Multiple micronutrient supplementation during pregnancy in developing-country settings: Policy and program implications of the results of a meta-analysis

Institute of Child Health, London, UK.
Food and nutrition bulletin (Impact Factor: 1.5). 12/2009; 30(4 Suppl):S556-73.
Source: PubMed

ABSTRACT An independent Systematic Review Team performed a meta-analysis of 12 randomized, controlled trials comparing multiple micronutrients with daily iron-folic acid supplementation during pregnancy.
To provide an independent interpretation of the policy and program implications of the results of the meta-analysis.
A group of policy and program experts performed an independent review of the meta-analysis results, analyzing internal and external validity and drawing conclusions on the program implications.
Although iron content was often lower in the multiple micronutrient supplement than in the iron-folic acid supplement, both supplements were equally effective in tackling anemia. Community-based supplementation ensured high adherence, but some mothers still remained anemic, indicating the need to concomitantly treat infections. The small, significant increase in mean birthweight among infants of mothers receiving multiple micronutrients compared with infants of mothers receiving iron-folic acid is of similar magnitude to that produced by food supplementation during pregnancy. Larger micronutrient doses seem to produce greater impact. Meaningful improvements have also been observed in height and cognitive development of the children by 2 years of age. There were no significant differences in the rates of stillbirth, early neonatal death, or neonatal death between the supplemented groups. The nonsignificant trend toward increased early neonatal mortality observed in the groups receiving multiple micronutrients may be related to differences across trials in the rate of adolescent pregnancies, continuing iron deficiency, and/or adequacy of postpartum health care and merits further investigation.
Replacing iron-folic acid supplements with multiple micronutrient supplements in the package of health and nutrition interventions delivered to mothers during pregnancy will improve the impact of supplementation on birthweight and on child growth and development.

Download full-text


Available from: Roger Shrimpton, Aug 25, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ResumenLa carencia de hierro (CH) es frecuente en lactantes, niños y adolescentes de todo el mundo debido a sus elevadas necesidades de hierro durante el crecimiento, la precaria ingestión de hierro alimentario y la dieta con biodisponibilidad baja. El estado de hierro deficitario se asocia a consecuencias adversas para la salud durante toda la infancia. Las medidas preventivas deben iniciarse precozmente, y entre ellas destacan el aporte complementario de hierro en mujeres gestantes, el retraso en el pinzamiento del cordón umbilical en el parto y la alimentación exclusiva con leche materna durante 6 meses. El hierro tiene que incrementarse considerablemente después de los 4 a 6 primeros meses de vida y el contenido elevado en hierro de los alimentos complementarios es crucial. Aunque el enriquecimiento con hierro de las leches para lactantes y los cereales para lactantes, la adición de polvos de micronutrientes en alimentos complementarios de preparación casera o el suministro de gotas de hierro son las estrategias preventivas más eficaces en lactantes destetados, la introducción temprana de carne y el retraso en la introducción de leche de vaca son también importantes. Las estrategias preventivas en niños mayores implican abordajes alimentarios que aumenten el contenido y la biodisponibilidad del hierro en la alimentación, así como el consumo de alimentos enriquecidos con hierro. En zonas de CH extensa puede ser necesario el aporte complementario de hierro. Si el paludismo es frecuente sólo deben administrarse dosis elevadas de aportes complementarios en niños con CH confirmada. Todas las intervenciones para el control de la CH pediátrica deben integrarse en programas sanitarios nacionales y globales más extensos destinados a mujeres gestantes y niños, incluyendo la educación sanitaria, la prevención del paludismo y la desparasitación. Debe monitorizarse el impacto de las estrategias preventivas de la CH sobre el estado de hierro y la frecuencia de la CH midiendo periódicamente el estado de hierro en la población.
    Annales Nestlé (Ed española) 01/2010; 68(3):121-132. DOI:10.1159/000324427
  • [Show abstract] [Hide abstract]
    ABSTRACT: Iron deficiency (ID) is prevalent in infants, children and adolescents worldwide due to their high iron requirements during growth, low dietary iron intake and low-bioavailability diet. Low iron status is associated with adverse health consequences throughout childhood. Prevention measures should be initiated early and include iron supplementation of pregnant women, delayed cord clamping at delivery and exclusive breast-feeding for 6 months. Iron needs to increase sharply after the first 4–6 months of life and high iron content of complementary foods is critical. Iron fortification of infant formulas and infant cereals, addition of micronutrient powders to home-prepared complementary foods, or provision of iron drops are the most effective prevention strategies in weaning infants, but early introduction of meat and delayed introduction of cow’s milk are also important. Prevention strategies in older children involve dietary approaches which increase iron content and bioavailability of the diet, and consumption of iron-fortified foods. In areas of extensive ID, iron supplementation may be required. If malaria is prevalent, large supplementation doses should only be given to children with confirmed ID. All interventions to control pediatric ID should be integrated into larger national and global health programs for pregnant women and children, including health education, malaria prevention and deworming. The impact of ID prevention strategies on iron status and the prevalence of ID should be monitored by measuring iron status periodically in the population.
    Annales Nestlé (English ed ) 01/2010; 68(3):120-131. DOI:10.1159/000319967
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Women's nutrition has received little attention in nutrition programming, even though clinical trials and intervention trials have suggested that dietary improvement or supplementation with several nutrients may improve their health, especially in low-income settings, the main focus of this paper. Most attention so far has focused on how improvements in maternal nutrition can improve health outcomes for infants and young children. Adequate vitamin D and calcium nutrition throughout life may reduce the risk of osteoporosis, and calcium supplementation during pregnancy may reduce preeclampsia and low birth weight. To reduce neural tube defects, additional folic acid and possibly vitamin B(12) need to be provided to non-deficient women before they know they are pregnant. This is best achieved by fortifying a staple food. It is unclear whether maternal vitamin A supplementation will lead to improved health outcomes for mother or child. Iron, iodine and zinc supplementation are widely needed for deficient women. Multimicronutrient supplementation (MMS) in place of the more common iron-folate supplements given in pregnancy in low-income countries may slightly increase birth weight, but its impact on neonatal mortality and other outcomes is unclear. More sustainable alternative approaches deserve greater research attention.
    Nutrition research and practice 02/2011; 5(1):3-10. DOI:10.4162/nrp.2011.5.1.3 · 1.13 Impact Factor
Show more