The authors of a new research study say that prenatal supplements that contain micronutrients such as zinc, iodine and vitamin A may be more effective than the iron and folic acid (IFA) supplements that are recommended in the current health policies.
A study published in the Annals of the New York Academy of Sciences compared the two supplementation guidelines and found that those who took multiple micronutrient supplements (MMS), commonly referred to as prenatal supplements, had a reduced risk of having a young child for gestational age (PEG) and low birth rate, compared to those taking IFA supplements.
Researchers at the University of California hypothetically replaced IFA supplements with MMS for one year in Bangladesh and Burkina Faso.
In addition to estimating effects, cost, and profitability, the team used the Lives Saved Tool (LiST) model, a source that lists population size, age structure, and distribution to assess the effect of replacement on mortality, adverse outcomes of birth and disability-adjusted life years (DALYs) prevented.
They noted an 8% risk reduction for stillbirth in the general population and a 21% risk reduction in anemic pregnant women, as well as a 15% risk reduction in 6-month mortality in girls and a reduction 29% risk among anemic pregnant women.
The team also noted a 12% reduction in risk of low birth weight (less than 2,500 grams) in the general population and a 19% reduction in risk among anemic pregnant women.
"The science is now unequivocal: Prenatal vitamin supplements are safe and significantly more effective than just iron and folic acid," said Gilles Bergeon, senior vice president for nutritional science at the New York Academy of Sciences.
"Micronutrient supplements for mothers are a solution that can prevent preterm labor and low birth weight for millions of babies."
Assuming 180 tablets are taken for each covered pregnancy, the team used this as the basis for calculating the marginal cost per tablet for complete replacement of MMS by IFA.
Along with improvements in mortality and low birth rates the team also found that this action, assuming 100% compliance and coverage, could prevent more than 15,000 deaths and 30,000 cases of preterm birth annually in Bangladesh.
In Burkina Faso, the switch from IFA to MMS resulted in more than 5,000 deaths and 5,000 cases of preterm birth that were theoretically avoided.
For decades, the World Health Organization (WHO) has recommended iron and folic acid (IFA) supplementation as part of routine prenatal care.
Developing countries have adopted this recommendation that includes the consumption of APIs during pregnancy in national nutrition plans.
These plans cite a body of evidence showing that deficiencies in other micronutrients such as zinc, iodine, and vitamin A affect fetal growth and development. Furthermore, these shortcomings are visibly prevalent in low- and middle-wage countries.
The WHO cites the lack of evidence as a reason for not recommending MMS in pregnant women to improve perinatal and maternal outcomes.
Considerable benefits of switching from IFA to SMM
The recent study notes: "The expected benefits of switching from IFA to MMS are considerable, both in reference to reductions in mortality and unwanted birth outcomes."
"Population-based models should be developed and used to predict the benefits of birth and mortality outcomes and the cost of switching from IFA to MMS during pregnancy."
“A model developed for the cases of Bangladesh and Burkina Faso and used to explore the benefits and costs of a year of a complete and immediate switch from IFA to SMM suggests that this policy could cost-effectively save lives and reduce lifelong disabilities”.
Emily Smith, Programming Officer for the Bill & Melinda Gates Foundation and Research Associate at Harvard TH Chan School of Public Health, said: “Women and girls around the world are often the last to eat and the least to eat, which leaves them and their future children vulnerable to the lasting effects of poor nutrition. "
"Good nutrition is essential for the growth and development of the fetus, so consuming a complete multivitamin during pregnancy offers newborns a better chance of a healthy start."
"As a matter of fairness, it is our responsibility to ensure that women around the world have access to prenatal vitamins that many of us take for granted are essential for a healthy pregnancy."
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