This review summarizes what is known about risks in pregnancy when Upper Limits (ULs) of micronutrients are exceeded and assesses the potential risk of exceeding the UL if a pregnant woman is taking a multiple micronutrient supplement. UL is an upper threshold value of micronutrients which may cause health risks, set by the United States and Canada, the World Health Organization, and other groups. Overall, there is limited information on pregnancy‐specific risks from excess intake. When assuming high dietary intake plus the amount in a standard multiple micronutrient supplement (with 30 mg of iron), only niacin and iron would be expected to slightly exceed the UL. Known risks for this level intake for each nutrient are transient and mild.

This paper is a situation analysis of the market, manufacturing, and policy factors that are driving the production of Multiple Micronutrient Supplementation (MMS) in 12 lower and upper middle‐income countries in Africa, South America and South Asia. Through a self‐administered structured questionnaire by key informants, this study examined the local context of products available in the market, their cost, regulations and policies. It was found that most countries have the capacity to produce MMS locally, the major barriers observed for sustainable and affordable production include (a) poor technical capacity and policies for ensuring quality along the value chain and (b) lack of policy coherence to incentivize local production and lower the manufacture and retail price of MMS. Also, it was determined that better guidelines and government oversight is required because none of the countries were able to match the globally recommended formulation for United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP).

This paper details the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. This Open Smart Register Platform (Open SRP) is also being used in Lombok, Indonesia to pilot introduction of multiple micronutrient supplementation (MMS) for pregnant women in ANC.

This paper assessed the effect of maternal supplementation with multiple micronutrients (MMN), compared with iron folic acid (IFA), on fetal loss and infant death in the setting of routine prenatal care services in a double-blind cluster-randomised trial in Lombok, Indonesia . The outcomes demonstrated that infants of women consuming MMN supplements had an 18% reduction in early infant mortality compared with those of women given IFA and a 14% reduction in risk of low birth weight.

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.