Setting research priorities on multiple micronutrient supplementation in pregnancy
Research snapshot1
A series of publications recently presented evidence of the benefits of multiple micronutrient supplementation (MMS) on maternal and perinatal outcomes in addition to those provided by iron and folic acid (IFA) alone. Outcomes included significant risk reduction of low birth weight (LBW), small for gestational age (SGA), preterm birth, and stillbirth. However, important gaps in knowledge remain in the implementation of MMS in prenatal care programmes, which affect the successful implementation of this intervention. To clarify research needs, the Child Health and Nutrition Research Initiative (CHNRI) methodology was applied to inform the direction of research and investments needed to support the implementation of MMS interventions for pregnant women in low- and middle- income countries. Between April and June 2019, a group of international specialists identified and ranked the most urgent gaps in knowledge, focusing particularly on aspects that would improve the delivery and effectiveness of this intervention.
Seventy-three research questions were received, analysed and reorganised, resulting in a final list of 35 research questions. These were scored in turn against four criteria, yielding a list of 10 ranked-priority research options. The questions that received the highest priority were those that focused on the use of behavioural change and counselling strategies, and community workers to increase antenatal care (ANC) attendance and adherence to MMS. This is not surprising, given that low adherence to prenatal micronutrient supplementation is a major barrier to achieving the full potential benefits of this intervention, even when programme coverage is satisfactory. Other high-ranked questions were about the best (field-friendly and cost-effective) indicators and methods needed to identify populations more likely to benefit from prenatal MMS interventions. This may be justified by the lack of clear guidance for countries interested in adopting MMS interventions in the 2016 World Health Organization (WHO) Guidelines for ANC. In addition, questions around the potential benefit of extending MMS interventions beyond pregnancy into the lactation period were also ranked high. The lowest-scored question pertains to the marginal costs and benefits of adding each vitamin or mineral to MMS (possibly ranked low due to the presence of the commonly accepted ‘UNIMMAP’ formulation used in many of the trials that demonstrated additional benefits of MMS over IFA). This exercise identified important research gaps that must be urgently addressed to improve the implementation of this important and cost-effective nutrition intervention.
Endnotes
1 Filomena Gomes, Megan W. Bourassa, Seth Adu Afarwuah, Clayton Ajello, Zulfiqar A. Bhutta, Robert Black, Elisabete Catarino, Ranadip Chowdhury, Nita Dalmiya, Pratibha Dwarkanath, Reina Engle Stone, Alison D. Gernand, Sophie Goudet, John Hoddinott, Pernille Kæstel, Mari S. Manger, Christine M. McDonald, Saurabh Mehta, Sophie E. Moore, Lynnette M. Neufeld, Saskia Osendarp, Prema Ramachandran, Kathleen M. Rasmussen, Christine Stewart, Christopher Sudfeld, Keith West, and Gilles Bergeron. 2019. Setting research priorities on multiple micronutrient supplementation in pregnancy. The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences. https://doi.org/10.1111/nyas.14267
More like this
Collective Statement of Support for multiple micronutrient supplements (MMS)
We've joined global experts & practitioners calling for urgent scale-up of MMS ensuring mothers receive more effective prenatal care & in turn babies have the best chance...
FEX: Review of the use of antenatal multiple micronutrient supplementation in low- and middle-income countries
View this article as a pdf Research snapshot1 Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant...
FEX: Current evidence on anaemia and micronutrient supplementation strategies in school-age children and adolescents
View this article as a pdf Lisez cet article en français ici By Elena Hemler, Wafaie Fawzi and Stephanie Wrottesley Elena Hemler is senior project coordinator for the...
FEX: Prevention of child wasting in Asia: Possible role for multiple micronutrient supplementation in pregnancy
View this article as a pdf Lisez cet article en français ici By Kristen M. Hurley, Endang L Achadi, Clayton Ajello, Sufia Askari, Madhavika Bajoria, Kalpana...
Resource: Women's nutrition: A summary of evidence, policy and practice including adolescent and maternal life stages
Please scroll down for links to download the Executive Summary (also available in French) and full report Lisez cet document d'information technique en français ici...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
View this article as a pdf Lisez cet article en français ici By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
This is a summary of a Field Exchange 'views' article that was included in issue 63 - a special edition on child wasting in South Asia. The original article was authored by...
FEX: Effectiveness of programme approaches to improve the coverage of maternal nutrition interventions in South Asia
View this article as a pdf Summary of research1 The nutritional status of women before and during pregnancy and after delivery has far-reaching consequences for maternal...
Resource: Research priorities for nutrition of school-aged children and adolescents in low- and middle-income countries
Abstract Purpose A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress...
Nepal’s success story: What helped to improve maternal anaemia?
View this article as a pdf Dr Ram Padarath Bichha is Director of the Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal. Kedar...
FEX: Weekly iron and folic acid supplementation and nutrition education for adolescent girls in Africa and Asia
View this article as a pdf Lisez cet article en français ici By Anjali Bhardwaj, Lucy Murage, Shibani Sharma, Dhian Dipo, Christine Makena, Marion Roche and Mandana...
Harnessing the potential of India’s medical colleges to bring maternal nutrition services to scale
View this article as a pdf Dr Sebanti Ghosh is Programme Director with Alive & Thrive (A&T), India. Dr Kaushal Kishore is a member of the Indian Administrative Service (IAS)...
FEX: Delivery of maternal nutrition interventions at scale and mainstreaming into the health system in Bangladesh
View this article as a pdf Lisez cet article en français ici By Deborah Ash, Zeba Mahmud, Kristen Kappos, Santhia Ireen and Thomas Forissier Deborah Ash is Project...
FEX: Intensified antenatal care nutrition interventions in Burkina Faso
View this article as a pdf This is a summary of the following paper: Kim S, Zagré R, Ouédraogo C et al (2023) Intensified nutrition interventions in antenatal...
FEX: The launch of the Healthy Mothers Healthy Babies Consortium
View this article as a pdf The Micronutrient Forum and its partners, supported by Kirk Humanitarian and the Children's Investment Fund Foundation, launched the Healthy Mothers...
FEX: Weekly iron and folic acid supplementation and nutrition education for adolescent girls in Africa and Asia
This is a summary of a Field Exchange field article that was included in issue 66. The original article was authored by Anjali Bhardwaj, Lucy Murage, Shibani Sharma, Dhian...
Addressing maternal nutrition service delivery gaps in Afghanistan: Policy and programming opportunities
View this article as a pdf Dr Zakia Maroof is a Nutrition Specialist working with UNICEF Afghanistan. Dr Homayoun Ludin is an Afghan doctor working with the Ministry of...
Blog post: Why we still need to prioritise nutrition targets and indicators for children and adolescents
Young Lives longitudinal data has allowed researchers around the world to examine how exposure to poor health and nutrition in early childhood impacts outcomes in later life....
FEX: MMS on Essential Medicine List
View this article as a pdf Multiple micronutrient supplements (MMS), which have been shown to reduce the risk of small-for-gestational age birth, low birth weight and...
FEX: Multiple micronutrient supplementation to improve the quality of nutrition care and prevent low birthweight
View this article as a pdf This is a summary of the following report: UNICEF (2022) Multiple Micronutrient Supplementation: An approach to improving the quality of nutrition...
Reference this page
Setting research priorities on multiple micronutrient supplementation in pregnancy. Field Exchange 62, April 2020. p51. www.ennonline.net/fex/62/mmsinpregnancy
(ENN_6588)