Compliance to Prenatal Iron and Folic Acid Supplement Use in Relation to Low Birth Weight in Lilongwe, Malawi.

Aaron Chikakuda,Sarah Comstock,Dayeon Shin,Won Song,Sujin Song

doi:10.3390/nu10091275

Aaron Chikakuda, Sarah Comstock + Show 3 more

Open Access

https://doi.org/10.3390/nu10091275

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Abstract

Prenatal iron and folic acid (IFA) supplements are offered free to all pregnant women in Malawi to reduce maternal anemia and improve birth outcomes. We investigated the association between self-reported compliance to IFA intake and risk of low birth weight (LBW). Pregnant women who attended Bwaila Maternity Wing of Lilongwe District Hospital for delivery were recruited (n = 220). We used a questionnaire to collect self-reported information on IFA use and maternal sociodemographic data. Before delivery, blood samples for maternal hemoglobin (Hb) and folate status, and upon delivery, birth weight, and other newborn anthropometrics were measured. We used multivariable logistic regression to determine risk of LBW by prenatal IFA intake. The self-reported number of IFA pills taken during pregnancy was positively associated with Hb, but not serum and RBC folate concentration: <45, 45–89 and ≥90 pills taken corresponded with mean (SD) Hb 10.7 (1.6), 11.3 (1.8), and 11.7 (1.6) g/dL, respectively (p = 0.006). The prevalence of LBW was 20.1%, 13.5% and 5.6% for those who reported taking IFA pills <45, 45–89, and ≥90 pills, respectively (p = 0.027). Taking >60 IFA pills reduced risk of LBW delivery (OR (95% CI) = 0.15 (0.03–0.70), p = 0.033) than taking ≤30 pills. Self-reported compliance to IFA use is valid for assessing prenatal supplement program in Malawi, especially Hb status, and can reduce the rate of LBW.

Highlights

Low birth weight (LBW) is internationally recognized as a birth weight below 2500 g (5.5 pounds).LBW is a birth outcome of importance to public health, associated with increased morbidity and mortality in neonates and infants and cardiovascular disease risks later in life [1,2,3]
The present study reported that the self-reported intake of iron and folic acid (IFA) reduced the risk of LBW
They found that at the population level, in a context where the burden of anemia is severe, IFA pills taken during pregnancy were significantly associated with low LBW

Summary

Introduction

LBW is a birth outcome of importance to public health, associated with increased morbidity and mortality in neonates and infants and cardiovascular disease risks later in life [1,2,3]. This practical cutoff for international comparison is based on epidemiological observations that LBW babies are 20 times more likely to die than heavier infants [4]. LBW prevalence in Sub-Saharan Africa (15%) is similar to the level in the Caribbean region (14%). The Central America and Oceania region has a LBW rate of about 10% [4]. LBW is Nutrients 2018, 10, 1275; doi:10.3390/nu10091275 www.mdpi.com/journal/nutrients

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