Maternal micronutrition beyond iron-folic acid: global evidence and Indian perspectives from preconception to lactation: an expert consensus

Abstract

Maternal undernutrition contributes substantially to adverse pregnancy outcomes in low- and middle-income countries. In India, anemia and deficiencies of vitamin B12, vitamin D, zinc, and folate remain widespread. Although iron-folic acid (IFA) supplementation is central to antenatal care, evidence suggests that multiple micronutrient supplementation (MMS) reduces low birth weight and small-for-gestational-age births compared with IFA alone. This review examined how global MMS evidence can inform context-specific strategies for Indian women. Published evidence on maternal micronutrient deficiencies, MMS, and international guidelines was synthesized with thematic analysis of seven regional advisory board meetings involving >90 Indian clinicians. Findings confirmed a high burden of micronutrient deficiencies and supported MMS over IFA alone. Expert panels favored a phased approach aligned with gestational physiology, beginning with folate, vitamin B12, and pyridoxine during preconception and early pregnancy, followed by iron, calcium, vitamin D, and DHA. Key barriers included gastrointestinal intolerance, complex dosing, and dietary insufficiency. These findings support transitioning from IFA-based supplementation toward a comprehensive, context-adapted strategy spanning preconception through lactation.