WHO recommendations on antenatal nutrition: an update on multiple micronutrient supplements

Optimal maternal nutrition, including adequate intake of essential vitamins and minerals, is important for fetal development and longer term impacts on the child’s health. Although pregnant women are considered to be at increased risk of micronutrient deficiencies due to increased maternal and fetal nutritional needs, there is some debate around how best to achieve an optimal diet with adequate and balanced intakes of the necessary nutrients during the antenatal period and before pregnancy.1 The most common micronutrient deficiency in pregnancy that is known to impact maternal health is iron deficiency, due to increased iron demands. Iron deficiency is a common cause of anaemia, which is estimated to affect 40% of pregnancies globally, highest in South-East Asia (49%), Africa (46%) and the Eastern Mediterranean (41%) and lower prevalence in Western Pacific (33%), the Americas (26%) and Europe (27%).2 Thus, iron supplementation has been recommended by WHO for all women during pregnancy since the 1950s. Current global nutrition targets call for a 50% reduction in anaemia among women of reproductive age by 2025, and the prevalence of anaemia in women aged 15–49 years, by pregnancy status, has now been proposed as an indicator for Sustainable Development Goal 2.3 In addition to routine iron and folic acid (IFA) supplementation, various other interventions have been proposed to increase the micronutrient intake before and during pregnancy, including food-based approaches. The 2016 WHO recommendations on routine antenatal care (ANC) for pregnant women and adolescent girls provide comprehensive guidance on the practice, organisation and delivery of ANC and prioritise woman-centred care to facilitate a positive pregnancy experience.4 Recognising that ANC provides a strategic platform for important healthcare functions including health promotion and disease prevention, 14 out of the 49 recommendations in the WHO ANC guideline relate to nutrition. Antenatal micronutrient interventions recommended in …