Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

Abstract

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

Maternal dietary diversity during pregnancy and congenital heart defects: a case-control study

“…The high prevalence of inadequate micronutrient intake during pregnancy in our study was similar to the results of the previous studies in Northwest China [7,29]. Although micronutrient supplementation has been recommended among the pregnant women, maternal adherence to micronutrient supplementation is reported to unsatisfactory in Northwest China [8]. Diverse diet can improve nutrient status offering some benefits not provided by supplementation in pregnancy, such as easy implementation, low risk, lesser economic costs, and an improvement in maternal dietary habits [30,31].…”

“…Such poor diets during pregnancy are likely to be deficient in multiple micronutrients; thus, micronutrient supplementation, particularly with iron and folic acid, has been recommended among pregnant women. However, maternal adherence to micronutrient supplementation is unsatisfactory in China, especially in Northwest China [8]. Therefore, complementary strategies that address the underlying poor dietary practices are needed.…”

Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review

“…An analysis of Demographic and Health Surveys from 22 LMICs showed that while 83% of pregnant women had at least one antenatal care visit and 81% received IFA supplements during that visit, only 8% adhered to the recommended dose (defined as at least 180 tablets during the entire pregnancy) 10 . Another large‐scale survey conducted in China showed similar results, even though it used a lower cutoff to define adherence (i.e., 90 tablets), with adherence varying by micronutrient, from 0.6% for iron up to only 11.7% for calcium supplements 11 …”

“…10 Another large-scale survey conducted in China showed similar results, even though it used a lower cutoff to define adherence (i.e., 90 tablets), with adherence varying by micronutrient, from 0.6% for iron up to only 11.7% for calcium supplements. 11 Adherence has been defined as "the extent to which a patient's behavior matches the agreed recommendations from a healthcare provider." 12 Many behavior theories exist to explain the constructs related to adopting positive healthy behavior.…”

Hypocalcaemia and calcium intake in pregnancy: A research protocol for critical analysis of risk factors, maternofoetal outcomes and evaluation of diagnostic methods in a third-category health facility, Cameroon

“…Even though highly recommended since 2013, prescription of calcium supplements during pregnancy by the medical personnel remains non-systematic and is judged case by case in our setting. According to a large scale cross-sectional survey on adherence to micronutrient supplementation in pregnancy carried out in China, only 57% of pregnant women took any form of calcium supplements during their pregnancies [ 21 ]. In this study, adherence levels to calcium supplementation were as low as 11.7%.…”