Effects of lipid‐based nutrient supplements or multiple micronutrient supplements compared with iron and folic acid supplements during pregnancy on maternal haemoglobin and iron status

Jorgensen, Josh M; Ashorn, Per; Ashorn, Per; Baldiviez, Lacey M.; Gondwe, Austrida; Maleta, Kenneth; Nkhoma, Minyanga; Dewey, Kathryn G.

doi:10.1111/mcn.12640

Cited by 12 publications

(9 citation statements)

References 36 publications

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“…Women from these trials were included in this cohort study if they had: 1 ) at least one measurement of Hb concentration or iron status, at either enrollment or 36 weeks of gestation, and 2 ) any newborn anthropometric measurement or an estimated pregnancy duration. We have previously reported that supplementation with SQ-LNSs or multiple micronutrients resulted in lower Hb and iron status at 36 weeks of gestation than for the iron and folic acid trial arm (22, 23). Assigned supplement group in the main trial was not the focus of the current study and was controlled for in analyses of the 36-wk measurements.…”

Section: Methodsmentioning

confidence: 99%

Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

Oaks

Jorgensen²,

Baldiviez

et al. 2019

The Journal of Nutrition

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Background Previous literature suggests a U-shaped relation between hemoglobin concentration and adverse birth outcomes. There is less evidence on associations between iron status and birth outcomes. Objective Our objective was to determine the associations of maternal hemoglobin concentration and iron status with birth outcomes. Methods We conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containing nutritional supplements (20–60 mg ferrous sulfate) in Ghana (n = 1137) and Malawi (n = 1243). Hemoglobin concentration and 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at ≤20 weeks and 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth (PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age. Results Prevalence of iron deficiency (sTfR >6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In early pregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33) and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was not associated with LBW in either country; replete iron status (sTfR <10th percentile) was associated with stunting (9% compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated with any birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country and iron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17, 3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associated with birth outcomes in Malawi. Conclusions The associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. These trials were registered at clinicaltrials.gov as NCT00970866 (Ghana) and NCT01239693 (Malawi).

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Section: Methodsmentioning

confidence: 99%

Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

Oaks

Jorgensen²,

Baldiviez

et al. 2019

The Journal of Nutrition

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“…We screened 19 studies, after which a total of 11 trials were included and contributed to the analyses of the three outcomes of interest. One trial 32 was excluded because of the intermittent (twice weekly) supplementation scheme, four trials 33 , 34 , 35 , 36 were excluded because hemoglobin was not assessed in the third trimester, two trials 15 , 16 , 17 , 18 were excluded because MMS provided 20 mg of iron, and one trial 37 was excluded because of lack of relevant information, for example, the amount of iron provided in both groups was not available.…”

Section: Resultsmentioning

confidence: 99%

“…Exclusion criteria for this analysis were: (1) trials that did not assess third trimester iron‐related outcomes (e.g., assessed only postpartum); (2) trials with nondaily supplementation regimens; (3) trials conducted in high‐income countries (e.g., Brough); 14 and (4) trials that provided MMS with 20 mg of iron (Ashorn 15 , 16 and Dewey 17 , 18 ), because this dose is not relevant for our comparison of interest, which is the difference between 60 mg of iron as used in many IFA supplementation programs and 30 mg dose of iron in MMS.…”

Section: Methodsmentioning

confidence: 99%

Multiple micronutrient supplements versus iron‐folic acid supplements and maternal anemia outcomes: an iron dose analysis

Gomes

Agustina

Black

et al. 2022

Annals of the New York Academy of Sciences

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Antenatal multiple micronutrient supplements (MMS) are more effective than iron and folic acid (IFA) supplements in reducing adverse pregnancy outcomes. Questions remain, however, about the ability of MMS to prevent anemia as effectively as IFA, especially at a lower dose of daily iron and in areas of high anemia prevalence. Analyzing data from 11 trials from a recent Cochrane review, we compared MMS to IFA, delivering either 30 or 60 mg of iron, in sustaining hemoglobin and preventing third trimester anemia and iron deficiency anemia (IDA), accounting for daily iron dose, total supplemental iron intake, and baseline prevalence of anemia. There were no differences between MMS and IFA in third trimester hemoglobin concentration or risks of anemia or IDA by iron dose or total supplemental iron consumed. MMS providing 30 mg of iron was comparable to IFA with 60 mg of iron: mean hemoglobin difference of −0.26 g/L (95% CI: −1.41 to 0.89), risk ratios of 0.99 (95% CI: 0.92-1.07) for anemia, and 1.31 (95% CI: 0.66-2.60) for IDA. Baseline prevalence of anemia did not explain heterogeneity in findings. Compared to IFA, MMS results in comparable hemoglobin concentration and protection against anemia during pregnancy, independently of iron dose.

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“…Antenatal iron use is associated with reduced risk of maternal anaemia [39]. Receiving LNS (with 20 mg iron) in the iLiNS-DYAD-Malawi trial was associated with a higher risk of maternal anaemia at 36 gestation weeks, compared to IFA with 60 mg of iron [40]. This therefore indicates that LNS could not have prevented FGR by reducing the risk of maternal anaemia in this study.…”

Section: Discussionmentioning

confidence: 95%

Lipid based nutrient supplements during pregnancy may improve foetal growth in HIV infected women – A cohort study

Nkhoma

Ashorn

et al. 2019

PLoS ONE

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Objectives Both maternal HIV infection and antiretroviral therapy are associated with adverse birth outcomes. The role of antenatal nutrient supplements with regard to adverse birth outcomes in HIV infected women exposed to antiretroviral therapy is not well known. We assessed the association between HIV and birth outcomes and explored whether antenatal lipid-based nutrient supplements (LNS) modulated this association. Methods We analysed a nested cohort of pregnant Malawian women who received daily LNS, multiple micronutrients (MMN) or iron and folic acid (IFA). Birth weight, length-for-age z-score (LAZ) and weight-for-age z-score (WAZ) were analysed as continuous outcomes and proportion of stunting and small-for-gestational age (SGA) as dichotomous outcomes. Results 134 HIV infected (46 LNS, 39 MMN, 49 IFA) and 833 HIV uninfected (271 LNS, 287 MMN, 275 IFA) women were included. Maternal HIV infection was associated with a lower mean birth weight (-129g (-209, -48), P = 0.002); LAZ (-0.34 (-0.54, -0.13), P = 0.002) and WAZ (-0.21 (-0.40, -0.02), P = 0.041) and a higher risk of stunting (RR (95% confidence interval), 1.87 (1.24, 2.83), P = 0.003) and SGA (1.66 (1.21, 2.26), P = 0.001) in the newborn. If the women received LNS, HIV was not associated with LAZ (mean difference (95%); -0.02 (-0.35, 0.31), P = 0.918) or newborn stunting (RR (95% CI), 0.84 (0.34, 2.03), P = 0.691). However HIV tended to be associated with LAZ if the women received MMN (-0.42 (-0.80, -0.03), P = 0.053); and was significantly associated with LAZ if the women received IFA (-0.52 (-0.89, -0.14), P = 0.021) and with newborn stunting if they received MMN (2.40 (1.15, 4.98), P = 0.029) or IFA (2.40 (1.26, 4.59), P = 0.024). Conclusions Further research to investigate the impact of LNS on various aspects of foetal growth in HIV infected women is warranted.

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Effects of lipid‐based nutrient supplements or multiple micronutrient supplements compared with iron and folic acid supplements during pregnancy on maternal haemoglobin and iron status

Cited by 12 publications

References 36 publications

Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

Multiple micronutrient supplements versus iron‐folic acid supplements and maternal anemia outcomes: an iron dose analysis

Lipid based nutrient supplements during pregnancy may improve foetal growth in HIV infected women – A cohort study

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