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Office of Partnerships and Innovation

Researcher contributes to WHO maternal health guidelines

Wednesday, August 19, 2020

As originally published in the Queen's Gazette.

New research from Queen’s University helps inform World Health Organization guidelines related to maternal nutrition during pregnancy.

Queen’s University researcher Bahman Kashi (Economics) has contributed to new World Health Organization (WHO) guidelines related to maternal nutrition. His research into cost-effectiveness analysis of alternative supplementations during pregnancy informed the 2020 WHO antenatal care guidelines, which supports public health policy globally. 

One of the ongoing questions around nutrition during pregnancy is related to transitioning from long-standing iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) to improve maternal and neonatal health. While IFAS only contains iron and folic acid, MMS includes iron, folic acid, and several other vitamins and trace minerals. MMS was proposed as a potential way to improve the nutritional profiles of pregnant women to reduce the risks of nutritional deficiencies on maternal and neonatal health. However, due to concerns regarding MMS's potential harms to newborns the World Health Organization's 2016 prenatal care guideline did not recommend transitioning from IFAS to MMS. 

Since the release of the 2016 guideline, emerging evidence suggests that MMS may be appropriate in low and middle-income countries. However, in addition to the concerns regarding potential harms, there were uncertainties regarding the cost and ultimate cost-effectiveness of MMS. Limestone Analytics, a Queen’s spin-off company led by Dr. Kashi, and Nutrition International conducted research to close these knowledge gaps. The analysis included evaluating the effectiveness of IFAS compared to MMS, comparing the costs, and calculating the cost-effectiveness of transitioning from IFAS to MMS. The analysis relies on publicly available data on health indicators, systematic reviews, and supplement costs. The main contribution of the study is the development of a model that allows for aggregating the impact on different health outcomes into one measure of effectiveness.

“A global policy shift on the choice of nutrition during pregnancy has the potential to improve the health and lives of millions of women and children around the world at a negligible cost," says Dr. Kashi. "For such a shift to happen, it is not only enough to collect an evidence base, but there is also the need to translate it through research into clear decisions. This research primarily focused on using the existing evidence to bridge the knowledge gaps and made the policy shift a possibility.”

The analysis was a critical component in informing the WHO's 2020 antenatal guideline, where the WHO position regarding MMS shifted from "not recommended" to "recommended in the context of rigorous research." This provides a path forward regarding the use of MMS and highlights the areas for future research. 

Two Queen’s University alumni, Zuzanna Kurzawa and Caroline Godin, were also a part of the research team. Godin's participation in this research was through a Mitacs internship, highlighting the importance of industry-academic partnerships facilitated by the Queen’s Partnerships and Innovation, and initiatives such as Mitacs.

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