JMIR Publications

ABSTRACT

Background:

Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation to pregnant and lactating women on their and infant's nutritional status remain largely unclear in LMICs.

Objective:

The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation for women on maternal and infant nutritional status in LMICs.

Methods:

Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the WHO library database will be used to identify relevant published studies, starting from the inception of each database until 28 February 2022. Cochrane Risk of Bias Tool will be used to assess the risk of bias in included studies. The selection of studies, data extraction, and risk of bias will be done independently by two reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and meta-regression. The certainty of the evidence for each outcome will be assessed using the GRADE approach (Grading of Recommendation, Assessment, Development, and Evaluation).

Results:

We will conduct meta-analyses using STATA Version 16 and present both a narrative and systematic summary of all studies included in this review in the text and table. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% confidence intervals and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity.

Conclusions:

This review will provide evidence on which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policymakers, researchers, practitioners, and government agencies adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence. Clinical Trial: Systematic review registration: PROSPERO ID: CRD42022308715