Government-Industry Partnership in Weekly Iron-Folic Acid Supplementation for Women of Reproductive Age in the Philippines: Impact on Iron Status

Angeles‐Agdeppa, Imelda; Paulino, Lourdes S.; Ramos, Adelisa C.; Etorma, Unita Marie; Cavalli-Sforza, Tommaso; Milani, Silvano

doi:10.1301/nr.2005.dec.s116-s125

Cited by 27 publications

(15 citation statements)

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“…These results are in contrast to previous evidence primarily from observational studies [20–22,40] and one RCT [41] showing that weekly consumption of iron containing supplements before conception increased hemoglobin concentrations and prevented anemia during pregnancy. However, we demonstrated modest improvements in iron stores during pregnancy among women who received preconception MM or IFA.…”

Section: Discussioncontrasting

confidence: 99%

“…This contrasts with recent global estimates that suggest 50% of anemia in non-pregnant and pregnant women is amendable to iron supplementation [42]. The differences in the etiology of anemia among different settings could account for the mixed impact of preconception supplementation on anemia in this study compared to others [21,22,41]. The low levels of iron-deficiency anemia at baseline in our study population may explain the lower potential to benefit from supplements compared to other settings where iron deficiency is the primary cause of anemia.…”

Section: Discussioncontrasting

confidence: 75%

“…Program experience with this policy from several countries including Vietnam, Cambodia, Egypt, India, Laos and Philippines have reported a wide range in average decreases in anemia (9% to 57%) [19]. In addition, providing WRA with weekly IFA pre-pregnancy significantly reduced iron deficiency for the first two trimesters of pregnancy in Vietnam [20] and improved iron status during pregnancy in Cambodia and Philippines [21,22]. …”

Section: Introductionmentioning

confidence: 99%

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Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam

et al. 2016

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ObjectivePreconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum.MethodsWe conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 μg FA (control group), IFA (60 mg Fe and 2800 μg FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 μg FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements ≥ 26 weeks before conception).ResultsAt baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 μg/L) and 3% had iron deficiency (ferritin <12 μg/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (μg/L) [95% CI]: 93.6 [89.3–98.2]) and IFA (91.9 [87.6–96.3]) compared to control (85.3 [81.5–89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3–127.8]), IFA 117.8 [108.7–127.7] vs control 101.5 [94.0–109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1–192.9]), IFA 189.9 [181.6–198.3] vs control 175.1 [167.9–182.6]).ConclusionPreconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia.Trial RegistrationClinicalTrials.Gov NCT01665378

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam

et al. 2016

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“…Careful examination of these studies resulted in the inclusion of 45 articles 20,23–66 most of which were based on observational studies (Table 1). The main reasons for excluding articles after completing abstraction were: (i) the intervention and/or exposure occurred after 12 weeks gestation, 67–74 (ii) missing our outcomes of interest, 75–83 and (iii) did not measure periconceptional exposures 84,85 …”

Section: Resultsmentioning

confidence: 99%

Effect of Women's Nutrition before and during Early Pregnancy on Maternal and Infant Outcomes: A Systematic Review

Ramakrishnan

Grant

Goldenberg³

et al. 2012

Paediatric Perinatal Epid

413

362

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Current understanding of biologic processes indicates that women's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and 32 observational studies) that were identified through PubMed and EMBASE database searches and examining review articles. Intervention trials and observational studies show that periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of neural tube defects. Observational studies suggest that preconceptional and periconceptional intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring who are low birthweight and/or small-forgestational age (SGA) and preterm deliveries (PTD). Some studies report that indicators of maternal prepregnancy size, low stature, underweight and overweight are associated with increased risks of PTD and SGA. The available data indicate the importance of women's nutrition prior to and during the first trimester of pregnancy, but there is a need for well-designed prospective studies and controlled trials in developing country settings that examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal mortality. The knowledge gaps that need to be addressed include the evaluation of periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well as the relationship between measures of prepregnancy body size and composition and maternal, neonatal and child health outcomes.

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“…Weekly IFA supplementation has been shown to improve iron status and reduce the burden of anemia in women of reproductive age (WRA) in the short term, but very few studies have evaluated subsequent pregnancy outcomes. Pre-pregnancy weekly IFA supplementation has been shown to improve iron status and reduce anemia during pregnancy compared to prenatal daily IFA alone in three effectiveness studies [16] conducted in Vietnam [17], Cambodia [18] and the Philippines [19,20]. However no study has assessed the effects of pre-pregnancy IFA supplementation on birth outcomes.…”

Section: Introductionmentioning

confidence: 99%

Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study

et al. 2012

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BackgroundLow birth weight and maternal anemia remain intractable problems in many developing countries. The adequacy of the current strategy of providing iron-folic acid (IFA) supplements only during pregnancy has been questioned given many women enter pregnancy with poor iron stores, the substantial micronutrient demand by maternal and fetal tissues, and programmatic issues related to timing and coverage of prenatal care. Weekly IFA supplementation for women of reproductive age (WRA) improves iron status and reduces the burden of anemia in the short term, but few studies have evaluated subsequent pregnancy and birth outcomes.The Preconcept trial aims to determine whether pre-pregnancy weekly IFA or multiple micronutrient (MM) supplementation will improve birth outcomes and maternal and infant iron status compared to the current practice of prenatal IFA supplementation only. This paper provides an overview of study design, methodology and sample characteristics from baseline survey data and key lessons learned.Methods/designWe have recruited 5011 WRA in a double-blind stratified randomized controlled trial in rural Vietnam and randomly assigned them to receive weekly supplements containing either: 1) 2800 μg folic acid 2) 60 mg iron and 2800 μg folic acid or 3) MM. Women who become pregnant receive daily IFA, and are being followed through pregnancy, delivery, and up to three months post-partum. Study outcomes include birth outcomes and maternal and infant iron status. Data are being collected on household characteristics, maternal diet and mental health, anthropometry, infant feeding practices, morbidity and compliance.DiscussionThe study is timely and responds to the WHO Global Expert Consultation which identified the need to evaluate the long term benefits of weekly IFA and MM supplementation in WRA. Findings will generate new information to help guide policy and programs designed to reduce the burden of anemia in women and children and improve maternal and child health outcomes in resource poor settings.Trial registrationNCT01665378

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Government-Industry Partnership in Weekly Iron-Folic Acid Supplementation for Women of Reproductive Age in the Philippines: Impact on Iron Status

Cited by 27 publications

References 0 publications

Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam

Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam

Effect of Women's Nutrition before and during Early Pregnancy on Maternal and Infant Outcomes: A Systematic Review

Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study

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