Fifty-Three Pre- and Antenatal Multiple Micronutrient Products on the Ukrainian Market: Cost Analysis of 180-Day Adherence and the “Product(s) of Choice”

Abstract

Background: This study investigated the compositions of the pre- and (or solely) antenatal multiple micronutrient (MMN) products available on the Ukrainian market, compared the included ingredients and their amounts with those listed in the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP), new prenatal benefit-versus-harm levels, and total upper safety levels, estimated and compared the 189-day price of continued supplementation, and identified the most suitable products for use in the context of rigorous research.

Methods: The “vitamins for pregnant women” catalog on the online platform tabletki.ua, which lists products available in 12,000 pharmacies in Ukraine, was manually searched for pre- and antenatal products containing thiamine, riboflavin, niacin, pyridoxine, folate derivative, cyanocobalamin, and iron, sold as capsules or tablets, by the author.

Results: Fifty-three of 113 (46.9%) of the MMN products contributed to the analysis. Among them, most products contained less than 30 mg of iron (84.9%; 45 of 53), less than 680 µg of folate converted into dietary folate equivalent (22.6%; 12 of 53), and less than the UNIMMAP’s levels of water-soluble vitamins (49.1%; 26 of 53). The median 189-day supply cost for the products with desirable levels of B-group vitamins and vitamin C was $88.35 (interquartile range (IQR): $64.92–$188.49) versus $105.96 (IQR: $75.53–$147.12) for those with under-supplemented water-soluble vitamin products, which were not statistically different (P = 0.603). No product limited its composition to the 15 nutrients and their amounts covered in the UNIMMAP formulation, though four products exceeded these minimum levels. Finally, the analysis identified Thorne Research Basic Prenatal (USA) as the best option for use on the Ukrainian market.

Conclusion: A significant variation of pre- and (or solely) antenatal MMN products in terms of essential micronutrient composition and even other ingredients than vitamins and minerals, including some of them underproviding iron and folate as well as exceeding the total upper safe levels, exists. Not only does it raise concerns about regulation, but it also underscores the need for clinical researchers to be aware of these issues, as only a few products can be opted for.