Dose-effect of iron-folic acid and multiple micronutrient supplementation on hemoglobin concentration in pregnancy
(English)Manuscript (preprint) (Other academic)
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.
anemia, hemoglobin, dose-response relationship, dietary supplements, micronutrients, pregnancy, prenatal nutritional physiological phenomena
Medical and Health Sciences
Research subject Nutrition
IdentifiersURN: urn:nbn:se:uu:diva-143055OAI: oai:DiVA.org:uu-143055DiVA: diva2:391599