title: Multiple micronutrient supplementation during pregnancy and lactation in low-to-middle-income developing country settings: impact on pregnancy outcomes.
abstract: BACKGROUND
  Malnutrition, including micronutrient deficiencies, remains one of the major public health challenges, particularly in low-to-middle-income countries. Micronutrient deficiencies affect people of all ages, but its effects appear more devastating in pregnant women and children. Poor maternal nutrition contributes to at least 20% of maternal deaths and increases the probability of poor pregnancy outcomes including intrauterine growth restriction, resulting in low birth weight, stunting, wasting and mortality. Key Messages: Several strategies have been employed to provide pregnant women with micronutrients. These strategies include education, dietary modification, food provision, agricultural interventions, supplementation and fortification either alone or in combination. Micronutrient supplementation is the most widely practiced intervention to prevent and manage single or multiple micronutrient deficiencies. Micronutrient supplementation either alone or in combination has shown to be effective in improving maternal, birth and child outcomes.
  
  
  CONCLUSIONS
  There is a need to focus on maternal micronutrient status as a continuum from the periconceptional period throughout pregnancy to lactation. Given the wide prevalence of multiple micronutrient deficiencies in low-to-middle-income countries, the challenge is to implement intervention strategies that combine appropriate maternal and child health interventions with micronutrient interventions.
authors.affiliation: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Rehana A
authors.initials: RA
authors.lastname: Salam
authors.forename: Jai K
authors.initials: JK
authors.lastname: Das
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D003906:Developing Countries; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology*; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors
chemical_list: D004044:Dietary Proteins; D018977:Micronutrients