Multiple micronutrient supplementation during pregnancy, lactation, and early childhood and the long-term child development: a systematic literature review

Micronutrient deficiencies remain a persistent form of malnutrition particularly among pregnant women posing significant risks to pregnancy outcomes and child development.
The World Health Organisation (WHO) has long been recommending iron and folic acid supplementation during pregnancy, as well as the use of iron-containing micronutrient powders to enrich complementary infants foods between 6 and 23 months, and food for children between 2 and 12 years old, and such programmes have proven positive effects.
Regarding antenatal multiple micronutrient (MMN) supplementation with additional micronutrients, evidence is scarce and their effects are uncertain. WHO recommends to use MMN supplementation only when supported by rigorous and context-specific research.
This systematic review evaluates existing evidence on the long-term impacts of MMN supplementation during pregnancy, lactation and early childhood on children’s cognitive development.
The review included 10 publications covering 11 different interventions and found limited evidence of statistically significant long-term effects on child cognitive development, highlighting the need for further robust studies.

The Nutrition Research Facility (NRF) conducted a series of consultations with decision-makers in European Union (EU) Member States, EU partner countries, within Delegations of the EU in partner countries and within the European Commission, in order to identify their current concerns in relation to nutrition issues in development contexts. This question arose from a consultation workshop with stakeholders from Asian countries.

A bibliographic search yielded 8,815 records that were screened according to inclusion criteria, resulting in 10 publications covering 11 interventions. These interventions included randomised controlled trials or cluster randomised controlled trials. They were conducted in 6 countries (Nepal, Pakistan, Indonesia, China, Tanzania and Peru) and assessed cognitive, motor and behavioural development outcomes in children aged 4-14 years old, through specific tests or combinations of tests.
Of the 11 interventions, seven consisted of maternal supplementation, three in early childhood supplementation, and one covered both. The quality of these studies was assessed using the Cochrane Risk of Bias tool, with seven classified as "low risk", three with "some concerns", and one of "poor quality".

The review found no consistent evidence of significant long-term effects of MMN supplementation on child cognitive development. Out of 36 cognitive development tests conducted, 27 showed no significant effect, three reported positive outcomes, and six indicated negative effects. It is worth mentioning that all negative outcomes recorded are issued from three interventions in Nepal, conducted by the same research team, for which the Cochrane Risk of Bias tool indicates risks of bias.

More methodological development and research are needed to assess the long-term impacts of multiple micronutrient supplementation of mothers and children on child’s cognitive capacities. In any case, the 2020 update of WHO recommendations regarding micronutrient supplementation during pregnancy remains to be followed.

Further research is needed to confirm the potential benefits of MMN supplementation and its long-term impact on children’s cognitive development. Future studies should improve assessment tools, integrate caregiving and education factors, target nutrient deficient populations, and explore sustainable solutions like locally fortified foods to design more effective interventions.

This research highlights the importance of evidence-based interventions to improve maternal and child health outcomes, particularly in vulnerable populations.

Main contact: Souheila Abbeddou

Organisation: Ghent University

Email address: Souheila.Abbeddou@UGent.be