e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Multiple micronutrient supplementation during pregnancy

Intervention | Last updated: 21 June 2023


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 may have limited benefit and little harm on birth outcomes, however, the evidence on low birthweight and its component parts (preterm birth and SGA) is difficult to interpret.

WHO Recommendations


Antenatal multiple micronutrient supplements that include iron and folic acid are recommended in the context of rigorous research.*

* Rigorous research includes implementation research using high-quality methods appropriate to the specific research questions.

(This updated recommendation on antenatal multiple micronutrient supplements supersedes the corresponding recommendation issued in the original WHO 2016 antenatal care guideline, 'WHO recommendations on antenatal care for a positive pregnancy experience').



Evidence


Systematic reviews used to develop the guidelines


Multiple-micronutrient supplementation for women during pregnancy

Keats EC, Haider BA, Tam E, Bhutta ZA Cochrane Database of Systematic Reviews 2019; Issue 3. Art. No.: CD004905.

Summary of this review Alternate Text

Other related systematic reviews


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.


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.


Cost-effectiveness Learn More Alternate Text


Cost-effectiveness analyses


Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh

Shaheen R, Persson LÅ, Ahmed S, Streatfield PK, Lindholm L. BMC Pregnancy Childbirth. 2015; 15:125.


Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh

Svefors P, Selling KE, Shaheen R, Khan AI, Persson LÅ, Lindholm L. PLoS One. 2018; 13(2):e0191260.