6-year research of 100,000 women of Botswana found that iron,  vitamin, and folic acid, supplements can minimise birth problems. Iron and folic acid supplementation (IFAS) and iron and folic acid plus essential vitamins and trace minerals (MMS) are related with decreased incidence of lower birth weight and other birth problems than iron or folic acid alone. Women who supplemented their meals with numerous micronutrients had the lowest amount of low birth weight and birth complications.

Ellen Caniglia, ScD, an associate professor at Penn’s Perelman School of Medicine, led the study. Botswana-Harvard AIDS Institute and Harvard T.H. Chan School of Public Health researchers participated. The results validate earlier clinical study findings. In the largest research of this kind, researchers found IFAS and MMS had even larger advantages in HIV-positive pregnant women.

“Our findings support the World Health Organization’s existing guidance,” Caniglia stated. “They show IFAS outperforms micronutrient supplementation.”

15 – 20% of all newborns globally weigh below 2.5 kg. Low birth weight is linked to childhood illness, death, and adult disorders like diabetes and heart disease.  and Sub-Saharan Africa and South Asia have the highest low-birthweight newborns.

Based on clinical trial findings, the WHO advocates daily IFAS during pregnancy in all environments to minimise the rate of low birth weight newborns and accompanying birth problems. Daily prenatal MMS supplementation with iron, folic acid, vitamins (A, C, D, E, B1, B2, B3, B6, B12), minerals/metals (iodine, selenium, zinc, copper) may beat IFAS.

MMS’s benefits need more data, especially in IFAS, actual settings, and HIV-positive women. 

Caniglia and colleagues investigated 96,341 Botswana government hospital patients between 2014 to 2020. The study’s sample represents a significant share of Botswana’s births during the study period. Participating hospitals prescribed and gave free supplements, making it easier to track supplement consumption. Low birth weight and birth problems such as preterm or very preterm delivery neonatal deaths, and, stillbirth, were studied.

IFAS reduces pregnancy difficulties compared to folic acid or iron. In the folic acid-only and iron-only groups, low-birthweight birth rates were 16.92% and 12.70%, respectively, but 11.46 in the IFAS group.

Compared to IFAS, MMS users had lower preterm, very preterm, low birthweight, and caesarean delivery rates. Low-birthweight births were 10.48% among MMS women. Preterm birth was 12.68% in IFAS and 11.63% in MMS.

Nearly one fourth of pregnant women in Botswana are HIV-positive. The variations in unfavourable outcome rates between MMS and IFAS, as well as IFAS and folic acid or iron alone, were larger among HIV-positive women, showing supplementation benefits this population more.

Caniglia said HIV-positive pregnant women may be more prone to be vitamin deficient.

The study highlighted the benefits of prenatal vitamins as well as problems of “stock-outs”, or supplement shortages.  Due to stock shortages, well over 43% of women in the trial received folic acid alone, iron alone, or no supplement. Caniglia: “This underscores the necessity of innovative techniques to boost prenatal supplement coverage.”

Her colleagues and she aim to perform more research in Botswana to better understand prenatal supplement hurdles and demonstrate their effect on improving pregnancy outcomes.

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