scholarly journals Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression

2011 ◽  
Vol 89 (6) ◽  
pp. 402-411B ◽  
Author(s):  
Kosuke Kawai ◽  
Donna Spiegelman ◽  
Anuraj H Shankar ◽  
Wafaie W Fawzi
Keyword(s):  
Developing Countries ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Micronutrient Supplementation ◽  
Multiple Micronutrient ◽  
Meta Regression

Multiple Micronutrient Supplementation during Pregnancy in Developing-Country Settings: Policy and Program Implications of the Results of a Meta-Analysis

2009 ◽  
Vol 30 (4_suppl4) ◽  
pp. S556-S573 ◽  
Author(s):  
Roger Shrimpton ◽  
Sandra L. Huffman ◽  
Elizabeth R. Zehner ◽  
Ian Darnton-Hill ◽  
Nita Dalmiya
Keyword(s):  
Developing Country ◽  
Meta Analysis ◽  
Micronutrient Supplementation ◽  
Multiple Micronutrient

scholarly journals New Evidence Should Inform WHO Guidelines on Multiple Micronutrient Supplementation in Pregnancy

2019 ◽  
Vol 149 (3) ◽  
pp. 359-361 ◽  
Author(s):  
Christopher R Sudfeld ◽  
Emily R Smith
Keyword(s):  
Neonatal Mortality ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Micronutrient Supplementation ◽  
Who Guidelines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Multiple Micronutrient ◽  
Iron And Folic Acid ◽  
New Evidence

ABSTRACT Recent data from an individual patient data (IPD) meta-analysis of 17 randomized control trials including >100,000 women living in low- and middle-income countries found that multiple micronutrient supplementation (MMS) in pregnancy reduced the risk of low birth weight, preterm birth, and being born small for gestational age. Further, MMS reduced the risk of neonatal and infant mortality for females, and there was no evidence of increased risk among the 26 subgroups examined. The 2016 WHO antenatal care guidelines, which were released before the IPD meta-analysis, did not universally recommend MMS, noting: “There is some evidence of additional benefit … but there is also some evidence of risk.” The guidelines suggest that MMS may increase the risk of neonatal mortality based on an exploratory subgroup analysis of 6 randomized trials. However, we identified several issues with this subgroup analysis. In this report we correct and update the subgroup analysis and show that there is no evidence that MMS increases the risk of neonatal mortality. There is growing scientific consensus that MMS containing iron and folic acid (IFA) is superior to IFA alone. The WHO guidelines currently state that “policy-makers in populations with a high prevalence of nutritional deficiencies might consider the benefits of MMN [multiple micronutrient] supplements on maternal health to outweigh the disadvantages, and may choose to give MMN supplements that include iron and folic acid.” This equivocal guidance has created confusion about the best course of action for public health programs in low- and middle-income countries. Given the new evidence, WHO should review their statements regarding the potential neonatal mortality risks and re-evaluate the overall potential benefits of implementing MMS as a public health program.

scholarly journals Multiple Micronutrient Supplementation During Pregnancy: Evidence Review (P10-092-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Megan Bourassa ◽  
Gilles Bergeron ◽  
Filomena Gomes
Keyword(s):  
Pregnant Women ◽  
Task Force ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Cost Effective ◽  
Standard Of Care ◽  
Protective Effects ◽  
Micronutrient Supplementation ◽  
Micronutrient Deficiencies ◽  
Multiple Micronutrient

Abstract Objectives Insufficient pre-pregnancy intakes of micronutrients, combined with increased nutrient demands during pregnancy often result in maternal micronutrient deficiencies that affect the health of the mother and the development of the fetus. WHO currently recommends iron and folic acid (IFA) supplementation as standard of care for pregnant women, but recognizes that multiple micronutrient supplementation (MMS) may improve pregnancy outcomes under given conditions. New evidence on the effect of MMS compared to IFA during pregnancy was reviewed to develop guidance for countries that may want to consider providing MMS to pregnant women. Methods An expert task force was assembled by the Sackler Institute to assess the data from trials comparing MMS to IFA, the risks of reaching the upper intake levels with MMS, the risk of harm to pregnant women or their infants, and to do a cost-effectiveness analysis (CEA) of MMS compared to IFA. Recent data from a Cochrane review (CR) and an Individual Patient Data meta-analysis (IDP) were assessed. Results Both reviews, predominantly using data from low and middle income countries (LMIC), demonstrated improved pregnancy and birth outcomes among women receiving MMS instead of IFA, including a lower risk of low birth weight (RR 0.88 (95% CI 0.85–0.91) in the CR; RR 0.88 (95% CI 0.85–0.90) in the IPD) and of small for gestational age births (RR 0.92 (95% CI 0.86–0.98) in the CR and RR 0.97 (95% CI 0.96–0.99) in the IDP). The IDP identified further beneficial effects of MMS vs. IFA on preterm birth (RR 0.92 (95% CI 0.88–0.95)) and stillbirth (RR 0.92 (95% CI 0.86–0.99)). Larger protective effects of MMS were observed in subgroups of anemic and underweight women, two prevalent conditions in LMIC. The CEA also supported the transition from IFA to MMS. Conclusions Pregnant women in LMICs and their infants could benefit from MMS over IFA during pregnancy, as a cost-effective intervention. This presentation will discuss the approach used by the expert task force, its conclusions, as well as a framework to help LMIC decide on which program to support, and ongoing efforts to pilot the adoption of MMS in sample countries. Funding Sources Bill & Melinda Gates Foundation.

scholarly journals Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis

BMC Medicine ◽  
2016 ◽  
Vol 14 (1) ◽  
Author(s):  
Delan Devakumar ◽  
Caroline H. D. Fall ◽  
Harshpal Singh Sachdev ◽  
Barrie M. Margetts ◽  
Clive Osmond ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Health Benefits ◽  
Micronutrient Supplementation ◽  
Multiple Micronutrient
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