ARS | Publication request: Multiple micronutrient supplementation during pregnancy in low-income countries: Review of methods and characteristics of studies included in the meta-analysis

Submitted to: Food and Nutrition Bulletin
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 5, 2009
Publication Date: December 5, 2009
Repository URL: http://www.foodandnutritionbulletin.org/downloads/FNB_v30n4_suppl_web.pdf
Citation: Margetts, B.M., Fall, C.H., Ronsmans, C., Allen, L.H., Fisher, D.J. 2009. Multiple micronutrient supplementation during pregnancy in low-income countries: Review of methods and characteristics of studies included in the meta-analysis. Food and Nutrition Bulletin. 30:S517-S526.

Interpretive Summary: There are several reasons to consider whether flour should be fortified with vitamin B12. There is a high prevalence of depletion and deficiency of this vitamin in persons of all ages in many resource-poor countries, and in elderly people from both wealthier and poor countries. Lack of this vitamin has multiple adverse effects. The most common cause of vitamin B12 insufficiency is a low intake of animal source foods, and even lacto-ovo vegetarians have lower serum concentrations and greater risk of depletion of the vitamin than do omnivores. Mothers with poor intake and status of the vitamin during pregnancy give birth to depleted infants, and their breast milk B12 content is low. More than 20% of elderly have low serum B12 concentrations and 6% have deficiency, due to atrophy of the stomach, which results in impaired absorption from foods but probably not from supplements or fortified foods. The recommended level of fortification is 20 ug per kg flour assuming consumption of 75 to 100 g flour per capita per day. Cost of the vitamin is the factor limiting addition of higher amounts. Because there is little experience with vitamin B12 fortification, the effectiveness of this recommended level of B12 in programs should be monitored, and it is important to ensure that elderly with gastric atrophy can absorb sufficient from products made with fortified flour.

Technical Abstract: This paper reports on the methods and characteristics of 12 studies from developing countries included in a meta-analysis of the impact of antenatal supplements of multiple micronutrients compared with iron–folic acid on micronutrient status, maternal nutritional status, birth outcomes, and neonatal survival. The main purpose was to compare outcomes when the women were given multiple micronutrients rather than just iron plus folic acid. The results of the analysis are provided in a series of accompanying articles in the same journal Supplement.