Researchers reveal issues with WHO recommended pregnancy supplements

By Will Chu

- Last updated on GMT

Prenatal supplements containing micronutrients such as zinc, iodine, and vitamin A, could prove more effective than the iron-folic acid supplements suggested in current health policies, say researchers.

A study, published in Annals of the New York Academy of Sciences​, compared the two regimens and found those who took multiple micronutrient supplements (MMS) had a reduced the risk of small for gestational age (SGA) and low birth rate (LBW) compared to those on a course of IFA supplements.

Researchers from the University of California hypothetically replaced IFA supplements with MMS for one year in Bangladesh and Burkina Faso.

Along with estimating the effects, costs and cost‐effectiveness, the team used Lives Saved Tool (LiST) - a resource listing size, age structure and population distribution to evaluate the replacement’s effects on mortality, adverse birth outcomes, and disability‐adjusted life years (DALYs) prevented.

They noted an 8% reduced risk of stillbirth in the overall population and a 21% reduced risk among anaemic pregnant women as well as a 15% reduced risk of 6-month mortality in female infants and a 29% reduced risk among anaemic pregnant women.

The team also noted a 12% reduced risk of low birth weight (less than 2500 grams (g) in the overall population, and a 19% reduced risk among anaemic pregnant women.

“The science is now unequivocal – comprehensive prenatal vitamins are safe and significantly more effective than iron and folic acid alone,”​ said Gilles Bergeron, senior vice president of nutrition science at the New York Academy of Sciences.

“Maternal micronutrient supplements are a ready solution that can prevent millions of infants from being born too soon or born too small.”

The study

By assuming 180 tablets taken per covered pregnancy, the team used this as a basis to calculate the marginal tablet costs of completely replacing MMS with IFA.

Along with the improvements to mortality and low birth rates, the team also found this action, assuming 100% coverage and adherence could prevent over 15,000 deaths and 30,000 cases of preterm birth per year in Bangladesh.

In Burkina Faso, the switch from IFA to MMS resulted in over 5000 deaths and 5000 cases of preterm births theoretically averted.

Further estimates placed the cost per death prevented to be €155 – €164 in Bangladesh and €99 – €110 in Burkina Faso.

Cost per DALY prevented ranged from €2.70 to €13.30, depending on the country and consideration of subgroup effects.

Current recommendations

For decades, the World Health Organization (WHO) has recommended provision of iron‐folic acid (IFA) supplements as part of routine antenatal care.

Developing countries have readily adopted this recommendation, which include IFA intake during pregnancy in national nutrition plans.

These plans cite a body of evidence that show deficiencies in other micronutrients, such as zinc, iodine, and vitamin A, affect foetal growth and development. In addition, these deficiencies are notably prevalent in low‐ and middle‐income countries.

The WHO cites gaps in evidence as a reason not to recommend MMS for pregnant women to improve maternal and perinatal outcomes.

The organisation also points to a potential increased risk of pregnancy complications owing to increased incidence of large‐for‐gestational age (LGA).

‘Benefits of IFA to MMS shift substantial’

The recent study report notes: “The expected benefits of the shift from IFA to MMS are substantial, both with reference to reductions ​of mortality and undesirable birth outcomes (e.g., LBW).” 

“Population‐based models should be developed and used to predict the mortality and birth outcome benefits, and the costs, of shifting from IFA to MMS during pregnancy.

“A model developed for the cases of Bangladesh and Burkina Faso and used to explore the singleyear benefits and costs of a complete and immediate shift from IFA to MMS suggests that this policy would costeffectively save lives and reduce lifelong disabilities.

Emily Smith, program officer at the Bill & Melinda Gates Foundation and research associate at the Harvard T.H. Chan School of Public Health, said: “Women and girls around the world often eat last and eat least—leaving them and their future children vulnerable to the lasting effects of poor nutrition.

“Good nutrition is essential for foetal growth and development, so a comprehensive multivitamin taken during pregnancy offers newborns a better chance at a healthy start.

“As a matter of equity, it’s our responsibility to ensure that women everywhere have access to the prenatal vitamins that many of us take for granted as fundamental to a healthy pregnancy.”


Source: Annals of the New York Academy of Sciences

Published online:

“Replacing ironfolic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and costeffectiveness.

Authors: Reina Engle‐Stone, Sika Kumordzie, Laura Meinzen‐Dick,  Stephen Vosti.


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