Combating micronutrient deficiencies during pregnancy: how multiple micronutrient supplementation (MMS) can help optimize antenatal care

Summary

• Adverse pregnancy outcomes continue to be a global problem across low-, middle- and high-income countries alike. The World Health Organization (WHO) has developed a package of proven antenatal interventions to help reduce these adverse outcomes, including multiple micronutrient supplementation (MMS) - a combination of 15 vitamins and minerals that are crucial for a healthy pregnancy. 
• New evidence indicates that multiple micronutrients for pregnancy may significantly reduce the risk of adverse birth outcomes compared to iron and folic acid supplements (IFA). In fact, replacing IFA supplements with MMS could lead to a total annual economic benefit of over US$3.1 billion. 
• Read on to find out how dsm-firmenich is supporting partners to deliver MMS to the mothers that need it the most.  

Improving antenatal care to reduce adverse pregnancy outcomes 

Most pregnancies result in the birth of a healthy baby. But adverse pregnancy outcomes remain a global problem, particularly for women in low- and middle-income countries (LMICs).ⁱ Over 5,000 babies were stillborn at 28 weeks or more of gestation every day in 2021, which equates to 1.9 million babies stillborn in one year.ⁱⁱ In addition, a staggering 13.4 million babies were born preterm in 2020, with preterm birth also the leading cause of death among children under five years of age.^iii,iv There is an urgent unmet need to better support the health of mothers and babies during this critical time with antenatal interventions.  

To improve antenatal care and reduce the occurrence of early births and stillbirths, the World Health Organization (WHO) has developed a package of eight proven antenatal interventions.³ These include multiple micronutrient supplementation (MMS), balanced protein and energy supplementation; low-dose aspirin; progesterone provided vaginally; education for smoking cessation; malaria prevention; treatment of asymptomatic bacteriuria; and treatment of syphilis.  

The WHO stresses the importance of scaling up implementation of these interventions for all pregnant women. In fact, data has shown that more than 5 million preterm and small-for-gestational-age births, over half a million stillbirths and nearly half a million neonatal deaths could be prevented if full coverage (90%) of the eight interventions is achieved by 2030 in 81 LMICs.^v   

Implementation of all proven antenatal interventions could also reduce the neonatal mortality rate by 20% in LMICs, from 25.1 deaths per 1000 livebirths in 2023 to 20.1 in 2030. Moreso, the prevalence of low birthweight could see a reduction of 17.9% - which is more than half of the World Health Assembly’s 30% reduction target for 2030.⁵ 

Multiple micronutrients for pregnancy: the missing link in antenatal care 

Micronutrients play a crucial role throughout all phases of fetal development, however, two-thirds of non-pregnant women of reproductive age worldwide have micronutrient deficiencies.^vi While a healthy and balanced diet is required to receive adequate nutrition, this is often not available, accessible or affordable for pregnant women in LMICs.⁶  

MMS provides a comprehensive formulation of 15 vitamins and minerals that are essential for a healthy pregnancy, filling the gap between low micronutrient intakes and the higher nutritional requirements during this critical period. MMS is a safe and cost-effective solution that improves maternal and child health outcomes in populations that need it most.^vii 

Until recently, there has been a lack of evidence to support the use of MMS over iron and folic acid supplements (IFA) in antenatal care. But recent findings have illuminated the significant benefits of MMS for a healthy pregnancy. New evidence has shown that MMS containing iron and folic acid resulted in a significant reduction in the risk of adverse birth outcomes including low birthweights, small-for-gestational-age births, preterm births and still-births compared to IFA.⁶ The science also reveals that MMS had even greater benefits among anemic and under-weight pregnant women, as well as those who initiate supplementation earlier and those with higher adherence.⁶  

In 2020, the WHO identified a gap in evidence to support the use of MMS containing 30 mg of iron compared to IFA containing 60 mg of iron, especially in settings with high prevalence of anemia.⁶ However, new evidence has demonstrated that the use of MMS with 30 mg of iron could be comparable to IFA with 60 mg of iron in preventing maternal anemia and neonatal deaths.^viii As such, MMS is a safe and effective step towards achieving equal access to a better standard of antenatal care.  

Investing in the future  

Outside of supporting the health and development of mothers and babies, MMS can deliver significant socio-economic benefits. Scaling up maternal MMS to 90% coverage globally may result in substantial gains in schooling (5.0 million additional school years) and lifetime income (US$ 18.1 billion) per 5-year birth cohort.⁶ Further evidence indicates that replacing IFA supplements with MMS could lead to a total annual economic benefit of over US$3.1 billion, including US$94 million from averted stillbirths, US$428 million from averted preterm births and US$2.6 billion from averted low birth weights.^ix The cost of replacing IFA supplements with MMS is just US$84 million per year, yet the benefits are worth US$3.1 billion - resulting in more than US$37 economic return for every one dollar spent.⁸  

The International Maternal Newborn Health Conference (IMNHC): key takeaways 

For the first time in over eight years, in May 2023 the IMNHC brought together maternal newborn health communities in Cape Town, South Africa. dsm-firmenich attended the event alongside 1,500 stakeholders from around the world to accelerate solutions that improve maternal and newborn survival and prevent stillbirths. The event was a platform to share experiences with MMS implementation and learn from different partners and countries.  

Showcases presented at the conference emphasized the importance of switching from IFA to MMS, to better support mothers-to-be and reduce adverse pregnancy outcomes. Key takeaways from the event included the importance of supporting local production of MMS – a notable requirement from many countries. Addressing the poor regulatory framework around MMS was also highlighted as a key opportunity for countries to establish better guidelines that support local MMS production.  

IMNHC also served as a platform to discuss future strategies to better support mothers and babies. For example, implementing maternal and child health awareness weeks to help reach more women with MMS. The event also focused on the urgent need for the collaboration of public and private sectors to ensure mothers in LMICs receive high standards of antenatal care.

Expanding access to MMS solutions with dsm-firmenich

dsm-firmenich offers an MMS solution that is supported by WHO and UNICEF and is commercially available for pregnant and lactating women. This solution is currently produced and manufactured in South Africa. We are working hard with our partners to offer more locally produced MMS solutions, with aims to deliver MMS produced in other LMIC globally.