A tiny multi-nutrient pill could save the lives of hundreds of thousands of women who die from complications linked to pregnancy and childbirth every year – particularly in poorer countries.
The Independent reports that the common factor driving these deaths is anaemia, a critical but overlooked contributor to severe postpartum haemorrhage (PPH), according to research from trials released this year by the London School of Hygiene and Tropical Medicine.
Anaemia could be responsible for half of the severe cases in sub-Saharan Africa and South Asia, the researchers found, yet the deficiency receives relatively little attention in guidelines or public health programmes and, for decades, the main nutritional intervention has been the same: iron and folic acid tablets.
According to Dr Martin Mwangi, lead of the Healthy Mothers, Healthy Babies programme at the Micronutrient Forum, there are, in fact, six types of nutritional anaemia – meaning governments have been focused only on the iron-deficiency part of a broader problem and anaemia rates have barely changed.
The solution could be multiple micronutrient supplements, or MMS pills, which contain iron and folic acid, as well as 13 other vitamins and minerals.
While there have been no studies on their impact on maternal mortality, modelling across 25 low- and middle-income countries published in The BMJ recently estimated that replacing iron and folic acid with MMS could prevent 3.5m low-birthweight births and 186 000 stillbirths over five years.
Taking the MMS pill in pregnancy also reduces maternal anaemia at term by 12% compared with iron and folic acid alone, according to the World Health Organisation.
Other studies show that MMS helps prevent births of small newborns, who are at the highest risk for infant mortality.
The pill may also reduce childhood stunting that lasts until adulthood, and separate research published this week in Brain Communications also pointed to a correlation between anaemia during pregnancy and smaller brain volume in babies, with movement and learning affected.
According to this study by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and the University of Cape Town, the measurable differences in brain volumes emerge from around 12 months of age, offering some of the earliest evidence yet that maternal anaemia shapes infant brain development in the first year of life and beyond.
Organisations like the Micronutrient Forum advocate for the widespread adoption of the MMS pill for “its tremendous benefits for the women of the world”, Mwangi said. Providing full-pregnancy MMS often costs as little as $2 per woman and yields massive health and economic benefits in terms of the cost of lives saved and other factors.
Although MMS has been around since the 1990s, improvements to medical technology and manufacturing have dramatically reduced costs, and governments are starting to adopt it.
In May, Ministers from Sierra Leone, Rwanda, Nigeria and Pakistan committed to integrating MMS into their national antenatal systems, and more than 30 others are also looking into or trialling the supplement.
A woman dies in childbirth globally almost every two minutes, with Sub-Saharan Africa accounting for more than two-thirds of the estimated 260 000 deaths a year. More than 90% of maternal deaths occur in low- and lower-middle-income countries.
Severe anaemia can increase the risk of PPH, infection and fatigue.
“The way we win this is if we get national governments to invest in MMS, and update their national policies to say that every pregnant woman requires a bottle of MMS, at least a bottle, maybe two,” Mwangi said.
Sierra Leone as a test case
More than half of all pregnant women in Sierra Leone are estimated to be anaemic. Anaemia reduces the blood’s ability to carry oxygen and can leave women less able to withstand blood loss during childbirth. Postpartum haemorrhage is one of the country’s leading causes of maternal death.
Feimata Russell, national micronutrient officer at Sierra Leone’s Ministry of Health, said the logic of the switch to MMS was straightforward. Sierra Leone has poor dietary diversity and pregnant women need more micronutrients than their diets can reliably provide.
A working group found that infant mortality was reduced by almost 30% in the first six months for anaemic mothers, while MMS was also found to lower the risk of stillbirth, reduce preterm births and improve outcomes for underweight pregnant women, lowering their health risks.
“MMS is not magic. It works best with good antenatal care, malaria prevention, deworming, and a good diet,” said Russell, adding that Sierra Leone is often seen as a “low-resource, high-learning country”.
“Yet despite its challenges, we’ve piloted and scaled some approaches that other countries can now look at,” she added.
Umu Alfa Jaloh, the Sierra Leone country director for the humanitarian organisation Helen Keller International, which has been assisting with the roll-out of MMS, said officials from Kenya and Cambodia had visited to see how the programme was integrated into the health system, as governments elsewhere consider making the same switch.
See more from MedicalBrief archives:
New guidelines to monitor postpartum haemorrhage
African study finds solution to reduce for childbirth-related haemorrhaging
Anaemia raises mortality risk in pregnant women