New HMHB and Micronutrient Forum brief highlights vital supplements for pregnancy

04 Jun 2024 --- The Healthy Mothers Healthy Babies Consortium (HMHB), a program of the Micronutrient Forum, Washington DC, US, has released a new brief detailing multiple micronutrient supplementation (MMS) during pregnancy. It served to inform advocates, implementers and national actors.

The document offers consolidated evidence on the benefits of MMS compared to iron-folic acid supplementation (IFAS) on pregnancy and birth outcomes. It compares iron intake through MMS versus IFAS and presents recommendations on MMS provision alongside anemia treatment during pregnancy. It further discusses the cost-effectiveness of MMS while linking to useful resources.

“Micronutrients (vitamins and minerals) are essential nutrients required in tiny amounts for healthy growth, disease prevention and well-being across all life stages. They have a particularly significant role during pregnancy,” the brief states.

In low- and middle-income countries, two in every three women of reproductive age suffer from some form of malnutrition, and according to the HMHB, the issue is likely to be even more exacerbated among pregnant women. “The daily requirements of vitamins and minerals during pregnancy increase by as much as 50%. For example, a non-pregnant woman needs 150 μg of iodine, but a pregnant woman needs 220 μg (+47%) of this nutrient.”

MMS and IFAS
The WHO included MMS on its list of essential medicines in 2021. The paper details that MMS should be provided to pregnant women in order to prevent micronutrient deficiencies and facilitate healthier pregnancy outcomes. 

Micronutrients are essential for healthy growth, disease prevention and well-being across all life stages, particularly during pregnancy.The most commonly used formulation of MMS is the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP). It is formulated to provide the correct amounts of 15 essential micronutrients necessary for a healthy pregnancy that is safe for the mother and fetus.

The brief highlights that studies conducted over the last 20 years consistently point to MMS intake being more effective than IFAS at decreasing the likelihood of lower birth weight (LBW), premature delivery and stillbirths. The benefits of MMS over IFAS are even more apparent when considering pregnant women who are anemic (19% decreased likelihood of LBW), underweight or in adolescent mothers in developing regions (also 19% LBW decrease). 

“The 12–14% risk reduction of low birth weight observed with MMS has the potential to benefit 2.2 million infants in low- and middle-income countries every year,” states the HMHB. 

Among pregnant women with anemia, infant mortality is 29%, and preterm births are 16% lower. Meanwhile, among adolescent pregnancies, the risk of “small for gestational age” and preterm births are 14% lower with MMS, in comparison to IFAS. 

One potential concern about MMS is that it prescribes 30 mg of iron as sufficient to prevent

maternal anemia, whereas IFAS formulations offer 60 mg of iron. However, according to the HMHB, 30 mg is the correct recommended dietary allowance of iron during pregnancy, stating that recent research shows that MMS with 30 mg of iron during pregnancy is

comparable to IFA with 60 mg of iron in terms of preventing maternal anemia and deaths. 

Prenatal vitamins and minerals, vitamin A and deworming treatments for pregnant people, mothers and infants is essential to combating malnutrition, tells us Vitamin Angels’ Stanfield.Additional MMS benefits 
This is likely the case because other micronutrients, particularly vitamins A, B2 and C, enhance iron absorption and utilization compared to IFAS. MMS also prevents other nutritional causes of anemia, namely vitamin A, B12 and folic acid deficiencies.

Another benefit of MMS that is spotlighted in the brief is cost-effectiveness. “MMS offers a remarkable return of over US$37 for every dollar invested.” This is despite the slightly higher cost of supplementation due to the inclusion of additional micronutrients. 

If 90% of pregnant women were allowed access to MMS, five million extra school years could become a reality for children, resulting in economic gains of US$18 billion in lifetime income. 

The provision of prenatal vitamins and minerals, vitamin A and deworming treatments for pregnant people, mothers and infants is essential in combating malnutrition, argued Amy Stanfield, chief operations officer at the US public health NGO Vitamin Angels, in a recent interview with Nutrition Insight. 

By Milana Nikolova