Antenatal Iron-Folic Acid Supplementation Reduces Neonatal and Under-5 Mortality in Nepal

Nisar, Yasir Bin; Dibley, Michael J.; Mebrahtu, Saba; Paudyal, Naveen; Devkota, Madhu Dixit

doi:10.3945/jn.114.206565

Cited by 19 publications

(29 citation statements)

References 21 publications

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“…Distribution of IFA and referral to ANC are performed at the community level by Female Community Health Volunteers in Nepal as part of an integrated delivery platform, where adherence and coverage rates are among the highest (Pokharel et al, ). Recent evidence from Nepal shows an association between IFA and newborn or child survival, with the greatest effect in women who started taking IFA early in pregnancy and took 150–240 supplements (Nisar et al, ). Yet regardless of the distribution point, supply‐side issues of adequate supplies of quality IFA tablets and distributing them in adequate amounts to women must also be addressed (Ayoya, Bendech, Zagre, & Tchibindat, ; Galloway et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Universal iron and folic acid (IFA) supplementation for anaemia prevention among pregnant women is one of the top‐ranked interventions recommended to improve maternal survival (Campbell, Graham, & Lancet Maternal Survival Series Steering Group, ). Recent evidence suggests that it may also be associated with improved neonatal and child survival (Nisar, Dibley, Mebrahtu, Paudyal, & Devkota, ). In 2012, the World Health Organization (WHO) updated its guidelines for IFA supplementation in pregnant women, continuing to recommend daily oral IFA supplementation (with a dose of 30–60 mg elemental iron and 400 μg folic acid) throughout pregnancy to reduce the risk of low birthweight, maternal anaemia, and iron deficiency (WHO, , ).…”

Section: Introductionmentioning

confidence: 99%

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Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women

Siekmans

Roche

Kung’u³

et al. 2017

Maternal & Child Nutrition

104

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In order to inform large scale supplementation programme design, we review and summarize the barriers and enablers for improved coverage and utilization of iron and folic acid (IFA) supplements by pregnant women in 7 countries in Africa and Asia. Mixed methods were used to analyse IFA supplementation programmes in Afghanistan, Bangladesh, Indonesia, Ethiopia, Kenya, Nigeria, and Senegal based on formative research conducted in 2012-2013. Qualitative data from focus-group discussions and interviews with women and service providers were used for content analysis to elicit common themes on barriers and enablers at internal, external, and relational levels. Anaemia symptoms in pregnancy are well known among women and health care providers in all countries, yet many women do not feel personally at risk. Broad awareness and increased coverage of facility-based antenatal care (ANC) make it an efficient delivery channel for IFA; however, first trimester access to IFA is hindered by beliefs about when to first attend ANC and preferences for disclosing pregnancy status. Variable access and poor quality ANC services, including insufficient IFA supplies and inadequate counselling to encourage consumption, are barriers to both coverage and adherence. Community-based delivery of IFA and referral to ANC provides earlier and more frequent access and opportunities for follow-up. Improving ANC access and quality is needed to facilitate IFA supplementation during pregnancy. Community-based delivery and counselling can address problems of timely and continuous access to supplements. Renewed investment in training for service providers and effective behaviour change designs are urgently needed to achieve the desired impact.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women

Siekmans

Roche

Kung’u³

et al. 2017

Maternal & Child Nutrition

104

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“…Several factors have been suggested to impact the secretion of B-vitamins in human milk, such as nutritional status of the mothers during pregnancy [31], supplementation [8,[16][17][18][19][20], diurnal variation [32], and preterm status of the infants [33]. In addition, maternal age [34], body weight index (BMI), education, income, and regular exercise [35] may also modify B-vitamins status in human milk.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous researches [5,6,8,[11][12][13][14][15] showed that the contents of B-vitamins in human milk were significantly affected by maternal status and dietary intake. Moreover, maternal deficiency can rapidly result in very low concentrations of B-vitamins in human milk [5], which has been shown to improve with dietary supplements [8,[16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Regional, socioeconomic, and dietary factors influencing B-vitamins in human milk of urban Chinese lactating women at different lactation stages

et al. 2017

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Background: Adequate B-vitamins concentrations in human milk are considered to be a prerequisite for healthy development of infants in early life. This study aims to determine the concentrations of B-vitamins in human milk from Chinese women and the relationships between their concentrations and different geographical origin, lactation stages, socioeconomic characteristics, and dietary intake. Methods: Human milk was obtained from 443 healthy lactating women from Beijing (n = 150), Suzhou (n = 146), and Guangzhou (n = 147) cities. Thiamine, riboflavin, vitamin B 3 (nicotinamide and nicotinic acid), and vitamin B 6 (pyridoxal, pyridoxine, and pyridoxamine) in human milk were analyzed by high performance liquid chromatography-tandem mass spectrometry. Pantothenic acid, biotin, and folates in human milk were analyzed by microbiological assay. The information from one 24-h dietary recall and socioeconomic characteristics were collected by interview and structured questionnaire, respectively. 34, 7.58, 8.60, 9.34, 10.20 (μg/100 g); biotin 0.462, 0.834, 0.606, 0.523, 0.464 (μg/100 g); folates 0.730, 2.390, 2.440, 2.420, 2.330 (μg/100 g). The levels of B-vitamins presented regional differences and varied significantly among different lactation stages. The inversely associations of thiamine, vitamin B 6 , and folates with maternal BMI were found in multivariate analyses (p < 0.05), as well as higher pantothenic acid, folates, and biotin concentrations in lactating women with supplement intake when compared with those without (p < 0.05). Riboflavin concentrations associated with regular exercise was found in multivariate analyses (p < 0.05).

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“…Maternal diet during pregnancy has been shown to impact fetal growth and development (Liu et al, 2015; Nisar, Dibley, Mebrahtu, Paudyal, & Devkota, 2015; Shapiro et al, 2016). Maternal high-fat diet (HFD) in particular has been shown to be causally associated with higher offspring adiposity and size at birth in animal models (Ashino et al, 2012; Franco et al, 2012; S.…”

Section: Introductionmentioning

confidence: 99%

Infant Adiposity is Independently Associated with a Maternal High Fat Diet but not Related to Niacin Intake: The Healthy Start Study

Shapiro

Ringham

Glueck

et al. 2017

Matern Child Health J

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Objectives Over-nutrition during pregnancy resulting from maternal obesity or an unhealthy diet can lead to excess infant adiposity at birth. Specific dietary macro- and micronutrients have been shown to increase fat cell development in both in-vitro and in-vivo models and may therefore link maternal diet to increased infant adiposity. We hypothesized that high maternal dietary niacin intake during pregnancy, especially in combination with a high-fat diet (HFD) would increase infant adiposity. Methods We included 1,040 participants from a pre-birth cohort of mother-infant pairs. Maternal diet was assessed using multiple 24-hour dietary recalls. HFD was defined as ≥ 30% of calories from fat and ≥ 12% of fat calories from saturated fat. Neonatal body composition (% fat mass [%FM], fat mass [FM], fat-free mass [FFM]) was measured by PEAPOD.. We used multivariate regression to assess the joint effect of maternal dietary niacin and maternal HFD on neonatal body composition.. Results Dietary niacin was not associated with neonatal body composition, and maternal HFD did not modify this finding. However, maternal HFD was independently associated with %FM (β= 0.8 [0.1, 1.4] %, p<0.01] and FM (β=32.4 [6.7, 58.0] grams, p<0.01). Conclusions for Practice Our results suggest that a HFD during pregnancy may increase infant adiposity, therefore supporting the need for improved diet counseling of pregnant women at both the clinical and community levels.

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Antenatal Iron-Folic Acid Supplementation Reduces Neonatal and Under-5 Mortality in Nepal

Abstract: Antenatal IFA supplementation significantly reduces the risk of neonatal and under-5 deaths in Nepal. The greatest effect on child survival was found in women who started IFA early in pregnancy and took 150-240 supplements. Universal IFA coverage could improve neonatal and child survival.

Cited by 19 publications

References 21 publications

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women

Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women

Regional, socioeconomic, and dietary factors influencing B-vitamins in human milk of urban Chinese lactating women at different lactation stages

Infant Adiposity is Independently Associated with a Maternal High Fat Diet but not Related to Niacin Intake: The Healthy Start Study

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