PAEDIATRICS: Edited by Berthold Koletzko and Raanan ShamirInterventions to prevent iron deficiency during the first 1000 days in low-income and middle-income countries recent advances and challengesLewies, Angéliquea; Zandberg, Lizellea; Baumgartner, Jeanninea,bAuthor Information aCentre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa bLaboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland Correspondence to Jeannine Baumgartner, PhD, Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092 Zurich, Switzerland. Tel: +41 44 632 86 34; e-mail: email@example.com,firstname.lastname@example.org Current Opinion in Clinical Nutrition and Metabolic Care: May 2019 - Volume 22 - Issue 3 - p 223-229 doi: 10.1097/MCO.0000000000000557 Buy Metrics Abstract Purpose of review Iron deficiency remains highly prevalent in women and young children in low-income and middle-income countries. To prevent the potentially life-long consequences of iron deficiency when occurring during early life, the WHO recommends iron supplementation of pregnant women and young children. However, increasing evidence of limited efficacy and risk of current iron intervention strategies are cause of concern. This review aims to highlight recent advances and challenges of established and novel intervention strategies for the prevention of iron deficiency during the first 1000 days in low-income and middle-income countries. Recent findings Recent meta-analyses and trials challenged the WHO's current recommendation to provide iron-folic acid rather than multiple micronutrient supplements during routine antenatal care. Furthermore, several studies explored optimal windows for iron supplementation, such as prior to conception. Studies are demonstrating that infectious and noninfectious inflammation is compromising the efficacy of iron interventions in vulnerable groups. Therefore, strategies addressing iron deficiency should focus on targeting infection and inflammation while simultaneously providing additional iron. Furthermore, both iron deficiency and iron supplementation may promote an unfavourable gut microbiota. Recent trials in infants indicate that the provision of a prebiotic together with iron may alleviate the adverse effects of iron on the gut microbiome and gut inflammation, and may even enhance iron absorption. Summary Recent studies highlight the need for and potential of novel intervention strategies that increase the efficacy and limit the potential harm of universal iron supplementation. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.