Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia.
Study Goal
The researchers aimed to determine whether prenatal iron-folic acid (IFA) or multiple micronutrient (MM) supplements improved iron status in pregnant women with no or mild anemia compared to folic acid (FA) alone.
Results Summary
Both IFA and MM supplements significantly reduced the prevalence of iron deficiency (ID) compared to FA alone, as measured by serum ferritin, serum soluble transferrin receptor, and body iron levels. However, there was no difference in anemia prevalence between the groups.
Population
834 pregnant women in China with hemoglobin > 100 g/L before 20 weeks of gestation.
Effective Dosage
Daily 400 μg folic acid (control), FA plus 30 mg iron, or FA, iron, plus 13 additional micronutrients.
Duration
From before 20 weeks of gestation to delivery.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Universal prenatal daily iron-folic acid (IFA) supplements | decrease | low birth weight | pregnant women | - | are recommended to reduce the risk of | #1 |
Universal prenatal daily iron-folic acid (IFA) supplements | decrease | maternal anemia | pregnant women | - | are recommended to reduce the risk of | #2 |
Universal prenatal daily iron-folic acid (IFA) supplements | decrease | iron deficiency (ID) during pregnancy | pregnant women | - | are recommended to reduce the risk of | #3 |
Universal prenatal daily multiple micronutrient (MM) supplements | decrease | low birth weight | pregnant women | - | are recommended to reduce the risk of | #4 |
Universal prenatal daily multiple micronutrient (MM) supplements | decrease | maternal anemia | pregnant women | - | are recommended to reduce the risk of | #5 |
Universal prenatal daily multiple micronutrient (MM) supplements | decrease | iron deficiency (ID) during pregnancy | pregnant women | - | are recommended to reduce the risk of | #6 |
IFA (FA plus 30 mg of iron) | decrease | ID (by low SF) | pregnant women with hemoglobin > 100 g/L | 35.3% | had significantly lower prevalence of | #7 |
IFA (FA plus 30 mg of iron) | decrease | ID (by high sTfR) | pregnant women with hemoglobin > 100 g/L | 53.6% | had significantly lower prevalence of | #8 |
IFA (FA plus 30 mg of iron) | decrease | ID (by low BI) | pregnant women with hemoglobin > 100 g/L | 34.5% | had significantly lower prevalence of | #9 |
MM (FA, iron, plus 13 additional MMs) | decrease | ID (by low SF) | pregnant women with hemoglobin > 100 g/L | 42.7% | had significantly lower prevalence of | #10 |
MM (FA, iron, plus 13 additional MMs) | decrease | ID (by high sTfR) | pregnant women with hemoglobin > 100 g/L | 59.9% | had significantly lower prevalence of | #11 |
MM (FA, iron, plus 13 additional MMs) | decrease | ID (by low BI) | pregnant women with hemoglobin > 100 g/L | 41.2% | had significantly lower prevalence of | #12 |
FA (400 μg of folic acid) | neutral | ID (by low SF) | pregnant women with hemoglobin > 100 g/L | 59.6% | had prevalence of | #13 |
FA (400 μg of folic acid) | neutral | ID (by high sTfR) | pregnant women with hemoglobin > 100 g/L | 69.9% | had prevalence of | #14 |
FA (400 μg of folic acid) | neutral | ID (by low BI) | pregnant women with hemoglobin > 100 g/L | 59.6% | had prevalence of | #15 |
IFA (FA plus 30 mg of iron) | no change | anemia prevalence (hemoglobin < 110 g/L) | pregnant women with hemoglobin > 100 g/L | - | there was no difference in | #16 |
MM (FA, iron, plus 13 additional MMs) | no change | anemia prevalence (hemoglobin < 110 g/L) | pregnant women with hemoglobin > 100 g/L | - | there was no difference in | #17 |
prenatal IFA supplements | increase | iron status later during pregnancy | women with no or mild anemia | - | improved | #18 |
prenatal MM supplements | increase | iron status later during pregnancy | women with no or mild anemia | - | improved | #19 |
prenatal IFA supplements | no change | perinatal anemia | women with no or mild anemia | - | did not affect | #20 |
prenatal MM supplements | no change | perinatal anemia | women with no or mild anemia | - | did not affect | #21 |
Universal prenatal daily iron-folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron status [serum ferritin (SF), serum soluble transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a randomized, double-blind trial in China. Women were randomly assigned to take daily 400 μg of folic acid (FA) (control), FA plus 30 mg of iron, or FA, iron, plus 13 additional MMs provided before 20 wk of gestation to delivery. Venous blood was collected in this subset during study enrollment (before 20 wk of gestation) and 28-32 wk of gestation. We found that, at 28-32 wk of gestation, compared with the FA group, both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 wk of gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% by using low SF, 53.6%, 59.9%, and 69.9% by using high sTfR, and 34.5%, 41.2%, and 59.6% by using low BI, respectively. However, there was no difference in anemia prevalence (hemoglobin < 110 g/L) between FA and IFA or MM groups. We concluded that, compared with FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia. This trial was registered at clinicaltrials.gov as NCT00137744.