01 October 2024
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journalArticle
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HMH Professional; ★

Discover the Best of Use of multiple micronutrient supplementation integrated into routine antenatal care: A discussion of research priorities

HoldMyHand / 1 FoodGap / MMS

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Abstract Optimal maternal nutrition, including adequate intake and status of essential micronutrients, is important for the health of women and developing infants. Currently, the World Health Organization (WHO) Antenatal care recommendations for a positive pregnancy experience recommend daily iron and folic acid (IFA) supplementation as the standard of care. The use of multiple micronutrient supplements (MMS) is recommended in the context of rigorous research as more evidence was needed regarding the impact of switching from IFA supplements to MMS, including evaluation of critical clinical maternal and perinatal outcomes, acceptability, feasibility, sustainability, equity and cost‐effectiveness. WHO convened a technical consultation of key stakeholders to discuss research priorities with the objective of providing guidance and clarity to donors, implementers and researchers about this recommendation. The overarching principles of the research agenda include the use of clinical indicators and impact measures that are applicable across studies and settings and the inclusion of outcomes that are important to women. Future studies should consider using standardized protocols based on current best practices to measure critical outcomes such as gestational age (GA) and birthweight (BW) in studies. As GA and BW are influenced by multiple factors, more research is needed to understand the biological impact pathways, and how initiation and considerations for timing of MMS influence these outcomes. A set of core clinical indicators was agreed upon during the technical consultation. For implementation research, the Evidence‐to‐Decision framework was used as a resource for discussing components of implementation research. The implementation research questions, key indicators and performance measures will depend on country‐specific context and bottlenecks that require further research and improved solutions to enable the successful implementation of iron‐containing supplements. , Key messages WHO recommends the use of MMS within the context of rigorous research. More evidence is desired on the impact of switching from supplements containing iron and folic acid alone to MMS, including evaluation of maternal and perinatal outcomes, acceptability, feasibility, sustainability, equity and cost‐effectiveness. Future research on MMS should include clinical indicators and impact measures that are applicable across studies and settings, and incorporate outcomes important to women, using standardized protocols. Specific research questions, key indicators and performance measures of implementation research activities will depend on the country context. This research can help improve the effectiveness of supplementation programmes and strengthen antenatal care services.
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