{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:44:01Z","timestamp":1792086241303,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eleanor Crook Foundation"},{"name":"Kirk Humanitarian"},{"name":"Gates Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Antenatal multiple micronutrient supplementation (MMS) improves birth outcomes more effectively than iron and folic acid (IFA) supplementation alone. However, the acceptability of MMS among pregnant individuals, a critical factor for adherence and program success, remains poorly defined and inconsistently assessed. This narrative review proposes a comprehensive definition of \u201cacceptability\u201d in the context of nutritional supplementation and evaluates the evidence on the acceptability of MMS compared to IFA in low- and middle-income countries (LMICs). Methods: We conducted a systematic literature search across Embase, Medline, and Scopus to identify studies (including grey literature) reporting on acceptability-related outcomes for MMS versus IFA among pregnant individuals. Studies exploring dimensions such as organoleptic properties, ease of consumption, side effects, cultural appropriateness, and socioeconomic factors were included. Results: Out of 1056 screened studies, five informed a novel multi-dimensional definition of acceptability. Six studies assessed acceptability-related characteristics. MMS was generally accepted across most organoleptic domains. Most studies reported fewer or comparable adverse side effects for MMS as compared to IFA. Studies consistently reported more perceived benefits for MMS than IFA. Facilitating factors included trust in health professionals, free provision, and family support. Barriers included poor taste or smell, fear of side effects, misconceptions, cost, and lack of family support. Conclusions: Antenatal MMS is widely acceptable in LMICs. Addressing socio-cultural, sensory, and socioeconomic factors is essential to increase uptake and adherence. This review provides a clear, standardized definition of acceptability to guide future research and inform effective program design.<\/jats:p>","DOI":"10.3390\/nu17182994","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T14:45:46Z","timestamp":1758206746000},"page":"2994","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Acceptability of Antenatal Multiple Micronutrient Supplementation (MMS) Compared to Iron and Folic Acid (IFA) Supplementation in Pregnant Individuals: A Narrative Review"],"prefix":"10.3390","volume":"17","author":[{"given":"Mihaela C.","family":"Kissell","sequence":"first","affiliation":[{"name":"Healthy Mothers Healthy Babies Consortium, Micronutrient Forum, Washington, DC 20005-3915, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7610-9675","authenticated-orcid":false,"given":"Carolina","family":"Pereira","sequence":"additional","affiliation":[{"name":"Healthy Mothers Healthy Babies Consortium, Micronutrient Forum, Washington, DC 20005-3915, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1702-1433","authenticated-orcid":false,"given":"Filomena","family":"Gomes","sequence":"additional","affiliation":[{"name":"Healthy Mothers Healthy Babies Consortium, Micronutrient Forum, Washington, DC 20005-3915, USA"},{"name":"NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1016-6656","authenticated-orcid":false,"given":"Kidist","family":"Woldesenbet","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health, Addis Ababa P.O. Box 1234, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7155-4815","authenticated-orcid":false,"given":"Masresha","family":"Tessema","sequence":"additional","affiliation":[{"name":"Ethiopia Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiwot","family":"Kelemu","sequence":"additional","affiliation":[{"name":"UNICEF Ethiopia, Addis Ababa P.O. Box 1169, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramadhani","family":"Noor","sequence":"additional","affiliation":[{"name":"UNICEF Ethiopia, Addis Ababa P.O. Box 1169, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz","family":"Escubil","sequence":"additional","affiliation":[{"name":"The Vitamin Angel Alliance, Goleta, CA 93117, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Panicker","sequence":"additional","affiliation":[{"name":"The Vitamin Angel Alliance, Goleta, CA 93117, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Mishra","sequence":"additional","affiliation":[{"name":"The Vitamin Angel Alliance, Goleta, CA 93117, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9979-6542","authenticated-orcid":false,"given":"Mai-Anh","family":"Hoang","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, No. 42 St 322, Phnom Penh 12302, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hou","family":"Kroeun","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, No. 42 St 322, Phnom Penh 12302, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Sauer","sequence":"additional","affiliation":[{"name":"Human Nutrition, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"BC Children\u2019s Hospital and Individuals\u2019 Health Research Institutes, Vancouver, BC V5Z 4H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Sokchea","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, No. 42 St 322, Phnom Penh 12302, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-2194","authenticated-orcid":false,"given":"Crystal D.","family":"Karakochuk","sequence":"additional","affiliation":[{"name":"Human Nutrition, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"BC Children\u2019s Hospital and Individuals\u2019 Health Research Institutes, Vancouver, BC V5Z 4H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masako","family":"Horino","sequence":"additional","affiliation":[{"name":"United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman 11814, Jordan"},{"name":"Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-362X","authenticated-orcid":false,"suffix":"Jr.","given":"Keith P.","family":"West","sequence":"additional","affiliation":[{"name":"Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Seita","sequence":"additional","affiliation":[{"name":"United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman 11814, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djeinam","family":"Toure","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Africa Region Office, Dakar 29898, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umu H.","family":"Jalloh","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9490-6537","authenticated-orcid":false,"given":"Francis","family":"Moses","sequence":"additional","affiliation":[{"name":"Reproductive Health and Family Planning, Ministry of Health and Sanitation, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aminata S.","family":"Koroma","sequence":"additional","affiliation":[{"name":"Food and Nutrition, Ministry of Health and Sanitation, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bakary","family":"Diarra","sequence":"additional","affiliation":[{"name":"Institut National de Sant\u00e9 Publique, Bamako 1771, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ousmane","family":"Camara","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Bamako 1557, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ouassa","family":"Sanogo","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Bamako 1557, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Garn","sequence":"additional","affiliation":[{"name":"Helen Keller Intl, Africa Region Office, Dakar 29898, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-4448","authenticated-orcid":false,"given":"Martin N.","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Healthy Mothers Healthy Babies Consortium, Micronutrient Forum, Washington, DC 20005-3915, USA"},{"name":"Division of Human Nutrition and Health, Wageningen University & Research (Bode 62), P.O. Box 17, 6700 AA Wageningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1590","DOI":"10.1016\/S2214-109X(24)00276-6","article-title":"Global Estimation of Dietary Micronutrient Inadequacies: A Modelling Analysis","volume":"12","author":"Passarelli","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1590","DOI":"10.1016\/S2214-109X(22)00367-9","article-title":"Micronutrient Deficiencies among Preschool-Aged Children and Women of Reproductive Age Worldwide: A Pooled Analysis of Individual-Level Data from Population-Representative Surveys","volume":"10","author":"Stevens","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_3","unstructured":"World Health Organization (2025, June 19). Anaemia. 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