Daily micronutrient supplements during pregnancy reduce birth complications

The results of a six-year study of nearly 100,000 women in Botswana suggest iron plus folic acid and vitamins is better at reducing adverse birth outcomes compared to iron or folic acid alone.

A six-year study of nearly 100,000 women in Botswana provides new evidence that relatively inexpensive daily diet supplementation of iron, folic acid and vitamin supplementation in pregnancy can reduce complications at birth. Researchers found that iron and folic acid supplementation (IFAS), as well as iron and folic acid plus essential vitamins and trace minerals (multiple micronutrient supplementation, or MMS), are associated with significantly lower rates of babies born at low birthweight and other complications at birth, compared to iron or folic acid alone.

Torso of a pregnant person with arms crossed standing by a hospital bed in Botswana.

Published in Lancet Global Health, the study is led by Ellen Caniglia, an assistant professor of epidemiology in the Department of Biostatistics, Epidemiology, and Informatics at the Perelman School of Medicine, as well as investigators at the Botswana-Harvard AIDS Institute Partnership and Harvard T.H. Chan School of Public Health. The results represent a broad, real-world confirmation of earlier clinical trial results. The study, the largest ever of its kind, also includes a substantial cohort of pregnant women with HIV, and found that IFAS and MMS appeared to have even larger benefits in this group.

“Our results support the current World Health Organization 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,” Caniglia says.

About 15-20% of children born every year around the world have low birthweight, defined as a weight less than 2.5 kg at birth. Commonly occurring with preterm birth, low birthweight is associated with significantly increased risks of childhood illnesses and death, and diseases later in life such as diabetes and cardiovascular disease. The highest rates of low-birthweight births occur in South Asia and Sub-Saharan Africa.

To help reduce the rate of babies born at low birthweight and related complications at birth, the World Health Organization (WHO) recommends daily IFAS throughout pregnancy, in all settings, based on substantial clinical trial evidence. There is also clinical trial evidence that daily prenatal MMS, which includes iron and folic acid plus vitamins and minerals/metals may be superior to IFAS.

However, there has been a need for more evidence for MMS’s benefits, especially with respect to IFAS, in real-world settings, and in high-risk women such as women with HIV. The new study provides proof that the approach can help.

This story is by Julie Wood. Read more at Penn Medicine News.