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Meta-Analysis
. 2019 Mar 14;3(3):CD004905.
doi: 10.1002/14651858.CD004905.pub6.

Multiple-micronutrient supplementation for women during pregnancy

Emily C Keats  1 , Batool A Haider, Emily Tam, Zulfiqar A Bhutta
Affiliations
Meta-Analysis

Multiple-micronutrient supplementation for women during pregnancy

Emily C Keats et al. Cochrane Database Syst Rev. .

Abstract

Background: Multiple-micronutrient (MMN) deficiencies often coexist among women of reproductive age in low- and middle-income countries. They are exacerbated in pregnancy due to the increased demands of the developing fetus, leading to potentially adverse effects on the mother and baby. A consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with MMNs. Since the last update of this Cochrane Review in 2017, evidence from several trials has become available. The findings of this review will be critical to inform policy on micronutrient supplementation in pregnancy.

Objectives: To evaluate the benefits of oral multiple-micronutrient supplementation during pregnancy on maternal, fetal and infant health outcomes.

Search methods: For this 2018 update, on 23 February 2018 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We also contacted experts in the field for additional and ongoing trials.

Selection criteria: All prospective randomised controlled trials evaluating MMN supplementation with iron and folic acid during pregnancy and its effects on pregnancy outcomes were eligible, irrespective of language or the publication status of the trials. We included cluster-randomised trials, but excluded quasi-randomised trials. Trial reports that were published as abstracts were eligible.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach.

Main results: We identified 21 trials (involving 142,496 women) as eligible for inclusion in this review, but only 20 trials (involving 141,849 women) contributed data. Of these 20 trials, 19 were conducted in low- and middle-income countries and compared MMN supplements with iron and folic acid to iron, with or without folic acid. One trial conducted in the UK compared MMN supplementation with placebo. In total, eight trials were cluster-randomised.MMN with iron and folic acid versus iron, with or without folic acid (19 trials)MMN supplementation probably led to a slight reduction in preterm births (average risk ratio (RR) 0.95, 95% confidence interval (CI) 0.90 to 1.01; 18 trials, 91,425 participants; moderate-quality evidence), and babies considered small-for-gestational age (SGA) (average RR 0.92, 95% CI 0.88 to 0.97; 17 trials; 57,348 participants; moderate-quality evidence), though the CI for the pooled effect for preterm births just crossed the line of no effect. MMN reduced the number of newborn infants identified as low birthweight (LBW) (average RR 0.88, 95% CI 0.85 to 0.91; 18 trials, 68,801 participants; high-quality evidence). We did not observe any differences between groups for perinatal mortality (average RR 1.00, 95% CI 0.90 to 1.11; 15 trials, 63,922 participants; high-quality evidence). MMN supplementation led to slightly fewer stillbirths (average RR 0.95, 95% CI 0.86 to 1.04; 17 trials, 97,927 participants; high-quality evidence) but, again, the CI for the pooled effect just crossed the line of no effect. MMN supplementation did not have an important effect on neonatal mortality (average RR 1.00, 95% CI 0.89 to 1.12; 14 trials, 80,964 participants; high-quality evidence). We observed little or no difference between groups for the other maternal and pregnancy outcomes: maternal anaemia in the third trimester (average RR 1.04, 95% CI 0.94 to 1.15; 9 trials, 5912 participants), maternal mortality (average RR 1.06, 95% CI 0.72 to 1.54; 6 trials, 106,275 participants), miscarriage (average RR 0.99, 95% CI 0.94 to 1.04; 12 trials, 100,565 participants), delivery via a caesarean section (average RR 1.13, 95% CI 0.99 to 1.29; 5 trials, 12,836 participants), and congenital anomalies (average RR 1.34, 95% CI 0.25 to 7.12; 2 trials, 1958 participants). However, MMN supplementation probably led to a reduction in very preterm births (average RR 0.81, 95% CI 0.71 to 0.93; 4 trials, 37,701 participants). We were unable to assess a number of prespecified, clinically important outcomes due to insufficient or non-available data.When we assessed primary outcomes according to GRADE criteria, the quality of evidence for the review overall was moderate to high. We graded the following outcomes as high quality: LBW, perinatal mortality, stillbirth, and neonatal mortality. The outcomes of preterm birth and SGA we graded as moderate quality; both were downgraded for funnel plot asymmetry, indicating possible publication bias.We carried out sensitivity analyses excluding trials with high levels of sample attrition (> 20%). We found that results were consistent with the main analyses for all outcomes. We explored heterogeneity through subgroup analyses by maternal height, maternal body mass index (BMI), timing of supplementation, dose of iron, and MMN supplement formulation (UNIMMAP versus non-UNIMMAP). There was a greater reduction in preterm births for women with low BMI and among those who took non-UNIMMAP supplements. We also observed subgroup differences for maternal BMI and maternal height for SGA, indicating greater impact among women with greater BMI and height. Though we found that MMN supplementation made little or no difference to perinatal mortality, the analysis demonstrated substantial statistical heterogeneity. We explored this heterogeneity using subgroup analysis and found differences for timing of supplementation, whereby higher impact was observed with later initiation of supplementation. For all other subgroup analyses, the findings were inconclusive.MMN versus placebo (1 trial)A single trial in the UK found little or no important effect of MMN supplementation on preterm births, SGA, or LBW but did find a reduction in maternal anaemia in the third trimester (RR 0.66, 95% CI 0.51 to 0.85), when compared to placebo. This trial did not measure our other outcomes.

Authors' conclusions: Our findings suggest a positive impact of MMN supplementation with iron and folic acid on several birth outcomes. MMN supplementation in pregnancy led to a reduction in babies considered LBW, and probably led to a reduction in babies considered SGA. In addition, MMN probably reduced preterm births. No important benefits or harms of MMN supplementation were found for mortality outcomes (stillbirths, perinatal and neonatal mortality). These findings may provide some basis to guide the replacement of iron and folic acid supplements with MMN supplements for pregnant women residing in low- and middle-income countries.

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Conflict of interest statement

Emily Keats: none

Batool A Haider: none

Emily Tam: none

Zulfiqar A Bhutta was the principal investigator of the UNIMAPP trial conducted in Pakistan (Bhutta 2009a). He was not involved in the screening and data extraction for this paper, which was conducted by other review authors acknowledged above. Dr Bhutta is also the recipient of a grant from the Bill & Melinda Gates Foundation to undertake an individual participant data analysis of nutrition interventions in adolescents and women during pregnancy.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
4
4
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.3 Low birthweight
5
5
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.4 Perinatal mortality
6
6
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.5 Stillbirths
7
7
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.6 Neonatal mortality
8
8
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.1 Preterm births
9
9
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.2 Small‐for‐gestational age
10
10
Funnel plot of comparison 1. Multiple micronutrients vs control, outcome: 1.9 Miscarriage (loss before 28 weeks)
1.1
1.1. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 1 Preterm births.
1.2
1.2. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 2 Small‐for‐gestational age.
1.3
1.3. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 3 Low birthweight.
1.4
1.4. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 4 Perinatal mortality.
1.5
1.5. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 5 Stillbirths.
1.6
1.6. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 6 Neonatal mortality.
1.7
1.7. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 7 Maternal anaemia (third trimester Hb < 110 g/L).
1.8
1.8. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 8 Maternal mortality.
1.9
1.9. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 9 Miscarriage (loss before 28 weeks).
1.10
1.10. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 10 Mode of delivery: caesarean section.
1.11
1.11. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 11 Congenital anomalies.
1.12
1.12. Analysis
Comparison 1 Multiple micronutrients vs control, Outcome 12 Very preterm birth (before 34 weeks of gestation).
2.1
2.1. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 1 Preterm births: mean maternal BMI.
2.2
2.2. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 2 Preterm births: mean maternal height.
2.3
2.3. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 3 Preterm births: timing of supplementation.
2.4
2.4. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 4 Preterm births: dose of iron.
2.5
2.5. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 5 Preterm births: MMN supplement formulation.
2.6
2.6. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 6 Small‐for‐gestational age: mean maternal BMI.
2.7
2.7. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 7 Small‐for‐gestational age: mean maternal height.
2.8
2.8. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 8 Small‐for‐gestational age: timing of supplementation.
2.9
2.9. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 9 Small‐for‐gestational age: dose of iron.
2.10
2.10. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 10 Small‐for‐gestational age: MMN supplement formulation.
2.11
2.11. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 11 Perinatal mortality: mean maternal BMI.
2.12
2.12. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 12 Perinatal mortality: mean maternal height.
2.13
2.13. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 13 Perinatal mortality: timing of supplementation.
2.14
2.14. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 14 Perinatal mortality: dose of iron.
2.15
2.15. Analysis
Comparison 2 Subgroup analysis for primary outcomes (MMN with iron and folic acid vs iron with or without folic acid)), Outcome 15 Perinatal mortality: MMN supplement formulation.
3.1
3.1. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 1 Preterm births.
3.2
3.2. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 2 Small‐for‐gestational age.
3.3
3.3. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 3 Low birthweight.
3.4
3.4. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 4 Perinatal mortality.
3.5
3.5. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 5 Stillbirths.
3.6
3.6. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 6 Neonatal mortality.
3.7
3.7. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 7 Maternal anaemia (third trimester Hb < 110 g/L).
3.8
3.8. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 8 Miscarriage (loss before 28 weeks).
3.9
3.9. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 9 Maternal mortality.
3.10
3.10. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 10 Very preterm birth (before 34 weeks of gestation).
3.11
3.11. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 11 Congenital anomalies.
3.12
3.12. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 12 Neurodevelopmental outcome: BSID scores.
3.13
3.13. Analysis
Comparison 3 Sensitivity analysis (all trials) excluding trials with > 20% loss to follow up, Outcome 13 Mode of delivery: caesarean section.
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SUMMIT 2008 {published data only}
    1. Iskandar W, Smith E, Aditiawarman A, Apriatni M, Tjiong R, Shankar A. Effect of maternal multiple micronutrients supplementation on the APGAR score of Indonesian neonates. FASEB Journal 2015;29(1 Suppl):741.13.
    1. Prado E, Sebayang S, Apriatni M, Hidayati N, Adawiyah S, Islamiyah A, et al. Maternal multiple micronutrient supplementation and children's cognition at age 9‐12 years in Indonesia. FASEB Journal 2015;29(1 Suppl):28.7. - PubMed
    1. Prado EL, Alcock KJ, Muadz H, Ullman MT, Shankar AH, for the SUMMIT Study Group. Maternal multiple micronutrient supplements and child cognition: a randomized trial in Indonesia. Pediatrics 2012;130(3):e536‐46. - PubMed
    1. Prado EL, Sebayang SK, Apriatni M, Adawiyah SR, Hidayati N, Islamiyah A, et al. Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9‐12 years in Indonesia: follow‐up of the SUMMIT randomised trial. Lancet Global Health 2017;5(2):e217‐28. - PubMed
    1. Prado EL, Ullman MT, Muadz H, Alcock KJ, Shankar AH. The effect of maternal multiple micronutrient supplementation on cognition and mood during pregnancy and postpartum in Indonesia: a randomized trial. PLoS ONE 2012;7(3):e32519. - PMC - PubMed
Sunawang 2009 {published data only}
    1. Sunawang, Utomo B, Hidayat A, Kusharisupeni, Subarkah. Preventing low birth weight through maternal multiple micronutrient supplementation: a cluster‐randomized controlled trial in Indramayu, West Java. Food and Nutrition Bulletin 2009;30(4):S488‐S495. - PubMed
Tofail 2008 {published and unpublished data}
    1. Ekstrom EC, Eneroth H, Arifeen SE, Persson L. Efficacy of micronutrient supplement intake in increasing hemoglobin in pregnancy: dose‐effect comparisons with multiple micronutrient in the MINIMat trial in rural Bangladesh. FASEB Journal 2013;27 Suppl:Abstract no: 845.25.
    1. Ekstrom EC, Lindstrom E, Raqib R, Arifeen S, Basu S, Brismar K, et al. Effects of prenatal micronutrient and early food supplementation on metabolic status of the offspring at 4.5 years of age. The MINIMat randomized trial in rural Bangladesh. International Journal of Epidemiology 2016;45(5):1656‐67. - PMC - PubMed
    1. Eneroth H, Arifeen S, Persson LA, Lonnerdal B, Hossain MB, Stephensen CB, et al. Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation. Journal of Nutrition 2010;140(3):618‐24. - PubMed
    1. Eneroth H, Persson LA, Arifeen S, Ekstrom EC. Infant anaemia is associated with infection, low birthweight and iron deficiency in rural Bangladesh. Acta Paediatrica 2011;100(2):220‐5. - PubMed
    1. Frith AL, Naved RT, Persson LA, Frongillo EA. Early prenatal food supplementation ameliorates the negative association of maternal stress with birth size in a randomised trial. Maternal & Child Nutrition 2015;11(4):537‐49. - PMC - PubMed
West 2014 {published data only}
    1. Christian P, Kim J, Mehra S, Shaikh S, Ali H, Shamim AA, et al. Effects of prenatal multiple micronutrient supplementation on growth and cognition through 2 years of age in rural Bangladesh: the JiVitA‐3 trial. American Journal of Clinical Nutrition 2016;104(4):1175‐82. - PubMed
    1. Christian P, Shamim A, Shaikh S, Ali H, Mehra S, Lee W, et al. Antenatal multiple micronutrient supplementation and growth in the first two years of life and cognitive function at 24 months in rural Bangladesh. FASEB Journal 2014;28(1 Suppl 1):Abstract no. 256.5.
    1. Gernand A, Schulze K, Shaikh S, Shamim A, Ali H, Wu L, et al. The effect of prenatal multiple micronutrient supplementation on biomarkers of placental angiogenesis in rural Bangladesh. FASEB Journal 2014;28(1 Suppl 1):Abstract no: 804.2.
    1. Gernand AD, Christian P, Paul RR, Shaikh S, Labrique AB, Schulze KJ, et al. Maternal weight and body composition during pregnancy are associated with placental and birth weight in rural Bangladesh. Journal of Nutrition 2012;142(11):2010‐6. - PMC - PubMed
    1. Gernand AD, Christian P, Schulze KJ, Shaikh S, Labrique AB, Shamim AA, et al. Maternal nutritional status in early pregnancy is associated with body water and plasma volume changes in a pregnancy cohort in rural Bangladesh. Journal of Nutrition 2012;142(6):1109‐15. - PMC - PubMed
Zagre 2007 {published data only}
    1. Zagre NM, Desplats G, Adou P, Mamadoultaibou A, Aguayo VM. Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster‐randomized, double‐blind, controlled programmatic study in rural Niger. Food and Nutrition Bulletin 2007;28(3):317‐27. - PubMed
Zeng 2008 {published data only}
    1. Cao Y, Wang T, Zeng L. Risk of childhood malnutrition at 24 months related to small for gestational age and low birth weight in rural Western China. Annals of Nutrition & Metabolism 2013;63(Suppl 1):556, Abstract no: PO619.
    1. Chang S, Zeng L, Brouwer ID, Kok FJ, Yan H. Effect of iron deficiency anemia in pregnancy on child mental development in rural China. Pediatrics 2013;131(3):e755‐63. - PubMed
    1. ISRCTN08850194. Impact of iron/folate versus multi‐micronutrient supplementation during pregnancy on birth weight: a randomised controlled trial in rural Western China. isrctn.com/ISRCTN08850194 (first received 7 November 2006).
    1. Li C, Zeng L, Wang D, Yang W, Dang S, Zhou J, et al. Prenatal micronutrient supplementation is not associated with intellectual development of young school‐aged children. Journal of Nutrition 2015;145(8):1844‐9. - PubMed
    1. Li Q, Yan H, Zeng L, Cheng Y, Liang W, Dang S, et al. Effects of maternal multimicronutrient supplementation on the mental development of infants in rural western China: follow‐up evaluation of a double‐blind, randomized, controlled trial. Pediatrics 2009;123(4):e685‐e692. - PubMed

References to studies excluded from this review

ACTRN12616001449426 {published data only}
    1. ACTRN12616001449426. Effect of multi aspect interventions in reduction of low birth weight incidence and maternal anemia during pregnancy. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12616001449426 (first received 17 October 2010).
Agarwal 2012 {published data only}
    1. Agarwal N, Dora S, Kriplani A, Garg P, Vivekanandhan S, Kulshrestha V. Response of therapy with vitamin B6, B12 and folic acid on homocysteine level and pregnancy outcome in hyperhomocysteinemia with unexplained recurrent abortions. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S759.
Aguayo 2005 {published data only}
    1. Aguayo VM, Kone D, Bamba SI, Diallo B, Sidibe Y, Traore D, et al. Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali. Public Health Nutrition 2005;8(1):33‐7. - PubMed
Ahn 2006 {published data only}
    1. Ahn E, Pairaudeau N, Pairaudeau N, Cerat Y, Couturier B, Fortier A, et al. A randomized cross over trial of tolerability and compliance of a micronutrient supplement with low iron separated from calcium vs high iron combined with calcium in pregnant women. BMC Pregnancy and Childbirth 2006;6:10. - PMC - PubMed
An 2001 {published data only}
    1. An H, Yin S, Xu Q. Effects of supplementing calcium, iron and zinc on the fetus development and growth during pregnancy. Chinese Journal of Preventive Medicine 2001;35(6):370‐3. - PubMed
Arsenault 2010 {published data only}
    1. Arsenault JE, Aboud S, Manji KP, Fawzi WW, Villamor E. Vitamin supplementation increases risk of subclinical mastitis in HIV‐infected women. Journal of Nutrition 2010;140(10):1788‐92. - PMC - PubMed
Asemi 2014 {published data only}
    1. Asemi Z, Samimi M, Tabassi Z, Ahmad E. Multivitamin versus multivitamin‐mineral supplementation and pregnancy outcomes: a single‐blind randomized clinical trial. International Journal of Preventive Medicine 2014;5(4):439‐46. - PMC - PubMed
    1. IRCT201212105623N3. Comparison of effectiveness of multivitamin, multivitamin‐mineral supplements, probiotic and normal Gaz on pregnancy outcomes in pregnant women. en.search.irct.ir/view/11730 (first received 26 December 2012). [IRCT201212105623N3]
Asemi 2015 {published data only}
    1. Asemi Z, Esmaillzadeh A. The effect of multi mineral‐vitamin D supplementation on pregnancy outcomes in pregnant women at risk for pre‐eclampsia. International Journal of Preventive Medicine 2015;6:62. - PMC - PubMed
Azami 2016 {published data only}
    1. Azami M, Azadi T, Farhang S, Rahmati S, Pourtaghi K. The effects of multi mineral‐vitamin D and vitamins (C+E) supplementation in the prevention of preeclampsia: an RCT. International Journal of Reproductive Biomedicine (Yazd, Iran) 2017;15(5):273‐8. - PMC - PubMed
    1. IRCT2016062528617N1. The effects of multi minerals (Zn, Mg and Ca) and vitamins (C and E) supplementation in the prevention of preeclampsia. en.search.irct.ir/view/31125 2016.
Beazley 2002 {published data only}
    1. Beazley D, Ahokas R, Livingston J, Griggs M, Scroggs M, Sibai B. Effects of vitamin C and E supplementation on total antioxidant status (TAS) and 8‐isoprostane (IP) levels in women at high risk for preeclampsia. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S76. - PubMed
    1. Beazley D, Livingston J, Kao L, Sibai L. Vitamin C and E supplementation in women at high risk for preeclampsia: a double‐blind placebo controlled trial. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S216. - PubMed
Bergmann 2006 {published data only}
    1. Bergmann RL, Haschke‐Becher, Bergmann KE, Dudenhausen JW, Haschke F. Low dose docosahexaenoic acid supplementation improves the DHA status of pregnant women. Pediatric Academic Societies Annual Meeting; 2006 April 29‐May 2; San Francisco, CA, USA 2006.
Biswas 1984 {published data only}
    1. Biswas MK, Pernoll MJ, Mabie WC. A placebo controlled comparative trial of various prenatal vitamin formulations in pregnant women. Clinical Therapeutics 1984;6(6):763‐9. - PubMed
Callaghan‐Gillespie 2017 {published data only}
    1. Callaghan‐Gillespie M, Schaffner AA, Garcia P, Fry J, Eckert R, Malek S, et al. Trial of ready‐to‐use supplemental food and corn‐soy blend in pregnant Malawian women with moderate malnutrition: a randomized controlled clinical trial. American Journal of Clinical Nutrition 2017;106(4):1062‐9. - PMC - PubMed
Carrasco 1962 {published data only}
    1. Carrasco EO, Jose FR, Samson GD, Germar E, Padilla B. Effect of D‐sorbitol on the absorption and transfer of nutrients from mother to fetus. American Journal of Clinical Nutrition 1962;11:533‐6. - PubMed
Caulfield 1999 {published data only}
    1. Caulfield LE, Zavaleta N, Figueroa A. Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. American Journal of Clinical Nutrition 1999;69:1257‐63. - PubMed
    1. Caulfield LE, Zavaleta N, Figueroa A, Leon Z. Maternal zinc supplementation does not affect size at birth or pregnancy duration in Peru. Journal of Nutrition 1999;129(8):1563‐8. - PubMed
Chames 2002 {published data only}
    1. Chames M, Liu H, Bendich A, Bogden J, Sibai B, Prada J. A randomized trial of calcium supplementation effects on blood lead levels in pregnancy. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S137.
Choudhury 2012 {published data only}
    1. Choudhury N, Aimone A, Hyder SM, Zlotkin SH. Relative efficacy of micronutrient powders versus iron‐folic acid tablets in controlling anemia in women in the second trimester of pregnancy. Food & Nutrition Bulletin 2012;33(2):142‐9. - PubMed
Christian 2009 {published data only}
    1. Christian P, Shahid F, Rizvi A, Klemm RDW, Bhutta ZA. Treatment response to standard of care for severe anemia in pregnant women and effect of multivitamins and enhanced anthelminthics. American Journal of Clinical Nutrition 2009;89:853‐61. - PubMed
    1. NCT00116493. Severe anemia treatment trials, Pakistan. clinicaltrials.gov/ct2/show/NCT00116493 (first received 30 June 2005).
Coles 2015 {published data only}
    1. Coles CD, Kable JA, Keen CL, Jones KL, Wertelecki W, Granovska IV, et al. Dose and timing of prenatal alcohol exposure and maternal nutritional supplements: developmental effects on 6‐month‐old infants. Maternal and Child Health Journal 2015;19(12):2605‐14. - PMC - PubMed
Cooper 2012 {published data only}
    1. Cooper WN, Khulan B, Owens S, Elks CE, Seidel V, Prentice AM, et al. DNA methylation profiling at imprinted loci after periconceptional micronutrient supplementation in humans: results of a pilot randomized controlled trial. FASEB Journal 2012;26(5):1782‐90. - PubMed
Czeizel 1996 {published data only}
    1. Czeizel AE. Controlled studies of multivitamin supplementation on pregnancy outcomes. Annals of New York Academy of Sciences 1993;678:266‐75. - PubMed
    1. Czeizel AE. Prevention of congenital abnormalities by periconceptional multivitamin supplementation. BMJ 1993;306:1645‐8. - PMC - PubMed
    1. Czeizel AE. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. American Journal of Medical Genetics 1996;62:179‐83. - PubMed
    1. Czeizel AE, Dudas I. Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation. New England Journal of Medicine 1992;327:1832‐5. - PubMed
    1. Czeizel AE, Dudas I, Fritz G, Tecsoi A, Hanck A, Kunovits G. The effect of periconceptional multivitamin ‐mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Archives of Gynecology and Obstetrics 1992;251:181‐5. - PubMed
Dawson 1987 {published data only}
    1. Dawson EB, McGanity WJ. Protection of maternal iron stores in pregnancy. Journal of Reproductive Medicine 1987;32(6):478‐87. - PubMed
Dawson 1998 {published data only}
    1. Dawson EB, Dawson R, Behrens J, DeVora M, McGanity WJ. Iron in prenatal multivitamin/multimineral supplements. Journal of Reproductive Medicine 1998;43:133‐40. - PubMed
Devi 2017 {published data only}
    1. Devi S, Mukhopadhyay A, Dwarkanath P, Thomas T, Crasta J, Thomas A, et al. Combined vitamin B‐12 and balanced protein‐energy supplementation affect homocysteine remethylation in the methionine cycle in pregnant South Indian women of low vitamin B‐12 status. Journal of Nutrition 2017;147(6):1094‐103. - PubMed
Dewey 2012 {published data only}
    1. Dewey KG, Mridha MK, Matias SL, Arnold CD, Cummins JR, Khan MS, et al. Lipid‐based nutrient supplementation in the first 1000 d improves child growth in Bangladesh: a cluster‐randomized effectiveness trial. American Journal of Clinical Nutrition 2017;105(4):944‐57. - PubMed
    1. Harding KL, Matias SL, Moniruzzaman M, Stewart CP, Mridha MK, Vosti SA, et al. Rang‐Din Nutrition Study: assessment of participant adherence to lipid‐based nutrient and iron‐folic acid supplements among pregnant and lactating women in the context of a study on the effectiveness of supplements in Bangladesh. FHI 360/FANTA. Washington, DC: US Agency for International Development (USAID), 2014.
    1. Harding KL, Matias SL, Mridha MK, Vosti SA, Dewey KG, Stewart CP, et al. Adherence to recommendations on lipid‐based nutrient supplement and iron and folic acid tablet consumption among pregnant and lactating women participating in a community health programme in northwest Bangladesh. Maternal and Child Nutrition 2017;13(1):e12252. - PMC - PubMed
    1. Matias S, Harding K, Mridha M, Vosti S, Paul R, Hussain S, et al. T3_005. Breastfeeding and postpartum weight change among rural Bangladeshi women. 17th Conference of the International Society for Research in Human Milk and Lactation (ISRHML); 2014 Oct 23‐27; Kiawah Island, South Carolina, USA. 2014:55‐6.
    1. Matias S, Harding K, Mridha M, Vosti S, Paul R, Hussain S, et al. TS_024. Breastfeeding and postpartum weight change among rural Bangladeshi women. 17th Conference of the International Society for Research in Human Milk and Lactation (ISRHML); 2014 Oct 23‐27; Kiawah Island, South Carolina, USA. 2014:189.
Dieckmann 1944 {published data only}
    1. Dieckmann WJ, Adair FL, Michel H, Kramer S, Dunkle F, Arthur B, et al. Calcium, phosphorus, iron and nitrogen balances in pregnant women. American Journal of Obstetrics and Gynecology 1944;47:357‐68.
Fall 2006 {published data only}
    1. ISRCTN62811278. Mumbai maternal nutrition project. isrctn.com/ISRCTN62811278 (first received 11 January 2006).
    1. Lawande A, Gravio C, Potdar RD, Sahariah SA, Gandhi M, Chopra H, et al. Effect of a micronutrient‐rich snack taken preconceptionally and throughout pregnancy on ultrasound measures of fetal growth: the Mumbai Maternal Nutrition Project (MMNP). Maternal & Child Nutrition 2018; Vol. 14, issue 1. - PMC - PubMed
    1. Potdar RD, Sahariah SA, Gandhi M, Kehoe SH, Brown N, Sane H, et al. Improving women's diet quality preconceptionally and during gestation: effects on birth weight and prevalence of low birth weight‐a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project). American Journal of Clinical Nutrition 2014;100(5):1257‐68. - PMC - PubMed
    1. Potdar RD, Sahariah SA, Gandhi M, Sane H, Brown NB, Fall C, et al. Preconceptual nutrition and weight gain in a) women during pregnancy and b) in babies at birth in Mumbai Maternal Nutrition Project (a RCT). The Power of Programming 2014: International Conference on Developmental Origins of Adiposity and Long‐Term Health; 2014 March 13‐15; Munich, Germany. 2014:61.
    1. Sahariah SA, Zagar EM, Potdar R, Gandhi M, Chopra H, Sane H, et al. Interaction of pre‐conceptional food supplementation with maternal BMI: reduces gestational diabetes in undernourished women and increases birthweight in well‐nourished women. The Power of Programming 2014: International Conference on Developmental Origins of Adiposity and Long‐Term Health; 2014 March 13‐15; Munich, Germany. 2014:59.
Fawzi 1998 {published data only}
    1. Fawzi W, Msamanga G, Antelman G, Xu C, Hertzmark E, Spiegelman D, et al. Effect of prenatal vitamin supplementation on lower genital levels of HIV type 1 and interleukin type 1 beta at 36 weeks of gestation. Clinical Infectious Diseases 2004;38(5):716‐22. - PubMed
    1. Fawzi WW, Msamanga G, Hunter D, Urassa E, Renjifo B, Mwakagile D, et al. Randomized trial of vitamin supplements in relation to vertical transmission of HIV‐1 in Tanzania. Journal of Acquired Immune Deficiency Syndromes 2000;23(3):246‐54. - PubMed
    1. Fawzi WW, Msamanga G, Spiegelman D, Wei R, Kapiga S, Villamor E, et al. A randomised trial of multivitamin supplements and HIV disease progression and mortality. New England Journal of Medicine 2004;351(1):23‐32. - PubMed
    1. Fawzi WW, Msamanga GI, Kupka R, Spiegelman D, Villamor E, Mugusi F, et al. Multivitamin supplementation improves hematologic status in HIV‐infected women and their children in Tanzania. American Journal of Clinical Nutrition 2007;85(5):1335‐43. - PubMed
    1. Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, McGarth N, Mwakagile D, et al. Randomized controlled trial of the effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV ‐1 infected women in Tanzania. Lancet 1998;351:1477‐82. - PubMed
Fernald 2016 {published data only}
    1. Fernald LC, Galasso E, Qamruddin J, Ranaivoson C, Ratsifandrihamanana L, Stewart CP, et al. A cluster‐randomized, controlled trial of nutritional supplementation and promotion of responsive parenting in Madagascar: the MAHAY study design and rationale. BMC Public Health 2016;16(1):466. - PMC - PubMed
Feyi‐Waboso 2005 {published data only}
    1. Feyi‐Waboso PA, Chris A, Nwaogu GC, Archibong EI, Ejikem EC. The role of parenteral multivitamin preparation (Eldervit‐12) in the prevention of anaemia in pregnancy. Tropical Journal of Obstetrics and Gynaecology 2005;22(2):159‐63.
Fleming 1986 {published data only}
    1. Fleming AF, Ghatoura GBS, Harrison KA, Briggs ND, Dunn DT. The prevention of anemia in pregnancy in primigravidae in the Guinea Savana of Nigeria. Annals of Tropical Medicine and Parasitology 1986;80(2):211‐33. - PubMed
Godfrey 2017 {published data only}
    1. Godfrey KM, Cutfield W, Chan SY, Baker PN, Chong YS. Nutritional intervention preconception and during pregnancy to maintain healthy glucose metabolism and offspring health ("NiPPeR"): study protocol for a randomised controlled trial. Trials 2017;18(1):131. - PMC - PubMed
Goldenberg 1995 {published data only}
    1. Goldenberg R, Tamura T, Neggers Y, Copper R, Johnston K, DuBard M, et al. Maternal zinc supplementation increases birthweight and head circumference. American Journal of Obstetrics and Gynecology 1995;172(1 Pt 2):368.
Gopalan 2004 {published data only}
    1. Gopalan S, Patnaik R, Ganesh K. Feasible strategies to combat low birth weight and intra‐uterine growth retardation. Journal of Pediatric Gastroenterology and Nutrition 2004;39 Suppl 1:S37.
Graham 2007 {published data only}
    1. Graham JM, Haskell MJ, Pandey P, Shrestha RK, Brown KH, Allen LH. Supplementation with iron and riboflavin enhances dark adaptation response to vitamin A‐fortified rice in iron‐deficient, pregnant, nightblind Nepali women. American Journal of Clinical Nutrition 2007;85(5):1375‐84. - PubMed
Guldholt 1991 {published data only}
    1. Guldholt IS, Trolle BG, Hvidman LE. Iron supplementation during pregnancy. Acta Obstetricia et Gynecologica Scandinavica 1991;70:9‐12. - PubMed
Gunaratna 2015 {published data only}
    1. Gunaratna NS, Masanja H, Mrema S, Levira F, Spiegelman D, Hertzmark E, et al. Multivitamin and iron supplementation to prevent periconceptional anemia in rural Tanzanian women: a randomized, controlled trial. PLoS One 2015;10(4):e0121552. - PMC - PubMed
Gupta 2007 {published data only}
    1. Gupta P, Ray M, Dua T, Radhakrishnan G, Kumar R, Sachdev HP. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double‐blind, randomized, placebo‐controlled trial. Archives of Pediatrics and Adolescent Medicine 2007;161(1):58‐64. - PubMed
Hambidge 2014 {published data only}
    1. Borengasser S, Kerns M, Palacios A, Baker P, Kemp J, Morrison S, et al. Preconceptional lipid‐based micronutrient supplementation reduced circulating branched chain amino acids in Guatemalan women who are overweight or obese at 12 weeks gestation: a pilot study. FASEB Journal 2017;31(1 Suppl):Abstract Number: 639.50. - PubMed
    1. Hambidge KM, Krebs NF, Westcott JE, Garces A, Goudar SS, Kodkany BS, et al. Preconception maternal nutrition: a multi‐site randomized controlled trial. BMC Pregnancy and Childbirth 2014;14(1):111. - PMC - PubMed
Hillman 1963 {published data only}
    1. Hillman RW, Cabaud PE, Nilsson DE, Arpin PD, Tufano RJ. Pyridoxine supplementation during pregnancy. American Journal of Clinical Nutrition 1963;12:427‐30. - PubMed
Hininger 2004 {published data only}
    1. Hininger I, Favier M, Arnaud J, Faure H, Thoulon JM, Hariveau E, et al. Beneficial effects of a combined micronutrient supplementation on maternal oxidative stress and newborn anthropometric measurements: a randomised double blind, placebo‐controlled trial in healthy pregnant women. 21st Conference on Priorities in Perinatal Care in South Africa; 2002 March 5‐8; Eastern Cape, South Africa. 2002.
    1. Hininger I, Favier M, Arnaud J, Faure H, Thoulon JM, Hariveau E, et al. Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometric measurements: a randomized double‐blind, placebo‐controlled trial in apparently healthy pregnant women. European Journal of Clinical Nutrition 2004;58:52‐9. - PubMed
Holly 1955 {published data only}
    1. Holly RG. Anemia in pregnancy. Obstetrics and Gynecology 1955;5:562‐9. - PubMed
Hossain 2014 {published data only}
    1. Hossain N, Kanani FH, Ramzan S, Kausar R, Ayaz S, Khanani R, et al. Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open label randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. Journal of Clinical Endocrinology and Metabolism 2014;99(7):2448‐55. - PubMed
Huang 2017 {published data only}
    1. Huang S, Mo TT, Norris T, Sun S, Zhang T, Han TL, et al. The CLIMB (Complex Lipids In Mothers and Babies) study: protocol for a multicentre, three‐group, parallel randomised controlled trial to investigate the effect of supplementation of complex lipids in pregnancy, on maternal ganglioside status and subsequent cognitive outcomes in the offspring. BMJ Open 2017; Vol. 7, issue 10:e016637. - PMC - PubMed
Hunt 1983 {published data only}
    1. Hunt IF, Murphy NJ, Cleaver AE, Faraji B, Swendseid ME, Coulson AH, et al. Zinc supplementation during pregnancy: effects on selected blood constituents and on progress and outcome of pregnancy in low‐income women of Mexican descent. American Journal of Clinical Nutrition 1984;40:508‐21. - PubMed
    1. Hunt IF, Murphy NJ, Cleaver AE, Faraji B, Swendseid ME, Coulson AH, et al. Zinc supplementation during pregnancy: zinc concentration of serum and hair from low‐income women of Mexican descent. American Journal of Clinical Nutrition 1983;37:572‐82. - PubMed
Hunt 1985 {published data only}
    1. Hunt IF, Murphy NJ, Cleaver AE, Faraji B, Swendseid ME, Browdy BL, et al. Zinc supplementation during pregnancy in low‐income teenagers of Mexican descent: effects on selected blood constituents and on progress and outcome of pregnancy. American Journal of Clinical Nutrition 1985;42:815‐28. - PubMed
Huybregts 2009 {published data only}
    1. Huybregts L, Roberfroid D, Lanou H, Meda N, Taes Y, Valea I, et al. Prenatal lipid‐based nutrient supplements increase cord leptin concentration in pregnant women from rural Burkina Faso. Journal of Nutrition 2013;143(5):576‐83. - PubMed
    1. Huybregts L, Roberfroid D, Lanou H, Menten J, Meda N, Camp J, et al. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. American Journal of Clinical Nutrition 2009;90(6):1593‐600. - PubMed
    1. Toe LC, Bouckaert KP, Beuf K, Roberfroid D, Meda N, Thas O, et al. Seasonality modifies the effect of a lipid‐based nutrient supplement for pregnant rural women on birth length. Journal of Nutrition 2015;145(3):634‐9. - PubMed
Huynh 2017 {published data only}
    1. Huynh DT, Low YL, Tey SL, Tran NT, Nguyen LT, Berde Y. Maternal nutritional adequacy and gestational weight gain in Vietnamese pregnant women. Annals of Nutrition and Metabolism 2017;71(Suppl 2):629.
    1. Huynh DT, Tran NT, Nguyen LT, Berde Y, Low YL. Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program on breastfeeding performance, birth and growth outcomes in a Vietnamese population. Journal of Maternal‐Fetal & Neonatal Medicine 2018;31(12):1586‐94. - PubMed
Iannotti 2008 {published data only}
    1. Iannotti LL, Zavaleta N, Leon Z, Shankar AH, Caulfield LE. Maternal zinc supplementation and growth in Peruvian infants. American Journal of Clinical Nutrition 2008;88(1):154‐60. - PMC - PubMed
ICMR 2000 {published data only}
    1. Indian Council of Medical Research (ICMR) Collaborating Centers, Central Technical Co‐ordinating Unit. Multicentric study of efficacy of periconceptional folic acid containing vitamin supplementation in prevention of open neural tube defects in India. Indian Journal of Medical Research 2000;112:206‐11. - PubMed
IRCT2015041321736N1 {published data only}
    1. IRCT2015041321736N1. Clinical trial on the evaluation of calcium and vitamin D in the cord serum of neonates, whose mothers were under vitamin D treatment during their pregnancy. en.search.irct.ir/view/22976 (first received 25 January 2016). [IRCT2015041321736N1]
IRCT201704225623N109 {published data only}
    1. IRCT201704225623N109. Clinical trial of the effect of multi mineral‐vitamin D supplementation compared with the placebo on pregnancy outcomes in women with gestational diabetes. en.search.irct.ir/view/37291 2017.
ISRCTN83599025 {published data only}
    1. ISRCTN83599025. GIFTS: mother and child health study. isrctn.com/ISRCTN83599025 (first received 14 July 2014). [ISRCTN83599025]
Itam 2003 {published data only}
    1. Itam IH. The effect of "Chemiron" on haematological parameters and ferritin levels in pregnant Nigerian women in Calabar. Mary Slessor Journal of Medicine 2003;3(2):17‐24.
Janmohamed 2016 {published data only}
    1. Janmohamed A, Karakochuk CD, Boungnasiri S, Chapman GE, Janssen PA, Brant R, et al. Prenatal supplementation with corn soya blend plus reduces the risk of maternal anemia in late gestation and lowers the rate of preterm birth but does not significantly improve maternal weight gain and birth anthropometric measurements in rural Cambodian women: a randomized trial. American Journal of Clinical Nutrition 2016;103:559‐66. - PubMed
Jarvenpaa 2007 {published data only}
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Kabir 2009 {published data only}
    1. Kabir I, Khan AI, Arifeen S, Alam DS, Persson LA. Effects of prenatal food and micronutrient supplementation and breastfeeding counseling on postnatal growth of rural Bangladeshi children. Pediatric Academic Societies Annual Meeting; 2009 May 2‐5; Baltimore, USA. 2009.
Kable 2012 {published data only}
    1. Chambers C, Yevtushok L, Zymak‐Zakutnya N, Wertelecki W, Jones KL, Keen CL, et al. Maternal alcohol consumption during pregnancy, nutritional status and impact on infant outcomes. Alcohol and Alcoholism 2013;48 Suppl:i21‐i22.
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    1. Kable J, Coles C, Chambers C, Keen C, Uriu‐Adams J, Jones K, et al. Preliminary analysis of the impact of micronutrient supplements on neurophysiological encoding and memory in Ukranian infants 12‐18 months postpartum. Alcoholism: Clinical and Experimental Research 2012;36(S1):212A.
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    1. Chelchowska M, Laskowska‐Klita T, Kubik P, Leibschang J. The effect of vitamin‐mineral supplementation on the level of MDA and activity of glutathione peroxidase and superoxide dismutase in blood of matched maternal‐cord pairs [Wplyw suplementacji witaminowo‐mineralnej na poziom MDA oraz aktywnosc peroksydazy glutationowej i dysmutazy ponadtlenkowej w krwi kobiet ciezarnych i krwi pepowinowej ich dzieci]. Przeglad Lekarski 2004;61(7):760‐3. - PubMed
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Merchant 2005 {published data only}
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Merialdi 1999 {published data only}
    1. Merialdi M, Caulfield LE, Zavaleta N, Figueroa A, DiPietro JA. Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development. American Journal of Obstetrics and Gynecology 1999;180(2 Pt 1):483‐90. - PubMed
Muslimatun 2001 {published data only}
    1. Muslimatun S, Schmidt MK, Schultink W, West CE, Hautvast JG, Gross R, et al. Weekly supplementation with iron and vitamin A during pregnancy increases hemoglobin concentration but decreases serum ferritin concentration in Indonesian pregnant women. Journal of Nutrition 2001;131(1):85‐90. - PubMed
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Nakano 2010 {published data only}
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NCT01795131 {published data only}
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NCT02802566 {published data only}
    1. NCT02802566. BMI‐based prenatal vitamins to ameliorate oxidative stress in obese pregnancy. clinicaltrials.gov/ct2/show/record/NCT02802566 (first received 16 June 2016). [NCT02802566]
NCT02959125 {published data only}
    1. NCT02959125. NutFish and nutrient supplementation in pregnancy class to improve maternal and birth outcomes. clinicaltrials.gov/show/NCT02959125 (first received 8 October 2016). [NCT02959125]
Nguyen 2012 {published data only}
    1. Gonzalez‐Casanova I, Nguyen PH, Young MF, Harding KB, Reinhart G, Nguyen H, et al. Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam. BMC Public Health 2017;17(1):452. - PMC - PubMed
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    1. Nechitilo M, Webb‐Girard A, Gonzalez‐Casanova I, Martorell R, Ramakrishnan U, Nguyen P, et al. A qualitative study of factors influencing initiation and adherence to micronutrient supplementation among women of reproductive age in Vietnam. Food and Nutrition Bulletin 2016;37(4):461‐74. - PubMed
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    1. Nguyen PH, DiGirolamo AM, Gonzalez‐Casanova I, Pham H, Hao W, Nguyen H, et al. Impact of preconceptional micronutrient supplementation on maternal mental health during pregnancy and postpartum: results from a randomized controlled trial in Vietnam. BMC Women's Health 2017;17(1):44. - PMC - PubMed
Nguyen 2017 {published data only}
    1. Nguyen PH, Kim SS, Sanghvi T, Mahmud Z, Tran LM, Shabnam S, et al. Integrating nutrition interventions into an existing maternal, neonatal, and child health program increased maternal dietary diversity, micronutrient intake, and exclusive breastfeeding practices in Bangladesh: results of a cluster‐randomized program evaluation. Journal of Nutrition 2017; Vol. 147, issue 12:2326‐37. - PMC - PubMed
Nossier 2015 {published data only}
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Ochoa‐Brust 2007 {published data only}
    1. Ochoa‐Brust GJ, Fernandez AR, Villanueva‐Ruiz GJ, Velasco R, Trujillo‐Hernandez B, Vasquez C. Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy. Acta Obstetricia et Gynecologica Scandinavica 2007;86(7):783‐7. - PubMed
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Otoluwa 2017 {published data only}
    1. Otoluwa AS, Hadju V, Thaha AR, As'ad S, Monoarfa Y, Yatim H. Effect of periconceptional multi micronutrient supplementation on the level of total antioxidant status. Annals of Nutrition and Metabolism 2017; Vol. 71, issue Suppl 2:502‐3.
Park 1999 {published data only}
    1. Park E, Wagenbichler P, Elmadfa I. Effects of multivitamin/mineral supplementation, at nutritional doses, on plasma antioxidant status and DNA damage estimated by sister chromatid exchanges in lymphocytes in pregnant women. International Journal for Vitamin and Nutrition Research 1999;69:396‐402. - PubMed
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People's League 1946 {published data only}
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Sachdeva 1993 {published data only}
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Salzano 2001 {published data only}
    1. Salzano P, Felicetti M, Laboccetta A, Borrelli P, Domenico A, Borrelli A. Prevention of gestational hypertension with calcium, linoleic acid, mono and polyunsaturated fatty acid supplements. Minerva Ginecologica 2001;53(4):235‐8. - PubMed
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    1. Schmidt MK, Muslimatun S, Schultink W, West CE, Hautvast JG. Randomised double‐blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life. European Journal of Clinical Nutrition 2002;56(4):338‐46. - PubMed
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    1. Semba RD, Kumwenda N, Taha TE, Mtimavalye L, Broadhead R, Garrett E, et al. Impact of vitamin A supplementation on anaemia and plasma erythropoietin concentrations in pregnant women: a controlled clinical trial. European Journal of Haematology 2001;66(6):389‐95. - PubMed
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Suharno 1993 {published data only}
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    1. Sun YY, Ma AG, Yang F, Zhang FZ, Luo YB, Jiang DC, et al. A combination of iron and retinol supplementation benefits iron status, IL‐2 level and lymphocyte proliferation in anemic pregnant women. Asia Pacific Journal of Clinical Nutrition 2010;19(4):513‐9. - PubMed
Suprapto 2002 {published data only}
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Taghizadeh 2014 {published data only}
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    1. Makola D, Ask DM, Tatala SR, Latham MC, Ndossi G, Mehansho H. A micronutrient‐fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration in pregnant Tanzanian women. Journal of Nutrition 2003;133:1339‐46. - PubMed
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    1. Wijaya‐Erhardt M, Muslimatun S, Erhardt JG. Fermented soyabean and vitamin C‐rich fruit: a possibility to circumvent the further decrease of iron status among iron‐deficient pregnant women in Indonesia. Public Health Nutrition 2011;14(12):2185‐96. - PubMed
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References to studies awaiting assessment

Gathwala 2012 {published data only}
    1. Gathwala G. Effect of antenatal multiple micronutrient supplementation of mothers on the birthweight of their infants. Journal of Paediatrics and Child Health 2012;48(Suppl 1):47‐8.

References to ongoing studies

NCT02190565 {published data only}
    1. NCT02190565. Supplementation with WellnessPack mama during pregnancy and lactation‐ a randomized double‐blind, placebo‐controlled study. clinicaltrials.gov/ct2/show/NCT02190565 (first received 15 July 2014).
NCT03287882 {published data only}
    1. NCT03287882. Prospective, cluster randomized effectiveness trial of multiple micronutrient supplementation and life skills education provided from preconception on health and nutrition outcomes of young, reproductive‐age Pakistani women (15‐24 years). clinicaltrials.gov/ct2/show/NCT03287882 (first received 19 September 2017).
Sumarmi 2015 {published data only}
    1. Sumarmi S, Wirjatmadi B, Melaniani S, Kuntoro K, Dachlan EG, Thaha AR, et al. Prolonging micronutrients supplementation 2‐6 months prior to pregnancy significantly improves birth weight by increasing hPl production and controlling il‐12 concentration: a randomized double blind controlled study. Annals of Nutrition and Metabolism 2017; Vol. 71, issue Suppl 2:554.
    1. TCTR20150614001. Preconceptional supplementation of multi micronutrients to improve maternal iron status and pregnancy outcomes: a randomized double blind community‐based trial (Laduni). clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fullt... (first received 11 June 2015).
Tu 2013 {published data only}
    1. Tu N, King JC, Dean D, Dirren H. Effect of food‐based supplement prior to and during pregnancy on birth weight and prematurity in rural Vietnam (VINAVAC study). Annals of Nutrition & Metabolism 2013;63(Suppl 1):806, Abstract no: PO3314.
    1. Tu N, King JC, Dirren H, Thu HN, Ngoc QP, Diep AN. Effect of animal‐source food supplement prior to and during pregnancy on birthweight and prematurity in rural Vietnam: a brief study description. Food and Nutrition Bulletin 2014;35(4 Suppl):S205‐S208. - PubMed

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