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.

This study assesses the effects of prenatal supplementation with United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) compared with iron folic acid (IFA) on average birthweight and incidence of low birthweight. Pregnant women from 78 villages in Niger were included in a cluster-randomized, double-blinded, controlled supplementation trial. Data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight.

The study is a factorial, double-blind, randomized controlled trial, with directly observed supplement intake. Pregnant women were randomly assigned to receive either iron folid acid (IFA) or United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) daily until 3 months after delivery. The primary outcomes examined were gestational duration, birth weight, birth length, and Rohrer ponderal index at birth [weight (g) × 100/length3 (cm)]. Secondary outcomes were low birth weight (LBW) (<2500 g), small-for-gestational age (SGA; birth weight below the 10th percentile of a reference population) (36), large for gestational age (LGA; birth weight above the 90th percentile of the study population), thoracic circumference, head circumference, mid-upper arm circumference, hemoglobin concentration in mothers during the third trimester, hemoglobin and sTfR concentrations in cord blood, preterm birth (born at <37 wk of gestation), stillbirth (delivery of an infant showing no sign of life after a gestational age of 28 wk), and perinatal death.

A randomised, controlled, double masked trial to assess the effects of daily prenatal multimicronutrient supplementation on birth weight (BW) and perinatal mortality in Guinea-Bissau. A total of 2100 pregnant women  were recruited through antenatal clinics, of which 1670 completed the trial. The results showed that prenatal micronutrient supplementation increased BW but did not reduce perinatal mortality in this study. Multimicronutrient supplementation with two recommended dietary allowance (RDA) should be considered in future programmes to reduce the proportion of low BW.

This article details a double-blind, randomised controlled trial in Dhanusha district, Nepal. Women attending for antenatal care with singleton pregnancies at up to 20 weeks’ gestation were invited to participate. Primary outcomes were birthweight and gestational duration. Secondary outcomes included infant length and head circumference. The study was not powered to detect differences in mortality.

This systematic review of randomized controlled trials evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST).