Differences in Hemoglobin Levels in Pregnant Women through Multi-Micronutrient Supplements and Iron Tablets

BACKGROUND: A high incidence of anemia, particularly severe anemia, among pregnant women has been a major cause of maternal mortality worldwide. Multi-micronutrient supplement (MMS) has been beneficial for health outcomes. AIM: The study was aimed to examine the effect of MMS compared to iron-folic acid supplement (IFA) on hemoglobin (Hb) levels among pregnant women. METHODS: The study was a quasi-experiment with a three-group pre-post-test design, namely, IFA group, MMS group, and MMS + IFA group. A total of 120 participants enrolled were divided equally in each group. The statistical analysis performed was paired t-test and one-way ANOVA using SPSS. RESULTS: The study result shows that there was a significant difference in the Hb levels of pregnant women after the intervention in all groups (p < 0.001). The highest increase in Hb levels was in the IFA + MMS combining group by 1.1 g/dL of Hb followed by MMS and IFA (0.8 ± 0.37 and 0.4 ± 0.31, respectively). CONCLUSION: The combination of Fe and MMS groups could increase Hb levels compared to IFA. Thus, replacing IFA with MMS is reasonably in preventing anemia among pregnant women.

Unpacking How a Social Norms-Based Intervention Affects Iron Folic Acid Supplement Use Among Rural Indian Women

Objectives More than a third of women worldwide and more than half of women in India have iron deficiency anemia. In 2012, the World Health Assembly made a global target of a 50% reduction in anemia among all women of reproductive age by the year 2025. Based on formative research, the Reduction in Anemia through Normative Innovations (RANI) project designed a social norms-based intervention to increase iron folic acid supplement use among women of reproductive age in Odisha, India. The objective of this paper is to examine midline data to understand which intervention components had the most effect on taking iron supplements and to suggest intervention modifications accordingly. Methods We collected and analyzed longitudinal data at baseline from the control and treatment arms and again from the same two arms at midline, six months later (n = 1,966 and n = 1,987). For this analysis, our sample includes non-pregnant women of reproductive age (15 – 49 years old). Using nested models, we analyzed data from the different intervention components: monthly community-based testing for anemia, attending participatory group education sessions, and watching locally made videos targeted at different referent groups. We also examined if age, caste, education, and communicating about the intervention moderated the effect of the intervention on iron supplement use. Results After controlling for iron supplement use at baseline, we found that simply being in the treatment arm increased the odds of taking supplements by more than 16 times (OR = 16.73; p = &lt; .001). Being exposed to each of the intervention components separately and as reported here, all together, also increased use. Getting tested for anemia increased a woman's odds of taking iron supplements by 38% (OR = 1.38; p = &lt; .001) followed by watching videos which increased the odds by 26% (OR 1.26; p &lt; .001).Participating in group education sessions had the smallest effect (OR = 1.09; p = &lt; .01). There was not a significant difference in how the intervention affected iron supplement use by age, caste, or education level. Similarly, interpersonal communication did not have an effect. Conclusions While all intervention components increased iron supplement use, community-based anemia testing had the greatest effect. In the final stage of this trial, more resources will go towards anemia testing. Funding Sources The Bill and Melinda Gates Foundation.

Preconception Dietary Folate Intake and Risk of Spontaneous Abortion

Objectives Previous studies suggest a beneficial effect of supplemental folic acid use and dietary folate intake on fertility, while results for fetal loss are conflicting. Most previous research on fetal loss focused on folic acid supplement use. We therefore, investigated the association between dietary folate intake and spontaneous abortion (SAB) in a Danish preconception cohort of couples trying to conceive. Methods We recruited couples who were trying to conceive and did not receive fertility treatment. Pregnancies were ascertained through bimonthly follow-up questionnaires completed up to 12 months after study entry. SABs were identified by self-report on the follow-up questionnaires and through the Danish National Patient Registry. Dietary folate intake at study entry was estimated using a validated food frequency questionnaire (FFQ). Folate intake was adjusted for total energy intake using the residual method and categorized as &lt; 250,250–399 and &gt; = 400µg/day. We used Cox proportional hazards regression models with gestational weeks as time scale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for SAB, adjusting for age, partner's age, educational attainment, smoking status, anthropometry, physical activity, alcohol intake, folic acid supplement use, time-to-pregnancy, gravidity and parity. In sensitivity analyses, we stratified by folic acid supplement use, body mass index (BMI) and alcohol intake. Results Of the 2,957 women who became pregnant within 12 months of study entry and completed the FFQ, we identified 432 SABs. HRs for an SAB among women who consumed 250–399 and &gt;= 400 µg/day of dietary folate compared with &lt;250 µg/day were 0.83 (95% CI: 0.53; 1.29) and 0.87 (95% CI: 0.54; 1.39), respectively. Comparing intake &gt; = 400 with &lt;250 µg/day, the association was stronger when the analysis was restricted to folic acid supplement users, 0.74 (95% CI: 0.39; 1.40), to women with a BMI &gt;= 25, 0.67 (95% CI: 0.31; 1.43), and to a reported alcohol intake &gt;4 drinks/week, 0.66 (95% CI: 0.16; 2.66). Conclusions Our study may suggest that high dietary folate intake among folic acid supplement users is associated with a lower risk of SAB, although our estimates are imprecise. Funding Sources National Institute of Child Health and Human Development.

Maternal Folic Acid Supplementation, Dietary Folate Intake and Low Birth Weight: A Birth Cohort Study

ObjectivesTo investigate the independent and collective effects of maternal folic acid supplementation or dietary folate intake upon the risk of low birth weight (LBW), and to further comprehensively examine the joint associations of folic acid supplementation and dietary folate intake with LBW by various clinical subtypes.DesignParticipants were recruited in Gansu Provincial Maternity and Child Care Hospital. A standardized and structured questionnaire was distributed to collect demographic factors, reproductive and medical history, occupational and residential history, physical activity and diet. Data on pregnancy-related complications and birth outcomes were extracted from medical records. Unconditional logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (95%CI) for single and joint associations of folic acid supplementation and dietary folate intake with LBW. SettingA birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China.Participants9231 pregnant women and their children were enrolled in the study. ResultsCompared to non-users, folic acid supplementation was associated with a reduced risk of LBW (OR: 0.80, 95%CI: 0.66-0.97), and the reduced risk was mainly seen for term-LBW (OR: 0.59, 95%CI: 0.41-0.85), and multiparous-LBW (OR: 0.72, 95%CI: 0.54-0.94). For dietary folate intake, there were no significant associations with LBW, and there was no interaction of folic acid supplement and dietary folate intake on LBW.ConclusionsOur study results indicated that folic acid supplementation was associated with a reduced risk of LBW, and there was not interaction of folic acid supplement and dietary folate intake on LBW.

Epidemiology and (Patho)Physiology of Folic Acid Supplement Use in Obese Women before and during Pregnancy

Preconception folic acid supplement use is a well-known method of primary prevention of neural tube defects (NTDs). Obese women are at a higher risk for having a child with a NTD. As different international recommendations on folic acid supplement use for obese women before and during pregnancy exist, this narrative review provides an overview of epidemiology of folate deficiency in obese (pre)pregnant women, elaborates on potential mechanisms underlying folate deficiency, and discusses considerations for the usage of higher doses of folic acid supplements. Women with obesity more often suffer from an absolute folate deficiency, as they are less compliant to periconceptional folic acid supplement use recommendations. In addition, their dietary folate intake is limited due to an unbalanced diet (relative malnutrition). The association of obesity and NTDs also seems to be independent of folate intake, with studies suggesting an increased need of folate (relative deficiency) due to derangements involved in other pathways. The relative folate deficiency, as a result of an increased metabolic need for folate in obese women, can be due to: (1) low-grade chronic inflammation (2) insulin resistance, (3) inositol, and (4) dysbiotic gut microbiome, which plays a role in folate production and uptake. In all these pathways, the folate-dependent one-carbon metabolism is involved. In conclusion, scientific evidence of the involvement of several folate-related pathways implies to increase the recommended folic acid supplementation in obese women. However, the physiological uptake of synthetic folic acid is limited and side-effects of unmetabolized folic acid in mothers and offspring, in particular variations in epigenetic (re)programming with long-term health effects, cannot be excluded. Therefore, we emphasize on the urgent need for further research and preconception personalized counseling on folate status, lifestyle, and medical conditions.