Multivitamin and iron supplementation to prevent periconceptional anemia in rural tanzanian women: a randomized, controlled trial.
Study Goal
The researchers aimed to determine whether pre-pregnancy supplementation with iron and multivitamins reduces the risk of anemia during the periconceptional period among rural Tanzanian women and adolescent girls.
Results Summary
Supplementation with iron and folic acid significantly reduced the risk of hypochromic microcytic anemia compared to folic acid alone, with similar effects observed in the multivitamin arm. Hemoglobin levels did not differ across treatments, but the risk reduction for anemia was statistically significant.
Population
Non-pregnant women and adolescent girls aged 15-29 years in rural Tanzania.
Effective Dosage
Folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance (RDA) doses, administered daily.
Duration
Six months.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
folic acid alone | no change | Hemoglobin levels | Non-pregnant women and adolescent girls aged 15-29 years | median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65 | were not different | #1 |
folic acid and iron | no change | Hemoglobin levels | Non-pregnant women and adolescent girls aged 15-29 years | median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65 | were not different | #2 |
folic acid, iron, and vitamins A, B-complex, C, and E | no change | Hemoglobin levels | Non-pregnant women and adolescent girls aged 15-29 years | median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65 | were not different | #3 |
folic acid and iron | decrease | risk of hypochromic microcytic anemia | Non-pregnant women and adolescent girls aged 15-29 years | 17%, RR: 0.61, 95% CI: 0.42-0.90, p = 0.01 | significant reduction | #4 |
folic acid, iron, and multivitamin | decrease | risk of hypochromic microcytic anemia | Non-pregnant women and adolescent girls aged 15-29 years | 19%, RR: 0.66, 95% CI: 0.45-0.96, p = 0.03 | significant reduction | #5 |
iron and folic acid | decrease | anemia | women and adolescents prior to pregnancy | - | reduces risk | #6 |
OBJECTIVE: Women's nutritional status during conception and early pregnancy can influence maternal and infant outcomes. This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce the prevalence of anemia during the periconceptional period among rural Tanzanian women and adolescent girls. DESIGN: A double-blind, randomized controlled trial was conducted in which participants were individually randomized to receive daily oral supplements of folic acid alone, folic acid and iron, or folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance (RDA) doses for six months. SETTING: Rural Rufiji District, Tanzania. SUBJECTS: Non-pregnant women and adolescent girls aged 15-29 years (n = 802). RESULTS: The study arms were comparable in demographic and socioeconomic characteristics, food security, nutritional status, pregnancy history, and compliance with the regimen (p>0.05). In total, 561 participants (70%) completed the study and were included in the intention-to-treat analysis. Hemoglobin levels were not different across treatments (median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65). However, compared with the folic acid arm (28%), there was a significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm (17%, RR: 0.61, 95% CI: 0.42-0.90, p = 0.01) and the folic acid, iron, and multivitamin arm (19%, RR: 0.66, 95% CI: 0.45-0.96, p = 0.03). Inverse probability of treatment weighting (IPTW) to adjust for potential selection bias due to loss to follow-up did not materially change these results. The effect of the regimens was not modified by frequency of household meat consumption, baseline underweight status, parity, breastfeeding status, or level of compliance (in all cases, p for interaction>0.2). CONCLUSIONS: Daily oral supplementation with iron and folic acid among women and adolescents prior to pregnancy reduces risk of anemia. The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT01183572.