Weekly Supplementation with Iron and Vitamin A during Pregnancy Increases Hemoglobin Concentration but Decreases Serum Ferritin Concentration in Indonesian Pregnant Women

Abstract

We investigated whether weekly iron supplementation was as effective as the national daily iron supplementation program in Indonesia in improving iron status at near term in pregnancy. In addition, we examined whether weekly vitamin A and iron supplementation was more efficacious than weekly supplementation with iron alone. One group of pregnant women (n = 122)was supplemented weekly with iron (120 mg Fe as FeSO4) and folic acid (500 microg); another group (n = 121) received the same amount of iron and folic acid plus vitamin A [4800 retinol equivalents (RE)]. A third ("daily") group (n = 123), participating in the national iron plus folic acid supplementation program, was also recruited. Data on subjects with complete biochemical data are reported (n = 190). At near term, hemoglobin concentrations increased, whereas serum ferritin concentrations decreased significantly in the weekly vitamin A and iron group, suggesting that vitamin A improved utilization of iron for hematopoiesis. Iron status in the weekly iron group was not different from that of the "daily" group. However, iron status decreased with daily supplementation if <50 iron tablets were ingested. Serum transferrin receptor concentrations increased in all groups (P < 0.01). Serum retinol concentrations were maintained in the weekly vitamin A and iron group, but decreased in the other two groups (P < 0.01). Thus, delivery of iron supplements on a weekly basis can be as effective as ona daily basis if compliance can be ensured. Addition of vitamin A to the supplement improved hemoglobin concentration.

The anemia of vitamin A deficiency: epidemiology and pathogenesis

“…A study conducted in Tanzania suggests that daily multivitamins, but not vitamin A, increased hemoglobin concentrations among HIV-positive pregnant women (Fawzi et al, 1998). In Indonesia, pregnant women who received weekly vitamin A and iron supplementation had a greater increase in hemoglobin that women who received weekly iron or daily iron (Muslimatun et al, 2001). There was an accompanying decrease in serum ferritin among women who received vitamin A and iron, suggesting to the investigators that vitamin A supplementation increased the utilization of iron for hematopoiesis.…”

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

“…Supplementation comprised 120 mg iron as ferrous sulphate and 500 mg folic acid or the same amounts of iron and folic acid plus 4800 RE vitamin A. Details of the study design and the effect of supplementation on maternal biochemical status near term and infant biochemical status at $ 4 months of age have been published elsewhere (Muslimatun et al, 2001;Schmidt et al, 2001). After birth, infants were followed up during the first year of life.…”

“…Infants were measured with light clothing. Neonatal weight and length of infants had been measured by two of the authors (MKS and SM) during a postnatal home visit (Schmidt et al, 2001). All field assistants had received training and were supervised every month by the two authors mentioned above.…”

“…Inadequate maternal nutrition during pregnancy is thought to be one of the contributors to this (Frongillo, 1999;Waterlow & Schürch, 1994;Kusin et al, 1992). Vitamin A supplementation of women before and during pregnancy has been shown to reduce maternal nightblindness and mortality (West et al, 1999;Christian et al, 1998) and improve serum retinol levels in infants (Katz et al, 2000;Schmidt et al, 2001). However it did not reduce foetal loss or early infant mortality (Katz et al, 2000) and other outcomes of infants have not been reported so far.…”

“…Supervised weekly iron supplementation has been shown to perform similar to the ongoing governmental iron supplementation program in preventing iron deficiency anaemia (Muslimatun et al, 2001). In this study, we investigated whether vitamin A supplementation in concurrence of iron supplementation to Indonesian pregnant women decreases morbidity and improves growth of their infants during the first year of life.…”