Periconceptional Iron and Folate Status Is Inadequate among Married, Nulliparous Women in Rural Bangladesh

Abstract

Recent evidence suggests that poor fetal growth is associated with preconception anemia and first trimester iron deficiency. Periconceptional iron and folate supplementation may improve the effectiveness of iron supplementation programs during pregnancy by treating preexisting anemia, building iron stores, and reducing risk of neural tube defects. Our objective in this study was to describe the iron and folate status of married, nulliparous women in rural Bangladesh from March to May 2007. Of 272 women, 37% were anemic (hemoglobin <120 g/L), 13% were folate deficient (plasma folate <or=10 nmol/L), 15% were iron deficient (plasma ferritin <12 microg/L or tranferrin receptor >4.4 mg/L), 11% were iron deficient and anemic, and 81% were estimated to have <500 mg of iron stores. Risk of anemia was 4 times greater among nonstudents than students (95% CI: 1.23, 14.69), twice as likely among women with a previous miscarriage compared with those who had never been pregnant (95% CI: 1.04, 5.47), and 6 times greater among iron-deficient compared to iron-replete women (95% CI: 2.76, 11.81). Adolescents (<or=19 y) had lower mean plasma ferritin concentration (38.3 +/- SD vs. 49.1 +/- SD microg/L; P = 0.004) and body iron stores [3.4 +/- 5.2 mg/kg vs. 4.3 +/- 5.6 mg/kg (0.06 +/- 0.09 mmol/kg vs. 0.08 +/- 0.10 mmol/kg); P = 0.006] compared with adults. An unacceptably high percentage of nulliparous women in rural Bangladesh have inadequate iron and folate status. As they enter pregnancy, more than one-third will be anemic, >80% will have inadequate iron stores, and more than one-tenth will be folate deficient. Further research is needed on risk factors of poor nutritional status before the start of a woman's childbearing years.

Prevalence of Periconception Risk Factors for Adverse Pregnancy Outcomes in a Cohort of Urban Indian Women: Implications for Preconception Health Education

“…Data from this study suggested that preconception health promotion messages should combine advice on preconception folic acid supplementation, correction of anaemia and correction of body weight prior to conception. These messages would also be applicable to women in other LMIC settings as similar high prevalence of undernutrition and anaemia have been reported in Vietnam and Bangladesh [9,10]. That obesity is also an emerging risk in other low income settings has been reported for women in Nepal and Bangladesh [22].…”

“…The prevalence of preconception risk factors has been reported from studies, and ongoing surveillance [5][6][7][8]. Most of these reports are however from women in high income countries (HICs), where the general health status, awareness and education levels are higher than those from low and middle-income countries (LMICs) [9][10][11]. Data on risk exposures of women in low income settings are needed, as these exposures are likely to be dissimilar due to differences in socio-economic, demographic, cultural, dietary, lifestyle, environmental, regulatory and health systems characteristics.…”

Dietary phytate intake inhibits the bioavailability of iron and calcium in the diets of pregnant women in rural Bangladesh: a cross-sectional study

“…This survey also highlights a nationwide high prevalence of zinc deficiency (57.5 %) but low iron deficiency (7.1 %) among rural women. Some other recent studies from Bangladesh have reported iron deficiency among the rural women from 0.0 % [15] to 11.0 % [16].…”

Determinants of iron status and Hb in the Bangladesh population: the role of groundwater iron

“…The study attributed this very low prevalence of Fe deficiency to drinking groundwater from tube wells that were a rich source of naturally occurring Fe. In addition, a few other studies have reported a low prevalence of Fe deficiency of 8 %, 13 % and 17 % among pregnant women, married nulliparous women and schoolchildren, respectively (4)(5)(6) . The present paper aimed to explore the association of groundwater Fe with population-level Fe nutrition and Hb status, at a nationwide scale.…”