Multiple micronutrient supplementation during pregnancy
Micronutrients are only needed in very small quantities but are essential for normal physiological function, growth and development. Deficiencies of micronutrients such as vitamin A, iron, iodine and folate are particularly common among during pregnancy, due to increased nutrient requirements of the mother and developing fetus. These deficiencies can negatively impact the health of the mother, her pregnancy, as well as the health of the newborn baby.
The most current evidence shows that giving multiple micronutrient supplements to pregnant women may reduce the risk of low birth weight and of small size for gestational age, compared with iron and folic acid supplementation alone. However, there is also some evidence of risk, as well as some important gaps in the evidence.
WHO recommendations
Multiple micronutrient supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.*
* There is some evidence of additional benefit of multiple micronutrient supplements containing 13 to 15 different micronutrients over iron and folic acid, but also some evidence of risk, and some important gaps in the evidence. Although the WHO guideline development group that developed this recommendation agreed that overall there was insufficient evidence to warrant a recommendation, the group agreed that policymakers in populations with a high prevalence of nutritional deficiencies might consider the benefits of multiple micronutrient supplements on maternal health to outweigh the disadvantages, and may choose to give multiple micronutrient supplements that include iron and folic acid.
WHO documents
GRC-approved guidelines
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WHO recommendations on antenatal care for a positive pregnancy experience
Publication date: 2016
Evidence
Systematic reviews used to develop the guidelines
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Multiple-micronutrient supplementation for women during pregnancy
Haider BA, Bhutta ZA.
Cochrane Database of Systematic Reviews 2015; Issue 11. Art. No.: CD004905. - Summary of this review
Related Cochrane reviews
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Multiple-micronutrient supplementation for women during pregnancy
Haider BA, Bhutta ZA.
Cochrane Database of Systematic Reviews 2017; Issue 4. Art. No.: CD004905. - Summary of this review
Other related systematic reviews
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Maternal multiple micronutrient supplementation and pregnancy outcomes in developing countries: meta-analysis and meta-regression
pdf, 1.44Mb
Kawai K, Spiegelman D, Shankar AH, Fawzi WW.
Bulletin of the World Health Organization. 2011; 89:402–411B. -
Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes
Haider BA, Yakoob MY, Bhutta ZA.
BMC Public Health. 2011; 11(Suppl.3):S19. -
Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality
Ronsmans C, Fisher DJ, Osmond C, Margetts BM, Fall CHD.
Food and Nutrition Bulletin. 2009; 30(Suppl.4):S547–S555.