Abstract
ABSTRACTBackgroundInterventions are needed to address iron deficiency in low-income settings.ObjectiveThis secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana.MethodsWomen ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 µg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants’ Hb (g/L) and ZPP (µmol/mol heme) at 6 and 18 mo of age.ResultsAt 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation.ConclusionsIn this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants’ Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants’ iron status at 18 mo of age.This trial was registered at clinicaltrials.gov as NCT00970866.
Highlights
Inadequate micronutrient intake is common in low-income countries [1] and has been associated with increased risk of perinatal morbidity and mortality [2], low birth weight [3], and poor child growth and development [4]
The LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) zinc protoporphyrin concentration (ZPP) (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06)
In the International Lipid-based Nutrient Supplements (iLiNS)-DYAD randomized, controlled supplementation trial in Ghana, we evaluated the efficacy of small-quantity lipid-based nutrient supplements (SQ-LNSs) given to women during pregnancy and the first 6 mo postpartum, and to their offspring from 6 to 18 mo of age, based on evidence that child malnutrition in developing countries often begins in utero and continues after birth [11]
Summary
Inadequate micronutrient intake is common in low-income countries [1] and has been associated with increased risk of perinatal morbidity and mortality [2], low birth weight [3], and poor child growth and development [4]. Conclusions: In this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants’ Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants’ iron status at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT00970866. The self-reported adherence to supplement intake for women (pregnancy/lactation) was 88.1%/85.7% for the IFA group, 87.0%/85.0% for the MMN group, and 83.7%/80.0% for the LNS group [45], and that for the infants in the LNS group was 73.5% [12]
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