Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Study answer

What this study found

MMN supplementation, vs IFA, reduced risk of low birthweight by 15% (RR 0.85; 95% CI 0.77–0.93), stillbirths by 9% (RR 0.91; 0.86–0.98), and small-for-gestational-age infants by 7% (RR 0.93; 0.88–0.98). Diarrhea incidence in children aged 6 months to <5 years declined by 16% (RR 0.84; 0.76–0.92); child retinol concentrations increased. Mortality outcomes were largely unchanged. LNS showed no clear advantages over MMN for most outcomes. IFA reduced maternal anemia (RR 0.53; 0.43–0.65) and LBW (RR 0.88; 0.78–0.99). Vitamin D alone may reduce preterm births (RR 0.64; 0.40–1.04; stronger effect…

Study & population

Healthy pregnant women of any age and parity in LMICs; study designs included randomized controlled trials and quasi-experimental designs; data collected from 1995 onwards; trials conducted across East Asia and Pacific, Middle East and North Africa, sub-Saharan Africa, South Asia, Latin America and the Caribbean; 64 studies (439,649 women) in data analyses.

Intervention

MMN (UNIMMAP): daily prenatal supplement containing iron 30 mg and zinc 15 mg plus vitamins/minerals per UNIMMAP (A 800 µg, B1 1.4 mg, B2 1.4 mg, B6 1.9 mg, B12 2.6 mg, C 70 mg, D 200 IU, E 10 mg, niacin 18 mg, folic acid 400 µg, copper 2 mg, selenium 65 µg, iodine 150 µg); duration from enrollment to end of pregnancy.

Key limitation

Heterogeneity in MMN formulations (UNIMMAP, adapted UNIMMAP, non-UNIMMAP); varying dosages and durations; limited data for several outcomes and populations (e.g., adolescent pregnancy, sex-disaggregated outcomes); few effectiveness trials; some analyses rely on outcomes with wide confidence intervals; incomplete…

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Original abstract