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.

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.