Abstract
Anemia affects over 500 million women, and in pregnancy is associated with impaired maternal and infant outcomes. Intermittent antenatal iron supplementation is an attractive alternative to daily dosing; however, the impact of this strategy on infant outcomes remains unclear. We compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Viet Nam. This cluster randomised trial was conducted in Ha Nam province, Viet Nam. 1,258 pregnant women (< 16 wk gestation) in 104 communes were assigned to daily iron-folic acid (IFA), twice weekly IFA, or twice weekly multiple micronutrient (MMN) supplementation. Primary outcome was birth weight. Mean birth weight was 3,148 g (standard deviation 416). There was no difference in the birth weights of infants of women receiving twice weekly IFA compared to daily IFA (mean difference [MD] 28 g; 95% CI -22 to 78), or twice weekly MMN compared to daily IFA (MD -36.8 g; 95% CI -82 to 8.2). At 32 wk gestation, maternal ferritin was lower in women receiving twice weekly IFA compared to daily IFA (geometric mean ratio 0.73; 95% CI 0.67 to 0.80), and in women receiving twice weekly MMN compared to daily IFA (geometric mean ratio 0.62; 95% CI 0.57 to 0.68), but there was no difference in hemoglobin levels. Infants of mothers who received twice weekly IFA had higher cognitive scores at 6 mo of age compared to those who received daily IFA (MD 1.89; 95% CI 0.23 to 3.56). Twice weekly antenatal IFA or MMN did not produce a clinically important difference in birth weight, when compared to daily IFA supplementation. The significant improvement in infant cognitive outcomes at 6 mo of age following twice weekly antenatal IFA requires further exploration, and provides additional support for the use of intermittent, rather than daily, antenatal IFA in populations with low rates of iron deficiency. Australia New Zealand Clinical Trials Registry 12610000944033.
Highlights
Iron deficiency anemia is a globally important public health problem, for low- and middle-income countries
The distribution of birth weight was similar in infants born to women who took twice weekly Iron–folic acid (IFA) compared to those who took daily IFA (MD 28 g; 95% confidence interval (CI) 222 to 78), and in infants born to mothers who took twice weekly multiple micronutrient (MMN) compared to those who took daily IFA (MD 236.8 g; 95% CI 282 to 8.2) (Table 3)
No difference was seen in infants born to women who received twice weekly MMN compared to daily IFA (MD 0.23; 95% CI 20.38 to 0.84)
Summary
Iron deficiency anemia is a globally important public health problem, for low- and middle-income countries. Pregnant women and young children are especially vulnerable [1], with increased maternal morbidity and mortality, higher rates of preterm birth and low birth weight, and reduced infant survival, with potential long-term consequences for child growth and development [2,3,4,5,6,7]. Anemia contributes to 20% of all maternal deaths and is linked to increased maternal morbidity, higher rates of preterm birth and low birth weight, and reduced infant survival, with potential long-term consequences for child growth and development. Iron–folic acid supplementation given from early in pregnancy is the standard recommended approach to prevent and treat anemia in pregnant women, but recently the World Health Organization recommended intermittent use because of poor compliance with daily regimes (because of side effects) and poor bowel absorption. The researchers conducted a communitybased cluster randomized trial (where groups of people are randomized, rather than individuals) in rural Viet Nam to compare the effect of antenatal iron–folic acid supplementation taken twice weekly (either alone, or in combination with other micronutrients) with daily iron–folic acid supplementation, on maternal and infant outcomes during the first six months of life
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