Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD010647. DOI: 10.1002/14651858.CD010647.pub2


The Plain Language Summary states:

“The benefits and risks of multiple-micronutrient supplementation during lactation are not clear from randomised controlled studies. Key vitamins and minerals, particularly iodine, iron and zinc, are required in small amounts to ensure normal body metabolism, physical growth and development. Nutrient deficiency affects nearly one third of the world’s population, especially in low- and middle-income countries. Breastfeeding mothers need higher levels than usual in order to provide sufficient vitamins and minerals for their own health and that of their babies, particularly for normal functioning and the growth and development of the baby.

Previous studies have assessed supplementation of individual micronutrients. This review looked at the use of multiple-micronutrient supplements for breastfeeding women for improving outcomes for the mother and her baby. We searched for studies on 30 September 2015 and identified two small studies (involving 52 women) for inclusion in this review. The studies were carried out in Brazil and the USA and included women who had a low socioeconomic status. The studies were poorly reported and this lack of information made it difficult to determine whether the studies were at risk of bias. Neither of the studies provided data for any of this review’s important outcomes: maternal illness (fever, respiratory infection, diarrhoea), adverse effects of micronutrients within three days of taking them, infant death (defined as a child dying before reaching one year of age).

Similarly, there were no data for any of the other outcomes that we were interested in. For the mother, these outcomes were maternal anaemia, and women’s satisfaction. For the baby, these outcomes were micronutrient deficiency; illness episodes (fever, respiratory infection, diarrhoea, other), adverse effects of micronutrients within three days of the woman receiving the supplement. However, one of the included studies reported that multiple-micronutrient supplementation was effective for lactating women recuperating from anaemia.

There is a need for high-quality studies to assess the effectiveness and safety of multiple-micronutrient supplementation for breastfeeding women for improving outcomes for the mother and her baby. Larger studies with longer-term follow-up would improve the quality of studies and provide stronger evidence. Further research should focus on whether multiple-micronutrient supplementation during lactation (compared with no supplementation, a placebo or supplementation with fewer than two micronutrients) is beneficial to the mother and her baby and any associated adverse effects of the intervention. Further studies should report on important outcomes such as those listed in this review and consider the risks of excess supplementation. Future studies could more precisely assess a variety of multiple-micronutrient combinations and different dosages and look at how these effect outcomes for the mother and her baby.”

Best wishes,


Holly Millward

Communications and Engagement Officer

Cochrane UK