Iron Supplementation In Pregnancy Research Articles

The Effect of Antenatal 60 mg Iron Supplementation on Neonatal Mortality: A Meta-Analysis

Abstract Objectives There is strong evidence that prenatal iron and folic acid supplementation reduces the risk of iron deficiency anaemia during pregnancy and low birth weight. However, evidence it reduces neonatal mortality is still inconclusive. We aim to investigate the effects of prenatal iron supplementation either alone or in conjunction with folic acid, or with other vitamins and minerals on neonatal mortality. Methods We included five studies that assessed the effect of iron supplementation either alone or in conjunction with folic acid or with other vitamins and minerals on neonatal mortality. We then undertook several subgroup meta-analyses which include supplements containing any amount of iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment and supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment. For all analyses, we used a fixed-effect model to calculate pooled RRs and 95% CIs. Our input variables were log RR, and we later we exponentiate all effect sizes and confidence intervals. Results The meta-analysis of the effect of supplements containing any iron versus placebo/vitamin/minerals/no treatment on neonatal death showed a 20% reduction (RR 0.80, 95% CI 0.68–0.94) in neonatal mortality rate. The meta-analysis of any supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment showed a 22% (RR 0.78, 95% CI 0.64–0.95) reduction in neonatal mortality rate. The meta-analysis of supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment showed a 33% (RR 0.67, 95% CI 0.52–0.85) reduction in neonatal mortality rate. The meta-analysis analysis of any supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment did not show any effect on neonatal mortality rate. Conclusions Our findings provided vital evidence that iron supplementation in pregnancy significantly reduces neonatal mortality. This evidence justifies further investments to improve that at-scale implementation of this program in low- and middle-income countries where there are high levels of maternal anaemia and high neonatal mortality rates. Funding Sources The University of Sydney.

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

BackgroundIron deficiency in pregnancy is associated with inferior maternal and fetal outcomes. Postpartum depression, prematurity, intrauterine growth restriction, impaired childhood cognition and transfusion are all sequelae of maternal iron deficiency anemia. Transfusion to women of childbearing age has important consequences including increasing the risk of hemolytic disease of the fetus and newborn with future pregnancies. The relative contribution of iron deficiency to transfusion rates in the peripartum period is unknown. This study aimed to identify the prevalence of iron deficiency and anemia in pregnant women that received peripartum transfusions relative to age-matched non-transfused controls.MethodsWe performed a retrospective case-control study of all women that were transfused in the peripartum period from January, 2014 to July, 2018. Cases were compared to the next age matched control to deliver at our institution. The primary objective was to determine the proportion of patients with iron deficiency in pregnancy or anemia in pregnancy in cases and controls. Charts were reviewed for predisposing risk factors for iron deficiency, laboratory measures of iron deficiency and anemia, iron supplementation history and maternal and fetal outcomes. Factors associated with peripartum transfusion were analyzed using a multivariate logistic regression.Results169 of 18, 294 (0.9%) women were transfused in the peripartum period and 64 (44%) of those transfused received 1 unit. Iron deficiency or anemia were present in 103 (71%) transfused women and 74 (51%) control women in pregnancy (OR 2.34, 95% CI: 3.7–18.0). Multivariate analysis identified social work involvement (adjusted OR 4.1, 95% CI: 1.8–10.1), intravenous iron supplementation in pregnancy (adjusted OR 3.8, 95% CI: 1.2–17.4) and delivery by unscheduled cesarean section (adjusted OR 2.8, 95% CI: 1.3–6.2) as significant predictors of peripartum transfusion.ConclusionsPregnant women being followed by a social worker, receiving intravenous iron supplementation in pregnancy or who deliver by unscheduled cesarean section are more likely to receive a red blood cell transfusion. Women with iron deficiency or anemia in pregnancy are at increased risk of peripartum blood transfusions and warrant early and rigorous iron supplementation.

The Benefits and Risks of Iron Supplementation in Pregnancy and Childhood.

Iron deficiency is the most common micronutrient deficiency in the world and disproportionately affects pregnant women and young children. Iron deficiency has negative effects on pregnancy outcomes in women and on immune function and neurodevelopment in children. Iron supplementation programs have been successful in reducing this health burden. However, iron supplementation of iron-sufficient individuals is likely not necessary and may carry health risks for iron-sufficient and potentially some iron-deficient populations. This review considers the physiology of iron as a nutrient and how this physiology informs decision-making about weighing the benefits and risks of iron supplementation in iron-deficient, iron-sufficient, and iron-overloaded pregnant women and children.

Maternal iron intake during pregnancy and the risk of small for gestational age.

Studies of iron and its association with the risk of small for gestational age (SGA) show inconsistent results. Consuming iron supplements during pregnancy is controversial because of possible risks. This study assessed the association between iron intake and the risk of having an SGA newborn and whether iron intake is associated with gestational diabetes. A case-control study of 518 pairs of Spanish women who were pregnant and attending five hospitals was conducted. Groups were matched 1:1 for age (±2years) and hospital. Cases were women with an SGA newborn at delivery. Controls were women with normal-sized newborns at delivery. Data were gathered on demographic characteristics, socio-economic status, adverse habits (like smoking), and diet. A 137-item food frequency questionnaire was completed. Iron intakes were categorized in quintiles (Q1-Q5). Crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. No significant relationship was found between dietary iron intake and SGA. A protective association was found for women receiving iron supplementation >40mg/day and SGA versus women not taking supplements (aOR=0.64, 95% CI [0.42, 0.99]). This association was identified in mothers both with (aOR=0.57, 95% CI [0.40, 0.81]) and without (aOR=0.64, 95% CI [0.64, 0.97]) anaemia. In women in the control group without anaemia, iron supplementation >40mg/day was positively associated with gestational diabetes (aOR=6.32, 95% CI [1.97, 20.23]). Iron supplementation in pregnancy may prevent SGA independently of existing anaemia but may also increase the risk of gestational diabetes.

Anemia & its associated factors among pregnant women attending antenatal clinic at Mbagathi County Hospital, Nairobi County, Kenya

Introduction: Anemia is one of the most common nutritional deficiency diseases observed globally. It affects more than a quarter of the world’s population. Globally, 41.8% of pregnant women and close to one third of non-pregnant women (30.2%) are anemic. The paper describes factors associated with anemia in pregnant women at Mbagathi County Hospital which admits many patients coming from Kibera. A low income slum in Nairobi. Kenya. Objective: The objective was to determine the prevalence of anemia and its associated factors among pregnant women attending antenatal care at Mbagathi County Hospital in Nairobi, Kenya. Methodology: A Hospital based cross-sectional study was conducted from September 01 to October 30, 2016 employing a systematic random sampling method to select participants. Analysis was done using SPSS version 17.0 to obtain descriptive statistics such as Frequency, Percentage, Mean and Standard deviation. This was used to describe selected variables. Chisquare test and odds ratio (OR) with corresponding 95% confidence intervals (CI) was computed to determine the association between INDEPENDENT and DEPENDENT variables. Logistic regression analysis was done to determine factors significantly and independently predicting anemia during pregnancy. Results: The results revealed the prevalence of anemia among pregnant women to be 40.7% with a significant association of Helminthic infestation and anemia (p =0.003). Education showed statistically significant relationship with anemia (p =0.001). There was a strong association between prevalence of anemia and the dietary practices (p =0.003). Anemia among pregnant women is found to be a severe public health problem, based on the World Health Organization classification of anemia. Conclusion: Thus, this study concluded that routine iron supplementation in pregnancy and early initiation of antenatal clinic attendance could reduce the prevalence of anemia in pregnancy. Hence, daily intake of foods rich in iron is recommended for women to reduce prevalence of iron deficiency (anemia) during pregnancy. In fact, girl child education can be used to further mitigate anemia in communities. Moreover, stringent measures should be taken to control parasitic infestations and other risk factors of anemia amongst women by disseminating Information to the public.

Iron deficiency during pregnancy is associated with a reduced risk of adverse birth outcomes in a malaria-endemic area in a longitudinal cohort study

BackgroundLow birth weight (LBW) and preterm birth (PTB) are major contributors to infant mortality and chronic childhood morbidity. Understanding factors that contribute to or protect against these adverse birth outcomes is an important global health priority. Anaemia and iron deficiency are common in malaria-endemic regions, but there are concerns regarding the value of iron supplementation among pregnant women in malaria-endemic areas due to reports that iron supplementation may increase the risk of malaria. There is a lack of evidence on the impact of iron deficiency on pregnancy outcomes in malaria-endemic regions.MethodsWe determined iron deficiency in a cohort of 279 pregnant women in a malaria-endemic area of Papua New Guinea. Associations with birth weight, LBW and PTB were estimated using linear and logistic regression. A causal model using sequential mediation analyses was constructed to assess the association between iron deficiency and LBW, either independently or mediated through malaria and/or anaemia.ResultsIron deficiency in pregnant women was common (71% at enrolment) and associated with higher mean birth weights (230 g; 95% confidence interval, CI 118, 514; p < 0.001), and reduced odds of LBW (adjusted odds ratio, aOR = 0.32; 95% CI 0.16, 0.64; p = 0.001) and PTB (aOR = 0.57; 95% CI 0.30, 1.09; p = 0.089). Magnitudes of effect were greatest in primigravidae (birth weight 351 g; 95% CI 188, 514; p < 0.001; LBW aOR 0.26; 95% CI 0.10, 0.66; p = 0.005; PTB aOR = 0.39, 95% CI 0.16, 0.97; p = 0.042). Sequential mediation analyses indicated that the protective association of iron deficiency on LBW was mainly mediated through mechanisms independent of malaria or anaemia.ConclusionsIron deficiency was associated with substantially reduced odds of LBW predominantly through malaria-independent protective mechanisms, which has substantial implications for understanding risks for poor pregnancy outcomes and evaluating the benefit of iron supplementation in pregnancy. This study is the first longitudinal study to demonstrate a temporal relationship between antenatal iron deficiency and improved birth outcomes. These findings suggest that iron supplementation needs to be integrated with other strategies to prevent or treat infections and undernutrition in pregnancy to achieve substantial improvements in birth outcomes.

Barriers to Adherence to Iron Supplements in Pregnancy in Rural South India

Background Despite ongoing iron supplementation programmes the prevalence of iron deficiency anemia in India is high. Alleged poor adherence to prescribed iron and folic acid supplements is an often-cited reason for poor outcome of the iron supplementation programme.Objective To assess the levels of adherence to iron supplements in pregnancy and to identify the barriers of adherence to iron supplements in pregnancy at an antenatal clinic in Rural Karnataka. Methodology This is a cross sectional study involving 150 pregnant women on iron supplements for at least one month at the antenatal clinic of a rural hospital near Bangalore between March and May 2011. Adherence to iron supplements and its barriers were assessed using a pretested interviewer administered questionnaire. Adherence was defined as the percentage of prescribed doses consumed in the month prior to the interview. Good adherence was considered as an adherence rate of ge 80. In addition qualitative methods like focus group discussions and Key informant interviews were used to supplement quantitative data obtained. Results The mean age of the participants was 21.93 plusmn 2.44yrs 97 were educated and 5 employed. Fifty seven percent were in their first pregnancy. Of the women 86 were anemic with mean hemoglobin level of 9.55 plusmn 1.47gmdl. Forty two percent had adherence levels le80. The most common reasons for non-adherence were medication side effects and forgetfulness. Encouragement from family determined adherence to iron supplements plt0.05.Conclusions The nearly 40 non-adherence to iron supplements implies that iron supplementation in some Indian settings is far from being successful. Side-effects of iron tablets followed by forgetfulness were the most common barriers of adherence identified in the study. Encouragement played an important role in adherence.

Letters to the Editor: Adherence to iron supplementation in pregnancy

Letters to the Editor: Adherence to iron supplementation in pregnancy

Statistical Analysis on Nutritional Status and its Associated Factors of Under Five Years Children in Nepal

Malnutrition among under five year of age group is a major underlying cause of the child morbidity and mortality in many developing countries like Nepal. Nutritional status of children is a proxy indicator for assessing the health status of entire population. This study was carried out to evaluate the nutritional status of the most vulnerable age group of children (0-59 months) and to identify different factors associated with it. Generally three anthropometric indicators were often used to assess the nutritional status of children height-for-age, weight-for-height and weight-for-age. This study is based on data of Nepal Demographic and Health Survey. WHO Anthro software and IBM SPSS 20 were used to analyze the data. The prevalence of the malnutrition (stunted, wasted and underweight) was found in the different aspect. This study consists of 2334 children of under five years age groups, out of this 50.9% were male children and 49.1% were female children, the prevalence of the stunted is 41%, wasted 29% and underweight 11%. The prevalence of diarrhea during the data collection period is 13.80% and prevalence of fever during the data collection period is 18.70%. The statistically significant factor were body mass index of mother, wealth index, size of child at birth and education of mother and smoking habit of mother. Malnutrition (stunted, wasted and underweight) still remains as a major health problem in our country Nepal. So, our government should be focused on those factors which are significantly associated with malnutrition like health care during pregnancy period, education of mother etc. Significant number of under-five children’s of Nepal was malnourished. Maternal factors have significant association with nutritional status of the children which include extra diet in pregnancy and lactation, iron supplements in pregnancy, exclusive breast feeding for six months.

Prophylactic Iron Supplementation in Pregnancy: A Controversial Issue.

In our world today, iron deficiency (ID) is the most frequent nutritional deficiency and it is being considered as an epidemic public health crisis. Women of reproductive age and infants are at particular risk of ID, especially in underdeveloped countries. During pregnancy, iron deficiency anemia is a specific risk factor associated with negative maternal and perinatal outcomes. Many countries have iron supplementation (IS) programs—as recommended by the World Health Organization—during pregnancy; however, IS clinical benefits and risks are unclear. This review aims to discuss the threats and benefits of routine IS on maternal and infant outcomes.

Iron Supplementation in Pregnancy or Infancy and Motor Development: A Randomized Controlled Trial.

Insufficient iron levels for optimal fetal and infant development is a concern during pregnancy and infancy. The goal of this study was to assess the effects of iron supplementation in pregnancy and/or infancy on motor development at 9 months. The study was a randomized controlled trial (RCT) of infancy iron supplementation linked to an RCT of pregnancy iron supplementation, conducted in Hebei, China. A total of 1482 infants were randomly assigned to receive placebo (n = 730) or supplemental iron (n = 752) from 6 weeks to 9 months. Gross motor development (assessed by using the Peabody Developmental Motor Scale, Second Edition, instrument) was the primary outcome. Neurologic integrity and motor quality were secondary outcomes. Motor outcome was available for 1196 infants, divided into 4 supplementation period groups: (1) placebo in pregnancy/placebo in infancy (n = 288); (2) placebo in pregnancy/iron in infancy (n = 305); (3) iron in pregnancy/placebo in infancy (n = 298); and (4) iron in pregnancy/iron in infancy (n = 305). Using the Peabody Developmental Motor Scale, instrument, iron supplementation in infancy but not pregnancy improved gross motor scores: overall, P < .001; reflexes, P = .03; stationary, P < .001; and locomotion, P < .001. Iron supplementation in infancy improved motor scores by 0.3 SD compared with no supplementation or supplementation during pregnancy alone. Effects of iron supplementation in infancy alone were similar to effects with iron in both pregnancy and infancy. The RCT design supports the causal inference that iron supplementation in infancy, with or without iron supplementation in pregnancy, improved gross motor test scores at 9 months.

Low-Dose Iron Supplementation in Infancy Modestly Increases Infant Iron Status at 9 Mo without Decreasing Growth or Increasing Illness in a Randomized Clinical Trial in Rural China

Background: Previous trials of iron supplementation in infancy did not consider maternal iron supplementation.Objective: This study assessed effects of iron supplementation in infancy and/or pregnancy on infant iron status, illnesses, and growth at 9 mo.Methods: Enrollment occurred from December 2009 to June 2012 in Hebei, China. Infants born to women in a pregnancy iron supplementation trial were randomly assigned 1:1 to iron [∼1 mg Fe/(kg · d) as oral iron proteinsuccynilate] or placebo from 6 wk to 9 mo, excluding infants with cord ferritin <35 μg/L. Study groups were pregnancy placebo/infancy placebo (placebo/placebo), pregnancy placebo/infancy iron (placebo/iron), pregnancy iron/infancy placebo (iron/placebo), and pregnancy iron/infancy iron (iron/iron). The primary outcome was 9-mo iron status: iron deficiency (ID) by cutoff (≥2 abnormal iron measures) or body iron <0 mg/kg and ID + anemia (hemoglobin <110 g/L). Secondary outcomes were doctor visits or hospitalizations and weight or length gain from birth to 9 mo. Statistical analysis by intention to treat and dose-response (between number of iron bottles received and outcome) used logistic regression with concomitant RRs and general linear models, with covariate control as applicable.Results: Of 1482 infants randomly allocated, 1276 had 9-mo data (n = 312–327/group). Iron supplementation in infancy, but not pregnancy, reduced ID risk: RRs (95% CIs) were 0.89 (0.79, 0.998) for placebo/iron compared to placebo/placebo, 0.79 (0.63, 0.98) for placebo/iron compared to iron/placebo, 0.87 (0.77, 0.98) for iron/iron compared to placebo/placebo, and 0.86 (0.77, 0.97) for iron/iron compared to iron/placebo. However, >60% of infants still had ID at 9 mo. Receiving more bottles of iron in infancy was associated with better infant iron status at 9 mo but only among iron-supplemented infants whose mothers were also iron supplemented (i.e., the iron/iron group). There were no group differences in hospitalizations or illnesses and no adverse effects on growth overall or among infants who were iron sufficient at birth.Conclusions: Iron supplementation in Chinese infants reduced ID at 9 mo without adverse effects on growth or illness. Effects of iron supplementation in pregnancy were observed only when higher amounts of iron were distributed in infancy. This trial was registered at clinicaltrials.gov as NCT00613717.

The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal

Background/Objectives:Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal.Subjects/Methods:In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein.Results:The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations.Conclusions:Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.

Summaries for Patients: Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnancy: U.S. Preventive Services Task Force Recommendations.

Summaries for Patients: Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnancy: U.S. Preventive Services Task Force Recommendations.

Association of genetic variants with response to iron supplements in pregnancy.

The incidence of iron deficiency anemia in pregnancy is high in India where iron supplementation is a regular practice. The response to oral iron is influenced by several factors such as age, body mass index, gravida, socioeconomic status, food, vitamin deficiency and compliance to supplements. The major challenge is to understand the various modulators of iron status in this high-risk group so that we can improve the diagnosis and the management of these patients. The current study was designed to evaluate the iron status during pregnancy and to identify factors which might be influencing their response to oral iron. We investigated a total of 181 pregnant women with anemia (Hb<11g/dl) and evaluated the impact of probable factors on anemia and their iron status. Assessment of the response was based on hemoglobin and serum ferritin or transferrin saturation level after 8 and 20weeks of iron supplementation. Socioeconomic, clinical, hematological, biochemical and genetic factors were all evaluated. Molecular analysis revealed that HFE variant allele (G) (rs1799945) was significantly associated with an adequate response to iron supplementation. We identified five subjects with a sustained poor response, and targeted re-sequencing of eleven iron-related genes was performed in them. We have identified seven novel variants in them, and in silico analysis suggested that these variants may have an iron regulatory effect. Taken together, our findings underscore the association of genetic variants with response to supplements in pregnancy, and they can be extended to other diseases where anemia and iron deficiency coexist.

Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria.

Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population. To find out the compliance rate and determinants of compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria. This was a questionnaire-based cross-sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013. The knowledge of iron supplementation was 76.3% ( n = 302), however, the compliance rate was 65.9% ( n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis ( P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non-affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers. The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and socioeconomic class of the populace in the long run.

Anemia and iron deficiency in pregnant women in Zaria, Nigeria

Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.

Prevalence and associated risk factors with malnutrition among under-five Nepalese children of Borbote village, Ilam

Background: Malnutrition is a major public health &amp; nutrition problem in Nepal. It is associated with many risk factors like low birth weight, multiple birth, short spaced birth, extra diet, and iron supplementation in pregnancy etc. Objectives: This study aims at finding out the nutritional status of under-five Nepalese children of Borbote village, Ilam and risk factors associated with malnutrition. Methods: A cross sectional study was conducted in Borbote village, Ilam. A total of 186 under-five children was selected by purposive sampling. Non parametric test was applied to find out statistical significance. Logistic regression method was used to identify the factors influencing the malnutrion. Results: According to WHO, 20% children were malnourished . of which 14% were moderately undernourished and 6% were severely undernourished. Mothers exclusively breast feeding for 6 months had only 20.0% low weight for age children and those who didn.t had 34.8% (P=0.041). Pregnant ladies who took iron supplements had 20.5% of low weight for age children compared to 37.1% (P =0.037) in those who didn.t take supplements. Malnutrition was found more in those who were below poverty line 27.94% (P=0.023) compared to those above poverty line 12.00%. Conclusion: Significant number of under-five children of Bortbote village was malnourished. Maternal factors have significant association with nutritional status of the children which include extra diet in pregnancy and lactation, iron supplements in pregnancy, exclusive breast feeding for six months. Extra attention should be provided by the Ministry of Health towards maternal and child health. Health Renaissance, January-April 2013; Vol. 11 No.1; 111-118 DOI: http://dx.doi.org/10.3126/hren.v11i2.8217

Intermittent vs. Daily Iron Supplements in Pregnancy

According to this study: * Studies comparing intermittent and daily iron supplementation found little difference in maternal and infant outcomes.

Challenges to rational prescribing and use of essential medicines in India

I have read the Editorial entitled ‘Challenges to rational prescribing and use of essential medicines in India’ which was published in your journal with great interest. This has prompted me to address certain issues related to rational prescription of iron supplements in pregnancy.