Bibliographic Info
Guideline—
Year of Publication—
Issuing Institution—
Recommendation
Status
Updated
Recommendation in research context
Only in research contexts
Certainty of evidence
Moderate
Antenatal multiple micronutrient supplements that include iron and folic acid are recommended in the context of rigorous research
Notes and Remarks
- 1.This recommendation updates and supersedes the WHO recommendation found in the WHO ANC guideline issued in 2016
- 2.The evidence is derived from trials using MMS containing 13 to 15 micronutrients (including iron and folic acid) and the widely available United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP), which contains 15 micronutrients, including 30 mg of iron and 0.4 mg of folic acid (see Box 2 on the full guideline)
- 3.As the evidence was mainly derived from low- and middle-income countries, its applicability to high-income countries or to populations not at risk of micronutrient deficiencies – for example, due to an adequate diet and food fortification programmes – is unclear.
- 4.Research in this context therefore includes:
- 4.a controlled clinical trials in which early pregnancy ultrasound is used to establish gestational age with certainty, with assessment of critical maternal and perinatal outcomes, and follow-up of infants sustained into childhood; and
- 4.b where programmes of MMS are being considered, implementation research to establish the impact of switching from iron and folic acid supplements to MMS, including evaluation of acceptability, feasibility, sustainability, equity and cost-effectiveness.
- 5.Many MMS contain 30 mg or less of elemental iron and WHO recommends antenatal iron and folic acid supplements containing 60 mg of elemental iron in populations where anaemia is a severe public health problem (a prevalence of 40% or higher) (2). Therefore, countries should consider their population magnitude and distribution of anaemia, its nutritional determinants (i.e. iron deficiency), as well as the magnitude and distribution of the complex low birthweight and its component parts (i.e. preterm, small for gestational age [SGA] or a combination of these), when undertaking any research in the context of this recommendation.
- 6.Pregnant women should be supported and encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet consistent with guidelines on healthy eating