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Dose-effect of iron-folic acid and multiple micronutrient supplementation on hemoglobin concentration in pregnancy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Child Health Unit, ICDDR, B.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
(English)Manuscript (preprint) (Other academic)
Abstract [en]



Maternal multiple micronutrient supplementation has been suggested as an alternative to the 60 mg iron-folic acid supplementation recommended by the WHO. The effect on hemoglobin (Hb) concentration during pregnancy per capsule of multiple micronutrients has not been evaluated. To investigate the response of type of prenatal supplement on Hb concentration in pregnancy we used data from the MINIMat trial, Bangladesh, where pregnant women were randomized to food and micronutrient interventions. The daily micronutrient supplements starting at week 14 (baseline) were: 60 mg iron+ 400 µg folic acid (Fe60Fol), 30 mg iron+ 400 µg folic acid (Fe30Fol) and 30 mg iron+ 400 µg folic acid+ 13 other micronutrients (MMS). Hb was measured at baseline and week 30 (follow-up) by HemoCue® (n=2377). Intake of capsules was estimated by a device (eDEM®) recording the number of openings of the cap of the supplement bottles.We evaluated dose-effect associations in linear regression models and adjusted for potential confounding. Disregarding type of supplement, the Hb concentration increased with increasing capsule intake (β=0.09, p<0.001). The dose response levelled out at 60 capsules of Fe60Fol. Both anemic and non anemic women responded to supplementation but Hb increase per capsule was higher in anemic women (β=0.065, p=0.19 for interaction between anemia and capsule intake). Despite that the maximum potential Hb was reached, both for anemic and non-anemic women at intakes above 60 capsules, prevalence of anemia was high after supplementation (36%) indicating other causes of anemia than iron deficiency.

Keyword [en]
anemia, hemoglobin, dose-response relationship, dietary supplements, micronutrients, pregnancy, prenatal nutritional physiological phenomena
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-143055OAI: oai:DiVA.org:uu-143055DiVA: diva2:391599
Available from: 2011-01-25 Created: 2011-01-19 Last updated: 2011-03-21
In thesis
1. Infant Anemia and Micronutrient Status: Studies of Early Determinants in Rural Bangladesh
Open this publication in new window or tab >>Infant Anemia and Micronutrient Status: Studies of Early Determinants in Rural Bangladesh
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anemia and micronutrient deficiencies in infancy are common in low-income settings. These are partly due to maternal malnutrition and may impair child health and development. We studied the impact of maternal food and micronutrient supplementation, duration of exclusive breastfeeding (EBF), growth and infection on infant anemia and micronutrient status.

In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early or Usual promotion of enrolment in a food supplementation program and to one of three daily micronutrient supplements. Capsules containing 400µg folic acid and (a) 30 mg iron (Fe30Fol), (b) 60 mg iron (Fe60Fol), (c) 30 mg iron and other micronutrients (MMS) were provided from week 14 of gestation. Capsule intake was assessed with the eDEM device recording supplement container openings. Blood samples (n=2377) from women at week 14 and 30 were analyzed for hemoglobin (Hb). Duration of EBF and infant morbidity was based on monthly maternal recalls. Infants were weighed and measured monthly. Blood samples (n=1066) from 6-months-old infants were analyzed for Hb and plasma ferritin, zinc, retinol, vitamin B12 and folate.

In women, Hb increase per capsule reached a plateau at 60 Fe60Fol capsules, indicating that nine weeks of daily supplementation produced maximum Hb response. Anemia was common (36%) at capsule intakes >60 indicating other causes of anemia than iron deficiency.

In infants, vitamin B12 deficiency prevalence was lower in the MMS (26.1%) than in the Fe30Fol group (36.5%), (p=0.003) and zinc deficiency prevalence was lower in the Usual than in the Early group. There were no other differential effects of food or micronutrient supplementation on infant anemia or micronutrient status. Infants exclusively breast-fed for 4-6 months had a higher mean plasma zinc concentration (9.9±2.3 µmol/L) than infants exclusively breast-fed for <4 months (9.5±2.0 µmol/L), (p< 0.01). No other differences in anemia, iron or zinc status were observed between EBF categories. Infection, low birth weight and iron deficiency were independent risk factors for infant anemia. Regardless of studied interventions, prevalence of anemia (43%), deficiency of zinc (56%), vitamin B12, vitamin A (19%) and iron (22%) in infancy was high and further preventive strategies are needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 52 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 638
Keyword
Micronutrients, Anemia, Iron Deficiency, Zinc Deficiency, Vitamin A Deficiency, Vitamin B12 Deficiency, Folic Acid Deficiency, Infant, Pregnancy, Dietary Supplementation, Hemoglobin, Dose-Response Relationship, Exclusive Breast Feeding, Bangladesh
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-143058 (URN)978-91-554-7992-3 (ISBN)
Public defence
2011-03-09, Rosénsalen, Akademiska sjukhuset, Ing 95/96 nbv, Uppsala, 13:15 (English)
Opponent
Supervisors
Projects
MINIMat
Available from: 2011-02-16 Created: 2011-01-19 Last updated: 2011-03-21Bibliographically approved

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