Improving the Health of Pregnant Women and Their Babies

Adequate nutrition during pregnancy is important for the healthy development and growth of the baby, as well as for health of the expectant mother. In fact, for several micronutrients (i.e. vitamins and minerals such as vitamins B₆, B₉, B₁₂, iron, and iodine), recommended intakes increase by as much as 50% to accommodate higher maternal, placental, and fetal demands during pregnancy.

For many pregnant women, particularly in low- and middle-income countries, their diets do not meet their increased nutritional needs. Consequently, micronutrient deficiencies in pregnancy are associated with adverse pregnancy and birth outcomes, such as maternal and infant mortality, miscarriages, birth defects, low birth weight, being born too small or too early, and stunting, and may influence the cognitive development and cardiometabolic risk of the offspring. Micronutrient supplementation during pregnancy, therefore, is recommended to prevent nutritional deficiencies and adverse birth outcomes.

Although micronutrient supplements are proven interventions, poor adherence, which may be as low as 8% in some regions, remains a major barrier for supplementation programs. Low adherence prevents pregnant women and their unborn babies from receiving the maximum potential benefits of this intervention.

The two authors of this article, the Academy’s Dr. Filomena Gomes and Dr. Megan Bourassa, plus Dr. Gilles Bergeron, are among the nine researchers who conducted a systematic review of the scientific literature to assess the effectiveness of interventions designed to increase adherence to a micronutrient supplementation regimen in pregnant women. The team’s work was published on January 5 in the Annals of the New York Academy of Sciences.

Following a robust review process called the Cochrane Collaboration Methodology, the authors conducted literature searches in six electronic databases, screened more than 5,000 articles, and included 22 studies. They found a variety of strategies that resulted in increased adherence (consumption) of prenatal supplements, including:

• Education-based strategies, such as home visits from a trained midwife using pictorial handbooks and counseling, pharmacist counseling using a leaflet, and customized counseling delivered by community health workers using a mobile health application
• Education in combination with consumption monitoring, such as counseling session with pill counting
• Supervised consumption monitoring by volunteer health workers or family members
• SMS text message reminders and educational messages
• Free provision of supplements, when compared with prescriptions that needed to be filled and paid for
• Multicomponent interventions, such as a combination of counseling by health workers, home visits, free supplement provision, and husband education forums.

In many studies, increased adherence to supplements was accompanied by beneficial effects on pregnancy and birth outcomes, such as a decrease in anemia rates and an increase in birth weight.

The authors’ review highlights a number of effective strategies to increase adherence, which can now be put into practice to maximize the benefits of prenatal micronutrient supplementation programs. These strategies may need to be adapted to specific contexts (e.g. region or culture) when considered for program implementation. However, the Academy’s Nutrition Science Team’s research will help program implementers and policy makers choose among and prioritize interventions to improve the health of pregnant women and their babies.

Read the article: Interventions to increase adherence to micronutrient supplementation during pregnancy: a systemic review

Photo: UNICEF Ethiopia