Effects of lipid-based nutrient supplements or multiple micronutrient supplements compared with iron and folic acid supplements during pregnancy on maternal haemoglobin and iron status.

Josh M Jorgensen,Kathryn G Dewey,Minyanga Nkhoma,Ulla Ashorn,Per Ashorn,Lacey M Baldiviez,Austrida Gondwe,Ken Maleta

doi:10.1111/mcn.12640

Abstract

We examined the effect of three types of prenatal supplements containing different amounts of iron on haemoglobin (Hb) and iron status (zinc protoporphyrin [ZPP] and soluble transferrin receptor [sTfR]) in late pregnancy among 1,379 women in rural Malawi. Participants were recruited at ≤20 gestational weeks (gw) and randomly assigned to consume daily (1) 60‐mg iron and folic acid (IFA); (2) 20‐mg iron plus 17 micronutrients in a capsule (MMN); or (3) lipid‐based nutrient supplement (LNS; 118 kcal) with 20‐mg iron plus 21 micronutrients, protein, and fat. We analysed differences between intervention groups in mean Hb, ZPP, and sTfR at 36 gw, and the proportion with anaemia (Hb < 100 g L−1) and iron deficiency (ZPP > 60 μmol mol−1 haem or sTfR > 6 mg L−1) at 36 gw. Women in the IFA group had higher Hb at 36 gw than women in the LNS group (P = 0.030) and higher iron status (lower ZPP and sTfR) than women in both the LNS (P < 0.001 for both ZPP and sTfR) and MMN (P = 0.025 and P = 0.046) groups. Results for anaemia and iron deficiency showed similar trends. Further research is needed to elucidate the appropriate amount of iron to improve Hb and iron status, while improving birth outcomes.

Highlights

Anaemia during pregnancy is a risk factor for preterm birth and low birthweight, in addition to maternal and infant death (Allen, 2000; Abbreviations: AGP, α‐1‐acid glycoprotein; CRP, C‐reactive protein; Hb, haemoglobin; iron and folic acid (IFA), iron–folic acid; LNS, lipid‐based nutrient supplement; MMN, multiple micronutrient; sTfR, soluble transferrin receptor; ZPP, zinc protoporphyrinNew & Wirth, 2015)
We examine the effect of three iron‐containing supplements on Hb and markers of iron status among pregnant Malawian women
Among pregnant Malawian women enrolled in the iLiNS‐DYAD study, those who were provided with IFA (60 mg of iron per day) from enrolment (≤20 gw) to 36 gw had higher Hb and markers of iron status at 36 gw compared with those provided with LNS or MMN (20 mg of iron per day)

Summary

Introduction

Anaemia during pregnancy is a risk factor for preterm birth and low birthweight, in addition to maternal and infant death (Allen, 2000; Abbreviations: AGP, α‐1‐acid glycoprotein; CRP, C‐reactive protein; Hb, haemoglobin; IFA, iron–folic acid; LNS, lipid‐based nutrient supplement; MMN, multiple micronutrient; sTfR, soluble transferrin receptor; ZPP, zinc protoporphyrinNew & Wirth, 2015). Iron supplementation during pregnancy is helpful in preventing iron deficiency. A recent Cochrane review reported a 70% reduction in maternal anaemia and a 57% reduction in iron deficiency at term among women who received preventive iron supplementation during pregnancy (Pena‐Rosas, De‐Regil, Garcia‐Casal, & Dowswell, 2015). The WHO recommends 30–60 mg of elemental iron per day, with a preferred daily dose of 60 mg day−1 in areas where anaemia among pregnant women is a severe public health problem (WHO, 2012). The UNICEF/WHO/ UNU international multiple micronutrient preparation for pregnant and lactating women provides the Recommended Dietary Allowance (RDA) of 15 vitamins and minerals, including 30 mg of iron. Even supplementation with only 30 mg of iron has been associated with side effects (Pena‐Rosas, De‐Regil, Dowswell, & Viteri, 2012)

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Conclusion