165 Effect of pre-conceptional multiple micro-nutrient supplementation on maternal and birth outcomes among women from developing countries: A systematic review

Objective To compare the effect of pre-conceptional multiple micronutrient (MMN) vs Iron-folic acid (IFA) supplementation on anthropometric parameters of the new-born at birth, maternal nutritional status and general health during pregnancy and post-partum, and various other birth outcomes. Methods Randomised controlled trials (RCTs) including married women who are either nulliparous or multiparous with no current or planned contraceptive use, becoming pregnant ≥ 3 months after supplementation were included. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, PubMed, Embase), SCOPUS, and CINAHL using each PICO term till 15th September 2022. We performed statistical analysis according to the Cochrane Handbook for Systematic Reviews of Interventions. We used Review Manager 5 software to do the meta-analysis, and GRADE approach to assess the quality of evidence. Results Of 11826 total citations retrieved, 11 studies (n = 8017) were included in the meta-analysis. Cluster RCTs providing lipid based MMN supplementation in sachet form found significant difference in birth weight and length between the MMN and control group. Whereas, RCTs providing non-lipid based MMN supplementation in capsule/tablet form, found significant difference in birth length between the MMN and control group. There was a significant difference in the maternal weight gain (kg), and rate of small for gestational babies between the MMN and control group. Other outcomes were not significantly different between the two groups. The GRADE evidence generated was of ‘very low-quality to low-quality’ for all the outcomes except maternal weight gain (moderate quality). Conclusions Very-low quality evidence suggests that MMN supplementation may not be better than routine IFA supplementation in improving neonatal anthropometric parameters, although they improve maternal weight gain. We need better quality RCTs (preferably cluster RCTs) before any firm recommendation can be made.