Christina Oh 1 , Emily C. Keats 1 and Zulfiqar A. Bhutta 1,2, *

Overview

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Key numbers

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• Prenatal iron deficiency is one common example with a high global prevalence of 19.2% (95% confidence
• interval (CI) 17.1–21.5%), while maternal vitamin A deficiency affects approximately 15.3% (95% CI
• anemia prevalence is less than 20%, or where side effects from daily supplementation are severe, the
• of Sciences, Engineering, and Medicine (Table 1), the UNIMMAP formulation is very similar with
• RDAs, for vitamins C, D, and E, and folic acid and iodine (24). Similar tablets for supplementation
• of various age ranges (24). Traditionally, lipid-based products, like Plumpy’nut, have also been
• Table 1. Daily Recommended Dietary Allowance for Vitamins, Micronutrients and Macronutrients
• Table S1) based on medical subject headings (MeSH) and key words. Both grey literature and databases
• criteria are summarized in Table 2.
• Table 2. Inclusion and Exclusion Criteria.
• (nstudies = 12; (50,53,56–65)), Middle-East and North Africa (n = 13; (54,66–77)), sub-Saharan Africa
• (n = 18; (51,78–94)) and South Asia (n = 19; (49,95–112)). Seven studies were conducted in Latin
• Materials, Table S2.
• low, with at least 75% of the judgements assessed as low risk for four domains (blinding of participants,
• personnel and outcome assessment, selective reporting and other biases), and at least 50% of the
• (50,53,56–65)), Middle-East and North Africa (n = 13; (54,66–77)), sub-Saharan Africa (n = 18; (51,78–
• 94)) and South Asia (n = 19; (49,95–112)). Seven studies were conducted in Latin America and the
• Table S3). Thus, eight studies were included in the meta-analyses (60,63,79,86,92,94,110,111). Four
• Materials, Table S2.
• generally low, with at least 75% of the judgements assessed as low risk for four domains (blinding of
• 50% of the judgements as low risk for three domains of the quality assessment (random sequence
• (average risk ratio (RR) 0.90, 95% Confidence Interval (CI) 0.68 to 1.18; studies = 3; GRADE: low-quality
• or maternal hemoglobin concentration (average MD 0.51 g/L, 95% CI −2.42 to 3.43; studies = 5).
• (average risk ratio (RR) 0.90, 95% Confidence Interval (CI) 0.68 to 1.18; studies = 3; GRADE: low-
• quality evidence), nor any effect on the risk of stillbirths (average RR 1.01, 95% CI 0.96 to 1.07; studies
• = 3) or maternal hemoglobin concentration (average MD 0.51 g/L, 95% CI −2.42 to 3.43; studies
• during pregnancyMaterials, Table S3). Of these, twelve were included
• birthweight baby (average RR 1.08, 95% CI 0.94 to 1.25; studies = 10; GRADE: moderate-quality
• 0.43 umol/L, 95% CI -0.04 to 0.89; studies = 5) (Figure 3). In a post-hoc analysis, studies that provided
• MD 0.86 umol/L, 95% CI 0.67 to 1.05; studies = 2) than studies that provided additional micronutrients
• (average MD 0.43 umol/L, 95% CI -0.04 to 0.89; studies = 5) (Figure 3). In a post-hoc analysis, studies
• additional micronutrients (average MD 0.01 umol/L, 95% CI -0.70 to 0.72; studies = 3).
• synthesized (52) (see Supplementary Materials, Table S3).
• (see Supplementary Materials, Table S3).
• anemia by 47% (average RR 0.53, 95% CI 0.43 to 0.65; studies = 6; GRADE: moderate-quality evidence)
• of iron on the risk of perinatal mortality (average RR 0.88, 95% CI 0.71 to 1.08; studies = 4; GRADE:
• concentration (average MD 7.80 g/L, 95% CI 4.08 to 11.52; studies = 11) and maternal serum/plasma (69), nine weeks (67), and 10
• ferritin concentrations (average MD 25.30 ug/L, 95% CI 9.74 to 40.87; studies = 9). In a post-hoc
• iron (average RR 0.34, 95% CI 0.23 to 0.51; studies = 2) compared to studies that provided additional as a mode of delivery
• pre-eclampsia/eclampsia (average RR 1.55, 95% CI 0.91 to 2.63; studies= 3), neonatal mortality (averageprimary outcomes were
• 0.55 to 1.31), infant mortality (average RR 1.10, 95% CI 0.84 to 1.45; studies = 3),
• 0.93, 95% CI 0.51 to 1.53; studies = 3), the risk of having a Caesarean section as a mode of delivery

Methods (brief)

• Studies were eligible if they included data collected in or after 1995 on vitamin and mineral
• Folicprimary outcomes was conducted for this comparison due to an

Implications

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• Fish — marine, predatory (tuna, swordfish, shark, king mackerel)
• Fish — marine, non-predatory (sardines, anchovies, salmon, cod)
• Shellfish (shrimp, crab, lobster, clams, oysters, mussels)
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• Chromium

Verification notes

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• Full-PDF read: pdftotext -layout was run on the full PDF twice; extracted text hashes matched before the page was written.
• Numeric verification: numeric/table-bearing lines were selected mechanically from the verified extraction and preserved without unit conversion or rounding.
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Update history

The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.