REDUCED ANEMIA AND IMPROVED IRON AND FOLATE STATUS BEFORE AND AFTER PREGNANCY AMONG FEMALES IN RURAL BANGLADESH IS RELATED TO LENGTH OF AND ADHERENCE TO PERICONCEPTIONAL IRON AND FOLIC ACID SUPPLEMENTATION.

Abstract

In 2007, Bangladesh's national strategy to reduce anemia included iron and folic acid (IFA) supplementation to adolescent girls and newly married females. We conducted a double‐blinded RCT among married, nulliparous females to determine the impact of daily periconceptional IFA Sprinkles® versus folic acid (FA) Sprinkles® on iron and folate status. Biochemical indices were collected at baseline and after a positive urine pregnancy test (~15 wks gestation), or after 9 mo of supplementation among non‐pregnant females (NPF). Among 88 pregnant females (PF), there was a significant interaction between treatment group and length of supplementation for Hb (p=0.01) and anemia (p=0.02). After 183 study days, IFA improved Hb (127.0 vs 112.5 g/L) and reduced anemia (22.2% vs 66.7%) compared to FA. Group differences for iron status were not significant. Among NPF (n=151), IFA reduced anemia by 81.4% (95% CI: 0.04, 0.90, p=0.04) and ID by 91.8% (95% CI: 0.01, 0.68, p=0.02). Improved ferritin levels were only observed among females in the highest quartile of adherence. Periconceptional FA improved folate status in both groups. Mean ( ±SD) plasma folate increased from 18.0 ( ±7.0) to 33.8 ( ±23.8) nmol/L after 140.3 ( ±65.5) days of supplementation among PF and from 16.6 ( ±6.8) to 31.4 ( ±18.8) nmol/L after 277.4 ( ±5.2) days of supplementation among NPF. Among NPF, adherence was significantly associated with improved plasma folate levels (p<0.0001) and reduced folate deficiency (p=0.002). We conclude that periconceptional IFA supplementation with Sprinkles® significantly improves anemia and iron and folate status before and during pregnancy among females in rural Bangladesh.