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McDonald CM, Wessells KR, Stewart CP, Dewey KG, de Pee S, Rana R, Hafeez-Ur-Rehman H, Mwangi MN, Hess SY. Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13681. [PMID: 38949186 DOI: 10.1111/mcn.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Saskia de Pee
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | - Ritu Rana
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | | | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
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Kuche D, Abebe Z, Tessema M, Girma M, Hussen A, Baye K, Stoecker BJ. The effect of UNIMMAP multiple micronutrient supplements versus iron-folic acid and placebo in anemia reduction among women of reproductive age in Kebribeyah Woreda, Somali Regional State, Ethiopia: a study protocol for a community-based individual RCT. Trials 2024; 25:170. [PMID: 38448918 PMCID: PMC10916067 DOI: 10.1186/s13063-024-08024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Women of reproductive age (WRA) in developing countries are often at risk of micronutrient deficiencies due to inadequate intakes and excessive losses. OBJECTIVE The purpose of this trial is to assess the effectiveness of United Nations International Multiple Micronutrient Antenatal Preparation-Multiple Micronutrient Supplements (UNIMMAP-MMS) versus iron-folic acid (IFA) among WRA in reducing anemia. METHODS Three parallel groups of WRA will participate in a community-based, individually randomized, double-blinded, placebo-controlled superiority trial. After consent, the sample of 375 mildly or moderately anemic women based on hemoglobin by Hemocue will be randomly assigned across two interventions and one control arm. Trial participants in intervention arms will receive UNIMMAP-MMS or IFA while those in the control arm will receive placebos twice a week for 17 weeks. The primary outcome will be a change in mean hemoglobin (Hb) concentrations. Outcome assessors and study participants will be blinded to the type of supplements and study arm. DISCUSSION The World Health Organization (WHO) added UNIMMAP-MMS to its essential medicine lists in 2021 but recommended rigorous study. Several factors in addition to inadequate intakes of iron and folic acid contribute to the high prevalence of anemia among WRA in the Somali region. The findings of this study will provide evidence on the effect of UNIMMAP-MMS and IFA on Hb concentrations and anemia prevalence among anemic WRA. TRIAL REGISTRATION ClinicalTrials.gov NCT05682261. Registered on January 12, 2023.
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Affiliation(s)
- Desalegn Kuche
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Oklahoma State University, Stillwater, OK, USA.
- Addis Ababa University, Addis Ababa, Ethiopia.
| | | | | | - Meron Girma
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Kaleab Baye
- Addis Ababa University, Addis Ababa, Ethiopia
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Marcos Puig B, Llopis-Morales J, Picó Y. Effect of Adherence to the Mediterranean Diet on Maternal Iron Related Biochemical Parameters during Pregnancy and Gestational Weight Gain. Life (Basel) 2023; 13:life13051138. [PMID: 37240783 DOI: 10.3390/life13051138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Gestation is a crucial life stage for both women and offspring, and outcomes are affected by many environmental factors, including diet. The Mediterranean dietary pattern (MD) is considered a healthy eating pattern that can provide the nutritional requirements of pregnancy. Meanwhile, iron deficiency anemia is one of the most frequent complications related to pregnancy. This study aimed to evaluate how the level of adherence to the MD influences maternal gestational weight gain and specific iron-related maternal biochemical parameters during the pregnancy. Accordingly, an observational, population-based study using data from pregnant women conducted over the entire course of their pregnancy was carried out. Adherence to the MD was assessed once using the MEDAS score questionnaire. Of the 506 women studied, 116 (22.9%) were classified as demonstrating a high adherence, 277 (54.7%) a medium adherence, and 113 (22.3%) a low adherence to the MD. No differences were observed in gestational weight gain among the MD adherence groups but the adequacy of weight gain did vary among the groups, with the proportions of inadequate (insufficient or excessive) weight gain presenting the most notable differences. Total anemia prevalence was 5.3%, 15.6%, and 12.3%, respectively, during the first, second, and third trimesters. For iron-related biochemical parameters, no differences are observed among the adherence groups during pregnancy. With high adherence to the MD as the reference group, the crude odds of iron deficiency diagnosis are significant in the first trimester for both the medium [OR = 2.99 (1.55-5.75)] and low [OR = 4.39 (2.15-8.96)] adherence groups, with deficient adherence to the Mediterranean dietary pattern being responsible for 66.5% (35.5-82.6) and 77.2% (53.5-88.8) of the risk of iron deficiency diagnosis for medium and low adherence, respectively. However, adjusted odds ratios were not significant, possibly due to the small sample size. Our data suggest that MD adherence could be related to gestational weight gain adequacy and that optimal adherence could reduce iron deficiency and/or anemia during pregnancy in the studied population.
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Affiliation(s)
- María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Beatriz Marcos Puig
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Juan Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
| | - Yolanda Picó
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
- Environmental and Food Safety Research Group (SAMA-UV), Desertification Research Centre, (CIDE, CSIC-UV-GV), Moncada-Naquera Road Km 4.5, 46113 Moncada, Valencia, Spain
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Gomes F, Askari S, Black RE, Christian P, Dewey KG, Mwangi MN, Rana Z, Reed S, Shankar AH, Smith ER, Tumilowicz A. Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method. MATERNAL & CHILD NUTRITION 2023:e13509. [DOI: 10.1111/mcn.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences New York City New York USA
- NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal
| | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Kathryn G. Dewey
- Department of Nutrition University of California, Davis Davis California USA
| | | | - Ziaul Rana
- The New York Academy of Sciences New York City New York USA
| | - Sarah Reed
- The Bill & Melinda Gates Foundation Seattle Washington USA
| | - Anuraj H. Shankar
- Nuffield Department of Medicine University of Oxford Oxford UK
- Summit Institute for Development Mataram Indonesia
| | - Emily R. Smith
- Milken Institute School of Public Health The George Washington University Washington District of Columbia USA
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy S, Subramoney V, Briggs B, Fawzi WW. Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data. Am J Clin Nutr 2022; 116:1864-1876. [PMID: 36130877 PMCID: PMC10843965 DOI: 10.1093/ajcn/nqac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). OBJECTIVES We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. METHODS A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. RESULTS MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. CONCLUSIONS Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne M Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephen Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Brittany Briggs
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - members of the GWG Pooling Project Consortium
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Certara Canada, Montreal, Quebec, Canada
- DVPL Tech
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Liao Q, Tang P, Pan D, Song Y, Lei L, Liang J, Liu B, Lin M, Huang H, Mo M, Huang C, Wei M, Liu S, Huang D, Qiu X. Association of serum per- and polyfluoroalkyl substances and gestational anemia during different trimesters in Zhuang ethnic pregnancy women of Guangxi, China. CHEMOSPHERE 2022; 309:136798. [PMID: 36220436 DOI: 10.1016/j.chemosphere.2022.136798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Gestational anemia is a complication of pregnancy, and a low level of hemoglobin (Hb) has been linked to adverse pregnancy outcomes. Previous studies reported that PFASs were more strongly associated with Hb than red blood cells, indicating that Hb is more susceptible to the effect of PFASs. However, the evidences regarding the effects of per- and polyfluoroalkyl substances (PFASs) on gestational anemia are currently limited. Therefore, it is important to explore the effects of PFASs on anemia in Chinese pregnant women. METHODS A total of 821 pregnant women were recruited between June 2015 and April 2019 in the Guangxi Zhuang Birth Cohort. The concentrations of PFASs were assessed in maternal serum before 12 gestational weeks. To determine both individual and combined associations of PFASs exposure with anemia in the three stages of pregnancy, binary logistic regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) regression models were employed. RESULTS In single-pollutant analysis, maternal exposure to perfluorododecanoic acid (PFDoA) and perfluoroheptanoic acid (PFHpA) were associated with anemia in the first trimester, exposure to PFHpA and perfluorobutanesulfonic acid (PFBS) were associated with anemia in the second trimester, and exposure to perfluorodecanoic acid (PFDA) and perfluorononanoic acid (PFNA) were associated with anemia in the third trimester. Notably, perfluoroundecanoic acid (PFUnA) had a nonlinear association with anemia in the third trimester. In multiple-pollutant analysis, a positive association of PFDoA with anemia in the first trimester and a negative association of PFBS with anemia in the second trimester were confirmed by BKMR. Exposure to PFASs mixture was not associated with anemia in all three trimesters. In WQS, there was a significantly negative association between the PFAS mixture and anemia in the second trimester. CONCLUSION Maternal exposure to PFASs is associated with gestational anemia in different trimesters.
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Affiliation(s)
- Qian Liao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Peng Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yanye Song
- The Third Affiliated Hospital of Guangxi Medical University, Nanning, 530031, Guangxi, China
| | - Lei Lei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Bihu Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Mengrui Lin
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huishen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Meile Mo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chengtuo Huang
- Department of Physical Examination, Guangxi Tiandong Hospital of Traditional Chinese Medicine, Tiandong, 531500, Guangxi, China
| | - Ming Wei
- Department of Obstetrics and Gynecology, Child Hygiene, Maternal and Child Health Care Hospital of Tianyang District, Baise City, 542899, Guangxi, China
| | - Shun Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Ranjith A, Puri S, Vohra K, Khanam A, Bairwa M, Kaur R, Yadav K. Ideal Dose of Iron in Multiple Micronutrient Supplement: A Narrative Review of Evidence. Cureus 2022; 14:e28688. [PMID: 36199654 PMCID: PMC9526876 DOI: 10.7759/cureus.28688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/08/2022] Open
Abstract
Anemia is a significant public health problem in low- and middle-income countries (LMICs). The co-existence of other micronutrient deficiencies and iron deficiency among pregnant women may be the reason for the inability to control anemia through iron and folic acid (IFA) supplementation. Multiple micronutrient supplementation (MMS) in pregnancy may help to overcome this problem. However, the recent World Health Organization (WHO) guidelines on MMS supplementation in pregnancy raised concerns regarding the adequacy of a 30mg iron dose in the MMS supplements in LMICs. The review summarized the literature to answer this question. Though most studies showed a comparable effect of MMS with 30mg iron and IFA with 60mg iron on maternal anemia outcomes, anemia persisted in the third trimester in both groups. There is a need to consider the use of a higher iron dose in MMS, especially in LMICs, to combat the problem of anemia, alongside correcting other micronutrient deficiencies.
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