Modalities
Existing ANC/PNC services for women should be the delivery platform of choice. Where these don’t exist, activities should be merged with ongoing health platforms/interventions for pregnant or breastfeeding mothers and neonatal/young child services. It may also be integrated into other health and nutrition services or community platforms.
Iron–containing supplements should be given to all PBWG:
- Where iron folic acid (IFA) is already being effectively provided through health systems, it should be continued. Otherwise, multiple micronutrient supplements (MMS) can be supplied.
- Counselling on healthy eating should be integral to antenatal care. Nutrition counselling must go beyond simply providing information; instead, it must give women/ girls the tools to make decisions, even in the face of challenges.
Conditions and considerations
- Daily oral IFA supplementation as part of antenatal care, should contain 30–60mg of elemental iron and 400μg of folic acid to prevent maternal anaemia, puerperal sepsis, low birth weight and preterm birth. (Note: this recommendation is not applicable if MMS is provided instead).
- Multiple micronutrient supplements (MMS) is formulated to provide a combination of essential vitamins and minerals that are needed for the overall health and well–being of PBWGs. The specific formulation of MMS can vary depending on the target population, the purpose of the supplement, and the prevailing nutritional deficiencies in a particular region. The formula recommended for use in pregnancy, and for which there is a strong evidence base, is the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP). UNIMMAP MMS is formulated to contribute towards the Recommended Dietary Allowance of 15 micronutrients in pregnant women. - ENN, 2024.
Recent evidence shows that when compared to IFA, MMS reduces low birthweight by 15%, stillbirth by 9%, preterm birth by 4% and small–for–gestational–age deliveries by 7%. Compared to iron with or without folic acid MMS has similar benefits for preventing maternal anaemia. The 2023 Copenhagen Consensus Report underscores the considerable economic advantages of replacing IFA with MMS, estimating a return on investment of USD 37 for every USD 1 spent.
However, national policy and existing services for providing nutrition support for PBWGs is an important consideration for making decisions linked to replacing IFA with MMS.
In contexts where vitamin A is a severe public health problem, vitamin A supplementation is recommended for the prevention of night blindness in pregnant women & adolescent girls to a maximum dosage of 10,000 IU per day or a weekly dose of up to 25 000 IU77. (Note: this recommendation is not applicable if MMS is provided instead)