Contribution of Maternal Adherence to the Effect of Multiple Micronutrient Supplementation During Pregnancy: A Systematic Review and Individual Participant Data Meta-analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Multiple micronutrient supplements (MMS) in pregnancy reduces risk of infant low birthweight (LBW) and improves other maternal and infant outcomes compared with iron and folic acid (IFA) supplements alone. However, the impact of timing of initiation and adherence on the MMS effectiveness in real-world programs remains unclear. To address this, we conducted a 2-stage individual participant data meta-analysis that included 15 randomized trials (61,204 pregnant women) and assessed whether the relative effect of MMS differed by the following: adherence alone; adherence in combination with gestational age at initiation; and the total number of tablets taken. We also evaluated the observational association of these factors with outcomes among participants who received MMS. Compared with IFA supplements, the relative effect of MMS on the primary outcome of continuous birthweight was greater with higher adherence (P-interaction < 0.05). Among women who took ≥90% of supplements, MMS increased birthweight by 56 g (95% CI: 45, 67 g), whereas among women who took <60% of supplements, there was no difference in birthweight between MMS and IFA supplements [mean difference (MD): 9 g; 95% CI: -17, 35 g). Higher adherence was also associated with greater effect of MMS on LBW and birthweight-for-gestational age centile and women who took more supplements experienced a greater relative impact of MMS on birthweight-for-gestational age centile and small-for-gestational age births (SGA) as compared with IFA supplements. Observational analyses among participants who received MMS showed that ≥90% adherence was associated with increased birthweight (MD: 44 g; 95% CI: 31, 56 g) and lower risk of LBW [relative risk (RR): 0.93 g; 95% CI: 0.88, 0.98 g] and small-for-gestational age (RR: 0.95; 95% CI: 0.93, 0.98), whereas <75% adherence was associated with greater risk of stillbirth (RR: 1.43; 95% CI: 1.12, 1.83) and maternal anemia (RR: 1.26; 95% CI: 1.11, 1.43) than 75%-90% adherence. Programs should invest in strategies that promote early initiation and high adherence to MMS. This trial was registered at PROSPERO as CRD42022319207.
Source: Advances in Nutrition
Authors: Emily R Smith, Filomena Gomes, Seth Adu-Afarwuah, Victor M Aguayo, Shams El Arifeen, Zulfiqar A Bhutta, Ellen C Caniglia, Parul Christian, Delanjathan Devakumar, Kathryn G Dewey, Wafaie W Fawzi, Henrik Friis, Exnevia Gomo, Ousmane Guindo, Lotta Hallamaa, Sheila Isanaka, Pernille Kæstel, Carl Lachat, Ken Maleta, Sophie E Moore, Erin M Oakley, David Osrin, Anisur Rahman, Ziaul Rana, Arjumand Rizvi, Dominique Roberfroid, Saijuddin Shaikh, Bakary Sonko, Sajid Bashir Soofi, Inan Subarkah, Rahardjo Sunawang, Dongqing Wang, Keith P West, Lee Shu Fune Wu, Noel Zagre, Megan W Bourassa, Christopher R Sudfeld
Institutions: George Washington University, New York Academy of Sciences, Universidade Nova de Lisboa, University of Ghana, United Nations Children's Fund, International Centre for Diarrhoeal Disease Research, Aga Khan University, University of Pennsylvania, Johns Hopkins University, University College London, University of California, Davis, University of Copenhagen, University of Zimbabwe, Tampere University, University of Tampere, Harvard University, Epicentre, Ghent University, University of Malawi, King's College London, London School of Hygiene & Tropical Medicine, MRC Unit the Gambia, Medical Research Council, University of Namur, University of Indonesia, George Mason University
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,200
OpenAlex ID: W4410894069