Smith, Emily R;
Gomes, Filomena;
Adu-Afarwuah, Seth;
Aguayo, Victor M;
El Arifeen, Shams;
Bhutta, Zulfiqar A;
Caniglia, Ellen C;
... Sudfeld, Christopher R; + view all
(2025)
Contribution of maternal adherence to the effect of multiple micronutrient supplementation during pregnancy: a systematic review and individual participant data meta-analysis.
Advances in Nutrition
, Article 100455. 10.1016/j.advnut.2025.100455.
(In press).
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Abstract
Multiple micronutrient supplements (MMS) in pregnancy reduces the risk of infant low birthweight (LBW) and improves other maternal and infant outcomes as compared to iron-folic acid supplements (IFA) 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 two-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: 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 to IFA; the relative effect of MMS on the primary outcome of continuous birthweight was greater with higher adherence (p-value for interaction<0.05). Among women who took ≥90% of supplements, MMS increased birthweight by 56g (95%CI: 45, 67g), while among women who took <60% of supplements, there was no difference in birthweight between MMS and IFA (mean difference (MD): 9g; 95%CI: -17, 35). 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 to IFA. Observational analyses among participants who received MMS showed that ≥90% adherence was associated with increased birthweight (MD: 44g; 95%CI: 31, 56) and lower risk of LBW (RR: 0.93; 95%CI: 0.88, 0.98) and SGA (RR: 0.95; 95%CI: 0.93, 0.98), while <75% adherence was associated with a 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) as compared to 75-90% adherence. Programs should invest in strategies that promote early initiation and high adherence to MMS. PROSPERO ID: CRD42022319207.
| Type: | Article |
|---|---|
| Title: | Contribution of maternal adherence to the effect of multiple micronutrient supplementation during pregnancy: a systematic review and individual participant data meta-analysis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.advnut.2025.100455 |
| Publisher version: | https://doi.org/10.1016/j.advnut.2025.100455 |
| Language: | English |
| Additional information: | This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, https://creativecommons.org/licenses/by/4.0/. |
| Keywords: | Individual participant data meta-analysis; multiple micronutrient supplements; pregnancy; antenatal care |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10209459 |
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