicators of malnutrition during pregnancy who took multiple micronutrient supplements also had greater reductions in low birthweight, preterm, and small-for-gestational-age births. We found no evidence that multiple micronutrient supplements significantly increased the risk of stillbirth or neonatal, 6-month, or infant mortality, neither overall or in any of the 26 examined subgroups.

This Cochrane Review findings suggest a positive impact of multiple micronutrient (MMN) supplementation with iron and folic acid on several birth outcomes. MMN supplementation in pregnancy led to a reduction in babies considered low birth weight, and probably led to a reduction in babies considered small for gestational age (SGA). In addition, MMN probably reduced preterm births. No important benefits or harms of MMN supplementation were found for mortality outcomes (stillbirths, perinatal and neonatal mortality). These findings may provide some basis to guide the replacement of iron and folic acid supplements with MMN supplements for pregnant women residing in low‐ and middle‐income countries.

A Guideline Development Group (GDG) reviewed existing new evidence for two antenatal nutrition recommendations regarding Multiple Micronutrient Supplements (MMS) during pregnancy and Vitamin D supplements during pregnancy for updating of recommendations in the World Health Organization (WHO) 2016 Antenatal Care (ANC) guidelines, in accordance with WHO’s living guidelines approach. The 2020 guideline presents that evidence and updated recommendation on antenatal MMS, which supersedes the corresponding recommendation issued in the WHO 2016 ANC guideline.  

This study evaluated the acceptability of multiple micronutrient supplementation 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. 2,378 pregnant women were assigned to receive either iron–folic acid or multiple micronutrient supplements. The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers.