Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam.
Study Goal
The researchers aimed to determine whether pre-pregnancy supplementation with iron-folic acid (IFA) or multiple micronutrients (MM) compared to folic acid alone (FA) improves maternal and infant iron status and reduces anemia during pregnancy and postpartum.
Results Summary
Preconception supplementation with MM or IFA led to modest increases in maternal and infant iron stores but did not reduce anemia prevalence during pregnancy or postpartum. The effects were more pronounced in per-protocol analyses, with higher postpartum ferritin levels and greater infant iron stores in the MM and IFA groups compared to the control.
Population
5011 Vietnamese women of reproductive age, with 1813 becoming pregnant during the study.
Effective Dosage
Weekly pre-pregnancy supplements: FA (2800 μg), IFA (60 mg Fe + 2800 μg FA), or MM (15 micronutrients, including 60 mg Fe + 2800 μg FA). Daily IFA (60 mg Fe + 400 μg FA) during pregnancy.
Duration
Pre-pregnancy supplementation for ≥26 weeks before conception, followed by daily IFA through delivery.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
pre-pregnancy weekly multiple micronutrient (MM) supplements | increase | prenatal ferritin | women | 93.6 [89.3-98.2] μg/L (geometric mean) | significantly higher | #1 |
pre-pregnancy weekly iron-folic acid (IFA) supplements | increase | prenatal ferritin | women | 91.9 [87.6-96.3] μg/L (geometric mean) | significantly higher | #2 |
pre-pregnancy weekly multiple micronutrient (MM) supplements | increase | ferritin 3 months postpartum | women | 118.2 [109.3-127.8] μg/L (geometric mean) | had higher ferritin | #3 |
pre-pregnancy weekly iron-folic acid (IFA) supplements | increase | ferritin 3 months postpartum | women | 117.8 [108.7-127.7] μg/L (geometric mean) | had higher ferritin | #4 |
pre-pregnancy weekly multiple micronutrient (MM) supplements | increase | infant iron stores | infants | 184.3 [176.1-192.9] μg/L (geometric mean) | gave birth to infants with greater iron stores | #5 |
pre-pregnancy weekly iron-folic acid (IFA) supplements | increase | infant iron stores | infants | 189.9 [181.6-198.3] μg/L (geometric mean) | gave birth to infants with greater iron stores | #6 |
pre-pregnancy weekly multiple micronutrient (MM) supplements | no change | anemia | women | - | did not impact | #7 |
pre-pregnancy weekly iron-folic acid (IFA) supplements | no change | anemia | women | - | did not impact | #8 |
OBJECTIVE: Preconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum. METHODS: We conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 μg FA (control group), IFA (60 mg Fe and 2800 μg FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 μg FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements ≥ 26 weeks before conception). RESULTS: At baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 μg/L) and 3% had iron deficiency (ferritin <12 μg/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (μg/L) [95% CI]: 93.6 [89.3-98.2]) and IFA (91.9 [87.6-96.3]) compared to control (85.3 [81.5-89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3-127.8]), IFA 117.8 [108.7-127.7] vs control 101.5 [94.0-109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1-192.9]), IFA 189.9 [181.6-198.3] vs control 175.1 [167.9-182.6]). CONCLUSION: Preconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia. TRIAL REGISTRATION: ClinicalTrials.Gov NCT01665378.