In low- and middle-income countries, many women have poor diets and are deficient in nutrients and micronutrients which are required for good health. Micronutrients are vitamins and minerals that are needed by the body in very small quantities but are important for normal functioning, growth, and development. During pregnancy, with the need to provide nutrition for the fetus, these women often become more deficient. This deficiency can impact on their health and that of their babies. Combining multiple-micronutrients has been suggested as a cost-effective way to achieve benefits for women during pregnancy. However, a consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with multiple-micronutrients. Since the last update of this Cochrane Review, evidence from a few large trials has recently become available, the inclusion of which is critical to inform policy.
Two Cochrane authors based in Canada and United States worked with Cochrane Pregnancy and Childbirth to evaluate the benefits of oral multiple-micronutrient supplementation during pregnancy on maternal, fetal, and infant health outcomes. Seventeen trials, involving 137,791 women, contributed data to the review.
The included trials compared pregnant women who supplemented their diets with multiple-micronutrients, including iron and folic acid, with pregnant women who received a placebo or supplementation with iron, with or without folic acid. Overall, pregnant women who received multiple-micronutrient supplementation had fewer low birthweight babies, small-for-gestational-age babies, and stillbirths than pregnant women who received only iron, with or without folic acid. The evidence for the main outcomes was found to be of high quality. These findings, consistently observed in several other systematic reviews of evidence, provide a strong basis to guide the replacement of iron and folic acid with multiple-micronutrient supplements including iron and folic acid for pregnant women in low- and middle-income countries where multiple-micronutrient deficiencies are prevalent among women.
“Our findings support the additional benefits of multiple-micronutrients supplements containing iron and folic acid in improving birth outcomes. The findings provide a strong basis to guide the replacement of current strategies to supplement pregnant women with iron and folic acid alone with multiple-micronutrients supplements containing iron and folic acid,” said Batool Haider, lead author of the Cochrane Review, based at the Harvard School of Public Health in Boston (US) at the time of the study. “Further efforts should focus on the integration of this intervention in maternal nutrition and antenatal care programs in developing countries.”