Abstract
BackgroundLittle evidence about the effects of antenatal iron supplementation on infant anaemia is available. The aim was to compare effects on six-month-old infants’ Haemoglobin (Hb) concentration and anaemia of daily iron–folic acid (IFA), twice-weekly IFA with or without other micronutrients (MMN) and usual antenatal care in rural Vietnam.Methods and FindingsSecondary data analysis from: a prospective population-based observational study (OS) which examined effects of antenatal psychosocial factors, anaemia and iron deficiency on infant development and health; and a three-arm cluster randomised trial (CRT) of different antenatal iron supplementation regimens. In the OS 497 women (<20 weeks gestation) from 50 randomly-selected communes participated, and in the CRT 1,258 pregnant women (<16 weeks gestation) in 104 communes were allocated randomly to trial arms. The main outcome was six-month-old infant Hb concentration. Baseline data included women’s socio-demographic characteristics, reproductive health, Hb and serum ferritin. Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models, controlling for baseline differences and clustering, using robust standard errors.Infant anaemia prevalence was 68.6% in the OS, 47.2% daily IFA, 53.5% weekly IFA, and 50.3% MMN conditions. After adjustment, mean infant haemoglobin levels in daily IFA (mean difference = 0.95 g/dL; 95%CI 0.7-11.18); weekly IFA (0.91; 95%CI 0.69-1.12) and MMN (1.04; 95%CI 0.8-1.27) were higher than in the OS. After adjustment there were lower odds ratios of anaemia among infants in the daily IFA (OR = 0.31; 95% CI 0.22-0.43), weekly IFA (0.38; 95%CI 0.26-0.54) and MMN (0.33; 95%CI 0.23-0.48) groups than in the OS.ConclusionsInfant anaemia is a public health problem in Vietnam and other resource-constrained countries. All supplementation regimens could have clinically significant benefits for Hb and reduce anaemia risk among six-month-old infants. Universal provision of free intermittent iron supplements is warranted.
Highlights
Anaemia, often caused by iron deficiency, is highly prevalent among women and children in low- and middle-income countries (LAMIC) [1]
Daily iron–folic acid (IFA) supplementation has been the standard regimen for decades, World Health Organization (WHO) has recently recommended the use of intermittent IFA in non-anaemic pregnant women because it has fewer side effects and compliance is increased [3]
The aim of this study was to examine the effect on infant Hb concentration and anaemia at six months of age of daily provision of antenatal iron—folic acid (IFA) supplementation, or twice weekly provision of antenatal IFA supplementation with or without other micronutrients, compared with the voluntary and self-financed approach that constitutes usual care in rural Vietnam
Summary
Often caused by iron deficiency, is highly prevalent among women and children in low- and middle-income countries (LAMIC) [1]. Multiple micronutrient supplementation (MMN) during pregnancy is emerging as an approach to improve maternal and infant health in the setting of poverty [5]. There is an existing body of evidence on the effects of maternal antenatal folate status and iron level, antenatal IFA and MMN supplementation on pregnancy outcomes and infant development and health in LAMIC [2,6,7,8,9,10]. The aim was to compare effects on six-month-old infants’ Haemoglobin (Hb) concentration and anaemia of daily iron–folic acid (IFA), twice-weekly IFA with or without other micronutrients (MMN) and usual antenatal care in rural Vietnam
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