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将多种微量营养素补充剂纳入常规产前保健的应用:研究重点探讨。

Use of multiple micronutrient supplementation integrated into routine antenatal care: A discussion of research priorities.

作者信息

Firoz Tabassum, Daru Jahnavi, Busch-Hallen Jennifer, Tunçalp Özge, Rogers Lisa M

机构信息

Yale New Haven Health, New Haven, Connecticut, USA.

Wolfson Institute for Population Health, Queen Mary University of London, London, UK.

出版信息

Matern Child Nutr. 2025 Jan;21(1):e13722. doi: 10.1111/mcn.13722. Epub 2024 Oct 2.

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.

摘要

最佳的孕产妇营养,包括必需微量营养素的充足摄入和状态,对女性及发育中胎儿的健康至关重要。目前,世界卫生组织(WHO)关于获得良好妊娠体验的产前保健建议推荐每日补充铁和叶酸(IFA)作为标准护理措施。在严格研究的背景下推荐使用多种微量营养素补充剂(MMS),因为关于从IFA补充剂转换为MMS的影响,包括对关键的孕产妇和围产期临床结局、可接受性、可行性、可持续性、公平性和成本效益的评估,还需要更多证据。WHO召集了关键利益相关者的技术磋商会,以讨论研究重点,目的是为捐助者、实施者和研究人员就这一建议提供指导和明确说明。研究议程的总体原则包括使用适用于各项研究和不同环境的临床指标及影响测量方法,以及纳入对女性重要的结局。未来的研究应考虑使用基于当前最佳实践的标准化方案,以在研究中测量诸如孕周(GA)和出生体重(BW)等关键结局。由于GA和BW受多种因素影响,需要更多研究来了解生物学影响途径,以及MMS的起始时间和时机考虑如何影响这些结局。在技术磋商期间商定了一组核心临床指标。对于实施研究,证据到决策框架被用作讨论实施研究组成部分的资源。实施研究问题、关键指标和绩效衡量将取决于特定国家的背景和瓶颈,这些需要进一步研究并改进解决方案,以实现含铁补充剂的成功实施。

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