Trial reportThe American journal of clinical nutrition2025
Assessing the adherence and acceptability to iron and folic acid compared with multiple micronutrient supplements during pregnancy: a cluster-randomized noninferiority trial in Cambodia.
Trial report in The American journal of clinical nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05867836 (Trial of Adherence and Acceptance of Multiple Micronutrient Supplementation), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Trial of Adherence and Acceptance of Multiple Micronutrient Supplementation (MMS) vs Iron and Folic Acid (IFA) Among Pregnant Women and Health System Enablers and Constraints Related to MMS in Cambodia
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Feasibility and Readiness for Scaling-Up Multiple Micronutrient Supplements in Nepal: A Qualitative Study Using the Expandnet Scaling-Up Framework.Maternal & child nutrition · 2026Article
- Costs and benefits of replacing preventive antenatal iron and folic acid with multiple micronutrients in 25 low- and middle-income countries.BMJ global health · 2026Article
- Acceptability, Adherence, and Provision Through Antenatal Care: Evidence on Multiple Micronutrient Supplementation in Pakistan and Nigeria.Nutrients · 2026Article
- Article
- Article
- Validation Study of Adherence to Daily Multiple Micronutrient Supplementation by Palestine Refugee Women Attending United nations Relief and Works Agency for Palestine Refugees in the Near East Health Clinics in Jordan.Current developments in nutrition · 2025Article
- Fund contraction challenges for supplies for maternal and newborn health services in low- and middle-income countries: a scoping review.BMC public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Cambodian Ministry of Health is exploring transitioning from iron and folic acid (IFA) to multiple micronutrient supplements (MMS) during pregnancy and is seeking rigorous evidence to inform this policy change.
objectiveWe aimed to assess the adherence and acceptability of MMS compared with IFA supplementation during pregnancy.
methodsWe conducted an open-label cluster-randomized noninferiority trial across 48 health centers in Cambodia. A total of 1546 healthy pregnant individuals (18-45 y) were recruited at their first antenatal care (ANC) visit (<14 weeks of gestation) and randomized to 1 of 3 arms at the health center level: 1) IFA for 90 d (IFA-90, n = 515), the current standard of care; 2) MMS for 180 d via 1 180-tablet bottle (MMS-180, n = 516); or 3) MMS for 180 d via 2 90-tablet bottles (MMS-90, n = 515). Our primary outcome was the noninferiority of adherence rates of MMS-180 compared with IFA-90, assessed by tablet counts and compared against a predefined noninferiority margin of -15%. Mixed-effects linear regression models were used to estimate the mean difference (95% confidence interval [95% CI]) in adherence rates. Our secondary outcomes included the mean difference in ANC attendance between the MMS groups and the acceptability of MMS across 6 domains.
resultsOverall, 88% of participants completed the trial, with high mean adherence rates across arms (91% for IFA-90, 95% for MMS-180, and 95% for MMS-90). The adjusted mean (95% CI) difference in adherence rates between MMS-180 and IFA-90 groups was 3.9% (1.7, 6.2). The adjusted mean (95% CI) difference in ANC visits for MMS-180 and MMS-90 groups was 0.0 (-0.1, 0.2) visits. The acceptability of MMS was positive (90%-100% "agreement" across 6 domains).
conclusionsBoth IFA and MMS were highly acceptable, yet adherence to MMS was superior to IFA. These findings support the transition from IFA to MMS in Cambodia. This trial was registered at Clinicaltrials.gov as NCT05867836.
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