Multiple Micronutrient Supplementation (MMS)

Micronutrient deficiencies affect two out of three women of reproductive age worldwide [1] . Pregnancy increases the daily requirement of several vitamins and minerals to meet the nutritional needs of the developing fetus and other metabolic functions. Antenatal multiple micronutrient supplementation (MMS) is designed to address these heightened demands, which are often not met through diet alone. It is particularly beneficial for pregnant women in resource-poor settings where micronutrient intake is typically low due to poor dietary diversity, limited access to nutritious food, gender inequity, and prevalent social norms. 

MMS is delivered in the form of a tablet, capsule, powder, or liquid that provides a combination of vitamins and minerals in the right amount. It is often accompanied by nutrition education and counseling to help ensure daily consumption. 

The United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) MMS is an internationally accepted and standardized formulation that contains 15 essential vitamins and minerals, including iron and folic acid in recommended doses. In 2021, UNIMMAP MMS was included in the World Health Organization’s Model List of Essential Medicines based on evidence that it is effective and safe.

*United Nations International Multiple Micronutrient Antenatal Preparation – WHO, UNICEF, United Nations University. Composition of a multi-micronutrient supplement to be used in pilot programmes among pregnant women in developing countries.

The Multiple Micronutrient Supplementation (MMS) Technical Advisory Group (TAG) and the Micronutrient Forum (MNF) convened a technical consultation to develop an Expert Consensus on an Open-access UNIMMAP–MMS Product Specification for the manufacturing of this product in 2020. The 2024 revision of the Expert Consensus on an Open-Access UNIMMAP MMS Product Specification provides both purchasers and manufacturers with unified guidance on the production of UNIMMAP MMS. More specifically, it outlines the minimum requirements for manufacturing UNIMMAP MMS. It provides guidance on quality and regulatory standards based on whether the product is manufactured as a medicinal product or a dietary supplement. This publication also specifies labelling instructions for UNIMMAP MMS.

Label illustrating the minimum recommended information that should appear on the label of the UNIMMAP MMS.

More than 20 years of research [2, 3] have provided clear evidence that MMS is efficacious, safe, cost-effective, and affordable. 

MMS has been proven to improve maternal nutrition status [4, 5] and, in comparison with iron and folic acid supplements (IFAS), further reduce the risk of adverse birth outcomes such as preterm birth, stillbirth, low birth weight (LBW), and small-for-gestational-age (SGA) birth, [2, 3, 6] with additional benefits on infant growth up to six months of age. [7] Providing MMS to women during pregnancy can prevent long-lasting human capital losses in educational years and lifetime income [8].

Reduced Adverse Pregnancy Outcomes

Summary of benefits of MMS vs. IFAS on pregnant women overall and in anemic (hemoglobin <110g/L) or underweight (BMI <18.5 kg/m2) pregnant women [2, 3, 6].

Children born prematurely or with low birthweight (LBW) are less likely to go to school, develop reading and math skills, and earn higher wages in adulthood [10-12]. Studies show that using MMS instead of IFA can lead to better pregnancy outcomes and higher economic returns. The 2023 Copenhagen Consensus Report identifies MMS for pregnant women as one of the 12 best investments for global development. The report, authored by leading international economists, highlights the substantial economic benefits of MMS, resulting in a return of more than US$37 for every dollar spent [13].

Similarly, a recent analysis conducted by the MMS TAG also shows that transitioning from IFAS to MMS in 25 LMICs with the greatest burden of LBW would avert 3,514,594 LBW births, 186,369 stillbirths, and 218,914 female neonatal deaths, while generating large economic benefits ranging from $7.19 to $107.67 billion. 

The total cost of replacing IFAS with MMS would be equivalent to between 0.5 and 3.0% of current spending on efforts to reduce undernutrition [14]. While there is a small incremental cost for MMS over IFA because of the additional micronutrients, a bottle of 180 tablets of UNIMMAP MMS costs as little as $ 2.50 per pregnancy [15].