Real-world evidence confirms the benefit of taking MMS and IFAS during pregnancy
New real-world evidence suggests that a cheap, daily diet supplementation of iron, folic acid and other vitamins during pregnancy can reduce complications at birth. These results come from a six-y
New real-world evidence suggests that a cheap, daily diet supplementation of iron, folic acid and other vitamins during pregnancy can reduce complications at birth. These results come from a six-year study of nearly 100,000 women in Botswana, run by researchers at the Perelman School of Medicine at the University of Pennsylvania (US).
Researchers found that, when compared to iron or folic acid alone, iron and folic acid supplementation (IFAS), as well as other essential vitamins and trace minerals in the form of multiple micronutrient supplementation (MMS), are associated with significantly lower rates of birth complications, such as low birthweight.
Low birthweight can be defined as being under 2.5 kg at birth, with around 15–20% of children globally falling into this category. However, the majority of these cases occur in South Asia and Sub-Saharan Africa. The condition is associated with an increased risk of childhood illness and mortality, as well as diseases later in life, including diabetes and cardiovascular disease.
The study, published in Lancet Global Health, is the largest of its kind. Additionally, although it provides real-world confirmation of previous studies, it also includes a substantial number of participants with HIV, previously uninvestigated.
In total, 96,341 Botswanan women were studied between 2014–2020. The supplements were freely provided by government hospitals and the health of individuals was subsequently tracked by researchers. Data was also collected at the time of birth regarding birthweight, preterm or very preterm delivery, stillbirth and neonatal death status.
The results showed that 11.46% of women who took only IFAS gave birth to a baby with a low birthweight, compared to 16.92% of women who took only folic acid and 12.70% of women who only took iron supplements.
However, women who took only MMS experienced even lower rates of birth complications, including preterm delivery, very preterm delivery, low birthweight, very low birthweight and caesarean delivery, when compared to their peers who took only IFAS.
For example, only 10.48% of women in the MMS only group had a low birthweight birth. Similarly, the rate of preterm births in the MSS only group was 11.63%, compared to 12.68% in the IFAS only group.
Ellen Caniglia, from the Perelman School of Medicine at the University of Pennsylvania, comments: "Our results support the current WHO [(Geneva, Switzerland)] recommendation that pregnant women should take iron and folic acid supplementation daily, but also provide compelling evidence that multiple micronutrient supplementation has further advantages over IFAS."
Currently, WHO recommends that all women take IFAS daily throughout pregnancy. There is also newer clinical trial evidence that suggests that taking daily prenatal MMS, which includes iron and folic acid plus other vitamins, includingA, C, D, E, B1, B2, B3, B6 and B12, and minerals and metals, including iodine, selenium, zinc and copper, may provide more benefits than taking IFAS alone.
However, this current study is the first to provide real-world evidence for the benefit of MMS, especially compared to IFAS.
Further, nearly a quarter of this study’s population were HIV-positive. In this subpopulation, it was found that the advantages of MMS over IFAS and of IFAS over folic acid or iron alone was even more substantial. Although the reason for this is unknown, Caniglia hypothesizes that “possibly, pregnant women with HIV are more likely to be micronutrient deficient."
Additionally, the results suggested that in the overall population, compared to younger women, women over the age of 35 years also saw a greater benefit from taking IFAS or MMS than folic acid or iron alone.
Finally, the study also highlighted the issue of stock-shortages, as more than 43% of the study population received only folic acid, iron or no supplement at all due to lack in IFAS and MMS supplies. Caniglia concludes: “This highlights the need for new strategies to improve prenatal supplementation coverage among pregnant women.”