Effect of low‐dosage vitamin A and riboflavin on iron‐folate supplementation in anaemic pregnant women

Abstract

A double-blind, placebo, controlled trial was conducted in Banyudono subdistrict, Boyolali regency, Central Java province, Indonesia. The aim of the study was to determine whether adding low-dosage vitamin A and riboflavin can enhance the effect of iron-folate supplementation in anaemic pregnant women. From July to November 2000, 202 pregnant women were screened for anaemia (haemoglobin < 11.0 g/dL). One hundred and three pregnant women (51%) were found to be anaemic and were then allocated alternately into four groups. Over a period of 60 days, group IF (n = 29) received iron-folate tablets (200 mg FeSO4 and 250 microg folic acid) + 5 mg glucose: group IFR (n = 22) received iron-folate tablets + 5 mg riboflavin; group IFA (n = 29) received iron-folate tablets + 2.75 mg retinyl palmitate (equal to 5000 IU vitamin A); and group IFRA (n = 23) received iron-folate tablets + 5 mg riboflavin + 2.75 mg retinyl palmitate. At the end of the study 19 pregnant women (18.4%) were excluded from the analysis because of various reasons. Statistical analysis was based on 84 women (81.5%): group IF, n = 25; group IFR, n = 22; group IFA, n = 18; and group IFRA, n = 19. Haemoglobin measurements were carried out using the Technicon H1* (cyanmethaemoglobin method). All groups showed a significant increase in haemoglobin concentration (P < 0.05), except group IFA (P > 0.05), with the highest increment being in group FR. Multiple comparisons only showed significant differences between group IFR and group IFA (P < 0.05). It can be concluded that iron-folate supplementation can increase haemoglobin concentrations in anaemic pregnant women. Adding riboflavin tends to enhance the effect of iron-folate supplementation, but this is not the case with adding vitamin A.

Correcting a marginal riboflavin deficiency improves hematologic status in young women in the United Kingdom (RIBOFEM)

“…Pregnant women in rural China with low hemoglobin status (80-105 g/L) showed an enhanced hematologic response to a combined supplement of iron, folic acid, retinol, and riboflavin for 2 mo than to a supplement of iron and folic acid alone (33). Studies in mildly anemic populations in Indonesia showed that a supplement of riboflavin enhanced the increase in hemoglobin seen in response to conventional hematinics alone (9,34).…”

Maternal-child health

“…After supplementation, the proportion of women who became non-anaemic was 35% in the vitamin A-supplemented group, 68% in the iron-supplemented group, 97% in the group supplemented with both, and 16% in the placebo group. Therefore this study concluded that improvement in vitamin A status may contribute to the control of anemia in pregnant women (Suprapto et al, 2002).…”

“…251 women aged 17-35 years, parity 0-4, gestation 16-24 weeks and hemoglobin between 80 and 109 g/L were randomly allocated to four groups: vitamin A (2.4 mg retinol) and placebo iron tablets; iron (60 mg elemental iron) and placebo vitamin A ; vitamin A and iron; or both placebos, all daily for 8 weeks (Suprapto et al, 2002). Maximum hemoglobin was achieved with both vitamin A and iron supplementation (12.78 g/L, 95% , with one third of the response attributable to vitamin A (3.68 g/L, 95% CI 2.03-5.33) and two thirds to iron (7.71 g/L,.…”

The Influence of Vitamin A Supplementation on Iron Status

“…Clinical trials involving children, adolescents, pregnant and lactating women were developed in different regions of the world and most of them reported a significant impact of VA supplementation/fortification on Hb and other iron parameters [3,6,10,11,12,13,14,15,16,17,18]. However, the effect of VA supplementation/fortification on iron status should be taken with caution due to differences between populations in terms of VA and Fe status, age of the individuals, type of supplementation or fortification, and duration of the intervention.…”

“…Suprapto et al [17] evaluated the impact of adding low dose of VA (5000 IU) together with other micronutrients as a routine supplementation for 84 anemic Indonesian pregnant women (Hb < 110 g/L) in a placebo-controlled clinical trial. The women were allocated into the following groups: VA (5000 IU) + Fe (60 mg) + folic acid (250 μg) + riboflavin (5 mg); VA (5000 IU) + Fe (60 mg) + folic acid (250 μg); Fe (60 mg) + folic acid (250 μg) + riboflavin (5 mg); Fe (60 mg) + folic acid (250 μg) + placebo.…”