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How micronutrient supplements can improve pregnancy outcomes

By Ijeoma UKAZU

Among the many causes of maternal and child mortality is poor nutrition intake of pregnant women especially in low-and-middle-income countries, LMICs.

For the survival and well-being of women during and after pregnancy, adequate nutrition alongside adequate services and care is fundamental.

The United Nations Children’s Fund, UNICEF, said that women in many parts of the world have unacceptably poor nutritional status. “Far too many women – especially adolescents and those who are nutritionally at-risk – are not receiving the nutrition services they need to be healthy and give their babies the best chance to survive, grow and develop.”

The UN body states that women have distinct nutritional requirements throughout their life – especially before and during pregnancy and while breastfeeding, when a nutritional vulnerability is greatest, hence, making adequate nutrition paramount.

UNICEF further points out that during pregnancy, poor diets lacking in key nutrients – like iodine, iron, folate, calcium and zinc – can cause anaemia, pre-eclampsia, haemorrhage and death in mothers, adding that these deficiencies can also lead to stillbirth, low birth weight, wasting and developmental delays for children.

Medical experts said, multiple vitamin and mineral (micronutrient) deficiencies often coexist among women of reproductive age in low‐ and middle‐income countries, LMICs, especially during pregnancy when micronutrient requirements increase, thereby placing the health of the mother and child at risk.

To intervene, the World Health Organization, in its comprehensive antenatal care, ANC, guideline through the Executive Guideline Steering Group, GSG, prioritized and recommended amongst others; Multiple Micronutrient Supplements for women during pregnancy.

This Multiple Micronutrient Supplement, MMS, is a combination of supplements providing several vitamins and minerals, can fill nutrient gaps for pregnant women and be a safe and cost‐effective intervention to reduce adverse pregnancy and birth outcomes.

Experts add that MMS is widely used, has undergone a series of research, and is well‐established under the United Nations International Multiple Micronutrient Antenatal Preparation, UNIMMAP containing 15 vitamins and minerals.

MMS for pregnant women has been proven to enhance maternal nutrition status and, in comparison with Iron and Folic Acid, IFA, it further reduces the risk of adverse birth outcomes such as preterm birth, stillbirth, low birth weight, and small for gestational age.

The WHO said it aims to encourage countries to expand their healthcare agendas beyond survival, to maximize health, human rights and the potential of their populations. Recognizing that ANC provides a strategic platform for important healthcare functions, including health promotion and disease prevention.

To scale-up up adaptation and access to MMS in Nigeria -an issue which is becoming increasingly urgent, Dr Francis Ohanyido, the Country Director, of Vitamin Angels Nigeria, an international not-for-profit organisation said, Nigeria is at that point where nutrition should be at the front burner of national discussion.

He said, “In everything we do including implementation to make Nigeria better, it is also important that our leaders understand the dire nutrition issues placed before us.

“We as a country are trying to scale up the Multiple Micronutrient Supplements. A formulation of vitamins for pregnant women as identified by the United Nations to help women who are going through pregnancy to have a better value in terms of nutrition for both them and their child.”

Ohanyido, while speaking at a two-day media engagement and capacity-building workshop on MMS in pregnancy, stated that micronutrient deficiencies can have lifelong impacts on a child’s physical, mental, and emotional development.

Ohanyido adds that one of the things that are very evident from science is that the first 1000 days of life of the child -from conception to birth, whatever nutrition the mother takes has an impact on the child. Nutrition is important as a lot of pregnant women suffer from anaemia.

According to him, “About 60 per cent of Nigerian women are pre-anaemic. They are at that borderline. A little bleeding or challenge in terms of nutrition, they will be driven to full-blown anaemia. Because of that, when a woman attends a clinic in Nigeria, especially in primary healthcare settings or underserved settings, we must make sure providers give these women MMS. We currently use iron and folic acid supplements but the causes of anaemia are more than iron and folic acid deficiency.”

The Country Director for Vitamin Angels, Nigeria said the WHO and UN have said, countries must begin to move to MMS which has 15 micronutrients made up of vitamins and minerals inclusive of iron and folic acid that is traditionally given to women at the health facility level.

He emphasised the health and well-being of Nigerians start with the pregnant woman having a healthy and good experience and positive birth outcome.

In reducing infant and maternal mortality, Dr Francis adds that a significant part of mortality in Nigeria is around maternal and infant mortality.

He stated “One of the things done in public health which is important is giving supplements to vulnerable groups who need certain micronutrients. A lot of children are vulnerable to infections like measles. As a sort of preventative measure in public health, micronutrients are given to prevent chances of deficiencies.”

He said, “Because a mother is carrying a foetus, the demand on her body nutrients increases which needs proper supplements to help the immune system response. Multiple micronutrient supplements commonly referred to as prenatal multivitamins, are one of the most impactful nutrition interventions that significantly improve maternal health and birth outcomes.”

Dr Ohanyido said MMS is targeted at the nutritional shortfall of pregnant and nursing mothers and meets micronutrient requirements that poor diets cannot meet. It has significant benefits compared to Iron and Folic Acid (IFA) which contains just two essential vitamins and minerals.

He said, in Nigeria, MMS is a part of an inclusive strategy by the federal government to reduce the prevalence of malnutrition.

The medical expert said the program progress of Vitamin Angels is a call for increased improvement of maternal malnutrition possibility and accessibility of MMS in Nigeria, advocating for increased funding as well as investment by the government at all levels.

This call to action is to ensure that every Nigerian pregnant woman especially those in underserved and rural communities gets access to Multiple Micronutrient Supplements.

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