Micronutrient Status among Pregnant Women in Zinder, Niger and Risk Factors Associated with Deficiency

Abstract

Anemia and micronutrient (MN) deficiencies in pregnant women are associated with adverse pregnancy outcomes. In Niger, 58.6% of pregnant women are anemic; however, MN statuses are unknown. The study objectives were to estimate the prevalence of MN deficiencies among pregnant women in Zinder, Niger and explore associated risk factors. Pregnant women living in randomly selected rural villages (n = 88) were included. Capillary and venous blood samples (n = 770) were analyzed for hemoglobin (Hb) and plasma ferritin, soluble transferrin receptor (sTfR), zinc (pZn), retinol binding protein (RBP), folate and vitamin B12. C-reactive protein and alpha-1-acid glycoprotein were measured to adjust for inflammation. The prevalence of MN deficiencies in pregnant woman was high, indicative of a severe public health problem. Prevalence of iron deficiency was 20.7% and 35.7%, by ferritin (<15 µg/L) and sTfR (>8.3 mg/L), respectively. In total, 40.7% of women had low pZn (<50 µg/dL), 79.7% had marginal RBP (<1.32 µmol/L), 44.3% of women had low folate (<10 nmol/L) and 34.8% had low B12 concentrations (<148 pmol/L). Common risk factors associated with MN status included gravidity, mid-upper-arm circumference, geophagy, malaria, and result of the woman’s last pregnancy. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition and health interventions are critical among pregnant women in this population.

Prevalence and determinants of gestational weight gain among pregnant women in Niger

“…This project was a programmatic intervention to improve antenatal care (ANC) services and compared pre‐ and post‐intervention cohorts of pregnant women. Methods for the baseline survey assessments have been described in detail elsewhere (K. Begum et al, ; Wessells et al, ). Briefly, the community‐based baseline survey was conducted from March 2014 to September 2015.…”

“…Capillary blood samples were drawn to assess haemoglobin concentration by HemoCue® Hb 201+ (Hemocue, Inc; Lake Forest, CA). As described elsewhere (Wessells et al, ), venous blood samples (7.5 ml) were collected in a subgroup of participants for the measurement of folate, vitamin B 12 , retinol binding protein, plasma ferritin, soluble transferrin receptor (sTfR), zinc, α‐1‐acid glycoprotein (AGP), C‐reactive protein (CRP), and histidine‐rich protein II (HRP2) concentrations.…”

“…Potential predictors were identified based on a literature review and background knowledge and prespecified in the statistical analyses plan (Hess & Ouedraogo, ). These included maternal age, education, number of pregnancies, number of living children, height, occupation, SES, household food insecurity, reported increase or decrease in the number of meals per day and quantity of food consumed due to pregnancy, reported receipt of food assistance, adequate minimum dietary diversity, micronutrient status (plasma ferritin, zinc, and retinol binding protein adjusted for inflammation; Wessells et al, ; sTfR, vitamin B 12 , and folate), markers of inflammation (AGP and CRP), and malaria antigenemia (HRP2). To explore which predictors were consistently and significantly associated with GWG per week and low GWG, we ran five independent analyses including GWG per week and GWG < 0.35 kg/week adjusting for women's GA, and GWG per week, GWG less than the third centile and GWG < 50th centile INTERGROWTH‐21st standards not adjusting for GA following the methods of the respective standards (Cheikh Ismail et al, ; Hutcheon & Bodnar, ; IOM and NRC, ).…”

Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger

“…Indeed, many interviewed pregnant women stated that they wished to eat more diverse foods. In view of the high prevalence of multiple micronutrient deficiencies among pregnant women recently documented in this region of Niger (Hess et al, ; Wessells et al, ), IFA supplementation and nutrition counselling alone may not be adequate and multiple micronutrient supplements along with other nutritional interventions may be required.…”

Integrating nutrition into health systems at community level: Impact evaluation of the community‐based maternal and neonatal health and nutrition projects in Ethiopia, Kenya, and Senegal

“…We also discuss how the results inform scale‐up and their relevance outside their particular contexts. Because the approach was sufficiently different, results for the fourth country project in Niger are reported elsewhere (Hess et al, ; Wessells et al, ).…”