The New York Academy of Sciences, New York, New York.
Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands.
Ann N Y Acad Sci. 2019 May;1444(1):6-21. doi: 10.1111/nyas.14121. Epub 2019 May 27.
Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.
在中低收入国家（LMICs），微量营养素摄入不足相对较为常见，尤其是孕妇，她们对微量营养素的需求增加。这可能导致不良妊娠和出生结局的增加。本综述介绍了一个专门评估 LMICs 中微量营养素摄入不足和不良出生结局的患病率、比较含有铁和叶酸（IFA）的多种微量营养素补充剂（MMS）与单独 IFA 补充剂的试验数据、达到 MMS 最高摄入量的风险以及 MMS 与 IFA 相比的成本效益的特别工作组的结论。最近的荟萃分析表明，与单独使用 IFA 相比，MMS 可以降低早产、低出生体重和小于胎龄儿的风险。一项个体参与者数据荟萃分析还显示，对于贫血和体重不足的妇女和女婴，MMS 具有更大的益处。重要的是，MMS 对孕妇及其婴儿没有增加的危害风险。这些数据表明，摄入微量营养素不足的国家应考虑为孕妇补充 MMS，作为降低不良出生结局风险的一种具有成本效益的方法。
