Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries

Megan W. Bourassa, Saskia J.M. Osendarp, Seth Adu-Afarwuah, Saima Ahmed, Clayton Ajello, Gilles Bergeron, Robert Black, Parul Christian, Simon Cousens, Saskia de Pee, Kathryn G. Dewey, Shams El Arifeen, Reina Engle-Stone, Alison Fleet, Alison D. Gernand, John Hoddinott, Rolf Klemm, Klaus Kraemer, Roland Kupka, Erin McLeanSophie E. Moore, Lynnette M. Neufeld, Lars Åke Persson, Kathleen M. Rasmussen, Anuraj H. Shankar, Emily Smith, Christopher R. Sudfeld, Emorn Udomkesmalee, Stephen A. Vosti

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations


Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.

Original languageEnglish (US)
Pages (from-to)6-21
Number of pages16
JournalAnnals of the New York Academy of Sciences
Issue number1
StatePublished - May 2019

All Science Journal Classification (ASJC) codes

  • General Neuroscience
  • General Biochemistry, Genetics and Molecular Biology
  • History and Philosophy of Science


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