MMS, IFA, and MMS+IFA Supplementation in Pregnant Women

Maternal micronutrient deficiencies remain a major public health concern in low‐ andmiddle‐income countries, including Pakistan. Iron deficiency anemia, along withdeficiencies of folate, vitamin D, vitamin B12, zinc, iodine, and other micronutrients,contributes substantially to adverse maternal and neonatal outcomes. Although routineIron‐Folic Acid (IFA) supplementation is recommended during pregnancy, it may notadequately address the broader spectrum of micronutrient deficiencies commonly observedamong pregnant women.Multiple Micronutrient Supplementation (MMS) has emerged as a comprehensive alternativethat includes iron, folic acid, and additional essential vitamins and minerals requiredduring pregnancy. Evidence from randomized controlled trials and systematic reviewssuggests that MMS may improve selected neonatal outcomes; however, evidence regardingmaternal hemoglobin improvement and compliance remains inconsistent across settings.Furthermore, limited data are available from Pakistan comparing MMS, IFA, and combinedMMS+IFA supplementation.This study is a three‐arm, parallel‐group, open‐label randomized controlled trialconducted at the antenatal clinics of the Sindh Institute of Child Health and Neonatology(SICHN) in Karachi and Jamshoro, Pakistan. A total of 402 eligible pregnant women withgestational age ≤20 weeks and baseline hemoglobin ≥10 g/dL will be enrolled andrandomized in a 1:1:1 ratio to receive either MMS, IFA, or combined MMS+IFAsupplementation.Maternal hemoglobin concentration will be measured at baseline, 28 weeks gestation, and36‐37 weeks gestation or delivery. Maternal compliance will be assessed using pill countsand self‐reported supplement intake. Neonatal outcomes including birth weight, low birthweight, preterm birth, APGAR scores, and congenital anomalies will be evaluated atdelivery.The study aims to compare the effectiveness of MMS, IFA, and MMS+IFA supplementation onmaternal hemoglobin levels, neonatal outcomes, and maternal compliance. Findings fromthis study will contribute to strengthening evidence‐based antenatal nutrition policiesand maternal health programs in Pakistan.