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The Lancet Series on Maternal and Child Undernutrition Progress recommends MMS scale up

MMS is an intervention ready for prime time. It absolutely needs to be moved into programs.

8 March 2021 – As part of The Lancet Series on Maternal and Child Undernutrition Progress released today, Series authors highlighted new evidence that strongly supports the scale-up of multiple micronutrient supplementation (MMS) for preventing adverse pregnancy and birth outcomes and improving maternal health.
The latest Series includes three new papers that build upon findings from the previous 2008 and 2013 Series, which established an evidence-based global agenda for tackling undernutrition over the past decade.

Notably, one of the highlights of this Series is that the evidence on the effectiveness of MMS in reducing the risk of stillbirths, low birthweight, and babies born small-for-gestational age has strengthened.

According to the first paper in the Series, Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda, “Multiple forms of undernutrition among girls and adolescents lead to poor reproductive and other health consequences for women. In addition, they exacerbate the risk of poor birth outcomes, such as fetal losses, fetal growth restriction, and preterm delivery, as well as early life undernutrition and poor cognitive development among offspring.” Furthermore, “globally, there is a need to address inadequate quality of diets, especially among women of reproductive age, including pregnant and lactating women.”

On a webinar event to launch the Series, co-author Dr. Zulfiqar Bhutta, Co-Director, Director of Research, at the Sick Kids Centre for Global Child Health, told attendees that MMS: “Is an intervention ready for prime time. It absolutely needs to be moved into programs.”

In his presentation, Bhutta went on to say that this updated series reinforces that MMS in pregnancy should be prioritized over supplements with iron and folic acid alone to improve birth and child health outcomes. “The impact is evident for supplements using the UNIMMAP formulation,” said Bhutta. These conclusions are based on a systematic review of 33 randomized controlled trials undertaken in low- and middle-income countries.

Limited, uneven progress remains, and the Series highlights data gaps, social inequalities and the impact of COVID-19 as some of the reasons for this uneven progress. Micronutrient deficiencies were dubbed “the silent emergency” and remain largely unabated. Dr. Cesar Victora of the International Center for Equity in Healthy at the Federal University of Pelotas and Series author said: “We need to invest in and scale up cost-effective micronutrient solutions and we need more data to measure progress and target interventions.”

In a panel discussion, Bhutta, Victora and Dr. Rebecca Heidcamp of the Bloomberg School of Public Health, Division of Nutrition, at Johns Hopkins University, urged a continued focus on first 1,000 days as well as emphasizing the evidence-base for and a need to implement interventions spanning nutrition, health, food systems, social protection, and water, sanitation, and hygiene.

The Healthy Mothers Healthy Babies Consortium welcomes this strong evidence and support for MMS scale-up. “We have heard this call to action and share in the opinion that there is an urgency to act on MMS,” says Dr. Saskia Osendarp, Executive Director of the Micronutrient Forum, which acts as the Secretariat for the Healthy Mothers Healthy Babies Consortium. “We must take collective action to ensure that MMS is integrated into antenatal programs.”