Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality

Food Nutr Bull. 2009 Dec;30(4 Suppl):S547-55. doi: 10.1177/15648265090304S409.


Background: Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes.

Objective: To conduct a meta-analysis of the effects on stillbirths and on early and late neonatal mortality of supplementation during pregnancy with multiple micronutrients compared with iron-folic acid in recent randomized, controlled trials.

Methods: Twelve randomized, controlled trials were included in the analysis (Bangladesh; Burkina Faso; China; Guinea-Bissau; Indramayu and Lombok, Indonesia; Mexico; Sarlahi and Janakur, Nepal; Niger; Pakistan; and Zimbabwe), all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients or iron-folic acid to presumed HIV-negative women.

Results: Supplementation providing approximately I RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neonatal mortality (OR = 1.23; 95% CI, 0.95 to 1.59), late neonatal mortality (OR = 0.94; 95% CI, 0.73 to 1.23), or perinatal mortality (OR = 1.11; 95% CI, 0.93 to 1.33).

Conclusions: Our meta-analysis provides consistent evidence that supplementation providing approximately 1 RDA of multiple micronutrients during pregnancy does not result in any reduction in stillbirths or in early or late neonatal deaths compared with iron-folic acid alone.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Developing Countries / statistics & numerical data*
  • Dietary Supplements*
  • Female
  • Fetal Mortality
  • Folic Acid / administration & dosage
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Iron / administration & dosage
  • Maternal Nutritional Physiological Phenomena*
  • Micronutrients / administration & dosage*
  • Micronutrients / deficiency
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Pregnancy Complications / prevention & control
  • Pregnancy Outcome*
  • Randomized Controlled Trials as Topic
  • Stillbirth


  • Micronutrients
  • Folic Acid
  • Iron