A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Maternal iron deficiency anemia affects postpartum emotions and cognition. Preventing low Birthweight through Maternal Multiple Micronutrient Supplementation: A Cluster-Randomized, Controlled Trial in Indramayu, West Java Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia. Nutrient intake and anemia risk in the women's health initiative observational study. A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes The impact of systematic dietary counseling during the first year of life on prevalence rates of anemia and iron deficiency at 12-16 months. Albendazole therapy and reduced decline in haemoglobin concentration during pregnancy (Sierra Leone). Iron Supplementation in Iron-Replete and Nonanemic Pregnant Women in Tanzania: A Randomized Clinical Trial. Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. Micronutrient supplementation and pregnancy outcomes: double-blind randomized controlled trial in China. Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal. Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Effect of iron supplementation during pregnancy on the intelligence quotient and behavior of children at 4 y of age: long-term follow-up of a randomized controlled trial. [Prevention of iron-deficiency anemia in pregnancy using early iron supplementation: a controlled trial]. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. A prospective study of micronutrient status in adolescent pregnancy. Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation. Daily multivitamins with iron to prevent anemia in high-risk infants: a randomized clinical trial. [Deficiency of folates in pregnancy: effect of supplementary folic acid]. The effect of iron deficiency and mental stimulation on Indonesian children's cognitive performance and development.
Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies The aim of this study was to determine whether iron deficiency anemia ( IDA ) in mothers alters their maternal cognitive and behavioral performance , the mother-infant interaction , and the infant 's development . This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers . This prospect i ve , r and omized , controlled , intervention trial was conducted in South Africa among 3 groups of mothers : nonanemic controls and anemic mothers receiving either placebo ( 10 microg folate and 25 mg vitamin C ) or daily iron ( 125 mg FeS0(4 ) , 10 microg folate , 25 mg vitamin C ) . Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum ( n = 81 ) . Maternal hematologic and iron status , socioeconomic , cognitive , and emotional status , mother-infant interaction , and the development of the infants were assessed at 10 wk and 9 mo postpartum . Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers . However , iron treatment result ed in a 25 % improvement ( P < 0.05 ) in previously iron-deficient mothers ' depression and stress scales as well as in the Raven 's Progressive Matrices test . Anemic mothers administered placebo did not improve in behavioral measures . Multivariate analysis showed a strong association between iron status variables ( hemoglobin , mean corpuscular volume , and transferrin saturation ) and cognitive variables ( Digit Symbol ) as well as behavioral variables ( anxiety , stress , depression ) . This study demonstrates that there is a strong relation between iron status and depression , stress , and cognitive functioning in poor African mothers during the postpartum period . There are likely ramifications of this poorer " functioning " on mother-child interactions and infant development , but the constraints around this relation will have to be defined in larger studies Background Micronutrient deficiencies may contribute to a higher incidence of  low birthweight ( LBW ) . UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women , and several effectiveness trials were conducted to assess its impact . Objective To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size , pregnancy outcome , and maternal micronutrient status in comparison with iron – folic acid supplementation . Methods We carried out a cluster-r and omized , controlled trial in Indramayu , Indonesia , involving 843 pregnant women . Of these , 432 received multiple micronutrients and 411 received iron – folic acid . Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality . Results The mean number of supplements consumed during pregnancy and 30 days postpartum was high ( 136 in the group receiving multiple micronutrients and 140 in the iron – folic acid group ) . The women consumed the supplements on average 5 days per week . Although there were no significant differences between the groups in the percentage of infants with LBW , there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients ( 6.3 % vs. 7.3 % ) , and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron – folic acid group , although the difference was not significant . Among those who consumed 90 or more supplements during pregnancy , women taking multiple micronutrients had a 3.3 % combined rate of miscarriage , stillbirth , or neonatal death , as compared with 6.9 % for those taking iron – folic acid only ( p < .049 ) . The anemia rates in the two groups were similar after supplementation , even though the amount of iron in the multiple micronutrient supplement was half that in the iron – folic acid supplement . Serum retinol was higher in the group receiving multiple micronutrients . Conclusions Multivitamin supplementation use among pregnant women is as effective as iron – folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status The aim of this study was to determine whether iron deficiency anemia ( IDA ) in young South African mothers alters mother-infant interactions and the infant 's development . The study was a prospect i ve , r and omized , controlled intervention trial with 3 groups of mothers : nonanemic controls and anemic mothers administered either placebo ( 25 mg ascorbic acid and 10 microg folate ) or daily iron treatment ( 125 mg FeSO(4 ) plus ascorbate and folate ) . Mothers of full-term , normal birth weight infants ( n = 81 ) were followed from 10 wk to 9 mo postpartum . Maternal iron status , socioeconomic level , mother-infant interaction [ Parent/Caregiver Involvement Scale ( PCIS scale ) ] , and infant development ( Griffiths scale ) were assessed . At baseline , anemic mothers tended ( P < 0.10 ) to be less responsive to , and more controlling of , their infants . Infants of anemic mothers were developmentally delayed at 10 wk in h and -eye movement and overall quotient . Despite normalization of maternal iron status with supplementation in some mothers , the developmental delays were not diminished at 9 mo . At 9 mo , anemic mothers were significantly more " negative " towards their babies , engaged less in goal setting , and were less " responsive " than control mothers . In contrast , the behavior of anemic mothers given iron treatment toward their children was similar to that of the control mothers on all 11 scales of the PCIS . In conclusion , IDA altered mother-child interactions at both 10 wk and 9 mo postpartum . Additionally , infants whose mothers were anemic in the early postpartum scored worse on developmental tests at 10 wk and 9 mo of age Universal prenatal daily iron-folic acid ( IFA ) and multiple micronutrient ( MM ) supplements are recommended to reduce the risk of low birth weight , maternal anemia , and iron deficiency ( ID ) during pregnancy , but the evidence of their effect on iron status among women with mild or no anemia is limited . The aim of this study was to describe the iron status [ serum ferritin ( SF ) , serum soluble transferrin receptor ( sTfR ) , and body iron ( BI ) ] before and after micronutrient supplementation during pregnancy . We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a r and omized , double-blind trial in China . Women were r and omly assigned to take daily 400 μg of folic acid ( FA ) ( control ) , FA plus 30 mg of iron , or FA , iron , plus 13 additional MMs provided before 20 wk of gestation to delivery . Venous blood was collected in this subset during study enrollment ( before 20 wk of gestation ) and 28 - 32 wk of gestation . We found that , at 28 - 32 wk of gestation , compared with the FA group , both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator ( SF , sTfR , or BI ) was used for defining ID . The prevalence of ID at 28 - 32 wk of gestation for IFA , MM , and FA were 35.3 % , 42.7 % , and 59.6 % by using low SF , 53.6 % , 59.9 % , and 69.9 % by using high sTfR , and 34.5 % , 41.2 % , and 59.6 % by using low BI , respectively . However , there was no difference in anemia prevalence ( hemoglobin < 110 g/L ) between FA and IFA or MM groups . We concluded that , compared with FA alone , prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia . This trial was registered at clinical trials.gov as NCT00137744 BACKGROUND Nutrient-related anemia among postmenopausal women is preventable ; recent data on prevalence are limited . OBJECTIVE To investigate the association between nutrient intakes and anemia prevalence , in relation to both incidence and persistence , in a longitudinal sample of postmenopausal women . We hypothesized that anemia prevalence , incidence , and persistence would be greater among women reporting lower intake of vitamin B-12 , folate , and iron .  DESIGN Prospect i ve cohort analysis . PARTICIPANTS / SETTING The observational cohort of the Women 's Health Initiative , including 93,676 postmenopausal women , aged 50 to 79 years , who were recruited across the United States at 40 clinical study sites . Women were enrolled between 1993 and 1998 ; data collection for these analyses continued through 2000 . MAIN OUTCOME MEASURES Anemia was defined as a blood hemoglobin concentration of < 12.0 g/dL ( 120.0 g/L ) . Persistent anemia was defined as anemia present at each measurement time point . Diet was assessed by food frequency question naire for iron , folate , B-12 , red meat , and cold breakfast cereal ; inadequacies were based on dietary reference intakes for women older than age 50 years . STATISTICAL ANALYSIS Descriptive statistics ( mean ± st and ard deviation ) were used to characterize the population demographics , anemia rates , and diet . Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia . Associations are presented as odds ratio and 95 % confidence intervals . RESULTS Anemia was identified in 3,979 ( 5.5 % ) of the cohort . Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites ( 7.4 % ) than other race/ethnic groups ( inadequacies demonstrated in 14.6 % to 16.3 % of the sample ) . Age , body mass index , and smoking were associated with anemia . Women with anemia reported lower intakes of energy , protein , folate , vitamin B-12 , iron , vitamin C , and red meat . Multiple ( more than a single nutrient ) dietary deficiencies were associated with a 21 % greater risk of persistent anemia ( odds ratio 1.21 , 95 % confidence interval 1.05 to 1.41 ) and three deficiencies result ed in a 44 % increase in risk for persistent anemia ( odds ratio 1.44 , 95 % confidence interval 1.20 to 1.73 ) . CONCLUSIONS Inadequate nutrient intake , a modifiable condition , is associated with greater risk for anemia  in postmenopausal women participating in the Observational Study of the Women 's Health Initiative . Efforts to identify and up date incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken Background Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation . Intervention strategies largely consist of administration of iron – folic acid supplements during pregnancy . Objective We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-r and omized design . Methods We r and omly assigned 2,378 pregnant women to receive either iron – folic acid or multiple micronutrient supplements . The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers . Results The women in both groups consumed about 75 % of the supplements provided , and few reported adverse effects such as vomiting , abdominal pain , etc . There was a small ( 70 g ) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron – folic acid supplements ( 2.95 ± 0.6 vs. 2.88 ± 0.5 kg , p = .01 ) . This translated into a 10 % reduction ( p < 0.17 ) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients . Although stillbirth rates were comparable in the two groups , the early neonatal mortality rate in the group receiving multiple micronutrients was higher , although not significantly , than that in the group receiving iron– folic acid ( 43.2 vs. 23.5 deaths per 1,000 live births ; RR = 1.64 ; 95 % CI , 0.94 to 2.87 ) . Comparable reductions in anemia ( hemoglobin < 11 g/dL ) were observed , although the proportion with low iron stores ( assessed by serum ferritin ) was lower in the iron – folic acid group in the postnatal period . Although the proportion of women with sub clinical vitamin A deficiency after supplementation did not differ between the two groups , the iron – folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period . Conclusions These data suggest that multiple micronutrient supplements are well tolerated during pregnancy , but the effect on birthweight is modest . The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system setting OBJECTIVE To evaluate the impact that a program based on maternal dietary counseling covering breastfeeding and healthy complementary feeding had on the prevalence of  iron deficiency , anemia and iron deficiency anemia in children aged 12 to 16 months . METHODS Newborn infants were r and omized at birth to an intervention or a control group . Mothers in the intervention group received home visits during the children 's first year of life on a monthly basis up to 6 months , and at 8 , 10 and 12 months . The mothers in the control group received visits for data collection when children reached 6 and 12 months . All children were visited at ages between 12 and 16 months and 24-hour dietary recalls and hemoglobin and ferritin tests were conducted . RESULTS There was no evidence that the intervention had an effect on anemia incidence , which was 66.5 % in the intervention group and 61.8 % in the control group . There was also no evidence of any difference between the groups in the prevalence of iron deficiency anemia or of iron deficiency . However , a higher percentage of children in the intervention group were exclusively breastfed at 4 and 6 months , and breastfed at 6 and 12 months . Intervention group children also consumed more meat and were fed diets with better iron bioavailability and consumed less cow 's milk and calcium than children from the control group . CONCLUSION This intervention had no effect on the prevalence of anemia , iron deficiency or iron deficiency anemia . Clinical trial registry identification number : NCT00629629 WHO recommends that anthelmintic treatment be included in strategies to improve maternal nutrition in areas where hookworms are endemic and anaemia is prevalent . At present , few countries have adopted this recommendation , partly owing to the lack of data to support the adverse effects of hookworms on maternal health . A longitudinal study was conducted on 125 women in Sierra Leone ( in 1995/96 ) to measure the impact of single-dose albendazole ( 400 mg ) and daily iron-folate supplements ( 36 mg iron and 5 mg folate ) on haemoglobin and serum ferritin concentration during pregnancy . Women who received both albendazole and iron-folate supplements experienced no significant change ( P > 0.05 ) in the prevalence of anaemia and iron-deficiency anaemia between the first and third trimesters . These prevalence levels significantly increased ( P < 0.05 ) in women who received either albendazole or iron-folate supplements or neither . After controlling for baseline haemoglobin concentration and season , the mean decline in haemoglobin concentration between the first and third trimester in women who received albendazole was 6.6 g/L less than in women who received the control ( P = 0.0034 ) . The corresponding value for iron-folate supplements was 13.7 g/L haemoglobin ( P < 0.001 ) . The effects of albendazole and iron-folate supplements  were additive . These findings lend support to WHO 's recommendation for anthelmintic treatment during pregnancy IMPORTANCE Anemia is common in pregnancy and increases the risk of adverse outcomes . Iron deficiency is a leading cause of anemia in sub-Saharan Africa , and iron supplementation is the st and ard of care during pregnancy ; however , recent trials among children have raised concerns regarding the safety of iron supplementation in malaria-endemic regions . There is limited evidence on the safety of iron supplementation during pregnancy in these areas . OBJECTIVE To evaluate the safety and efficacy of iron supplementation during pregnancy in a malaria-endemic region . DESIGN , SETTING , AND PARTICIPANTS We conducted a r and omized , double-blind , placebo-controlled clinical trial among pregnant women presenting for antenatal care in Dar es Salaam , Tanzania , from September 28 , 2010 , through October 4 , 2012 . Iron-replete , nonanemic women were eligible if they were uninfected with human immunodeficiency virus , primigravidae or secundigravidae , and at or before 27 weeks of gestation . Screening of 21,316 women continued until the target enrollment of 1500 was reached . Analyses followed the intent-to-treat principle and included all r and omized participants . INTERVENTIONS Participants were r and omized to receive 60 mg of iron or placebo , returning every 4 weeks for st and ard prenatal care , including malaria screening , prophylaxis with the combination of sulfadoxine and pyrimethamine , and treatment , as needed . MAIN OUTCOMES AND MEASURES The primary outcomes were placental malaria , maternal hemoglobin level at delivery , and birth weight . RESULTS Among 1500 study participants ( 750 r and omized for each group ) , 731 in iron group and 738 in placebo group had known birth outcomes and 493 in iron group and 510 in placebo group had placental sample s included in the analysis . Maternal characteristics were similar at baseline in the iron and placebo groups , and 1354 ( 91.7 % ) used malaria control measures . The risk of placental malaria was not increased by maternal iron supplementation ( relative risk [ RR ] , 1.03 ; 95 % CI , 0.65 - 1.65 ) , and iron supplementation did not significantly affect birth weight ( 3155 vs 3137 g , P = .89 ) . Compared with placebo , iron supplementation significantly improved the mean increase from baseline to delivery for hemoglobin ( 0.1 vs -0.7 g/dL , P < .001 ) and serum ferritin ( 41.3 vs 11.3 µg/L , P < .001 ) . Iron supplementation significantly decreased the risk of anemia at delivery by 40 % ( RR , 0.60 ; 95 % CI , 0.51 - 0.71 ) but not severe anemia ( RR , 0.68 ; 95 % CI , 0.41 - 1.14 ) . Iron supplementation significantly reduced the risk of maternal iron deficiency at delivery by 52 % ( RR , 0.48 ; 95 % CI , 0.32 - 0.70 ) and the risk of iron deficiency anemia by 66 % ( RR , 0.34 ; 95 % CI , 0.19 - 0.62 ) . CONCLUSIONS AND RELEVANCE Prenatal iron supplementation among iron-replete , nonanemic women was not associated with an increased risk of placental malaria or other adverse events in the context of good malaria control . Participants receiving supplementation had improved hematologic and iron status at delivery compared with the placebo group . These findings provide support for continued administration of iron during pregnancy in malaria-endemic regions . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01119612 BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant BACKGROUND Beyond perinatal folic acid supplementation , the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear . We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia . METHODS In this r and omized double-blind controlled trial , 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009 . Women were r and omly assigned to daily folic acid ( 400 μg ) ( control ) , folic acid-iron ( 30 mg ) , or folic acid , iron , and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery . Primary outcome was perinatal mortality . Secondary outcomes included neonatal and infant mortality , preterm delivery , birth weight , birth length , gestational duration , and maternal hemoglobin concentration and anemia . RESULTS A total of 92.7 % of women consumed 80 % to 100 % of supplements as instructed . On average , women consumed 177 supplements . Compared with daily prenatal folic acid , supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality ( 8.8 , 8.7 , and 8.3 , respectively ) per 1000 births , and relative risks ( RRs ) were 1.00 ( 95 % CI , 0.68 - 1.46 ; P = .99 ) and 0.94 ( 95 % CI , 0.64 - 1.39 ; P = .76 ) , respectively . Risk of other adverse maternal and infant outcomes also did not differ , except that RRs for third-trimester maternal anemia were 0.72 ( 95 % CI , 0.63 - 0.83 ; P < .001 ) and 0.71 ( 95 % CI , 0.62 - 0.82 ; P < .001 ) , respectively . CONCLUSION Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia  prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00133744 Questions have been raised about potentially negative effects of antenatal folic acid use in population s with a high prevalence of vitamin B-12 deficiency . Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance  and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and /or vitamin B-12 status . Pregnant women were cluster r and omized to receive daily supplements containing vitamin A alone or with folic acid , folic acid+iron , folic acid+iron+zinc , or a multiple micronutrient .  In a sub sample ( n = 1132 ) , micronutrient status biomarkers were analyzed at baseline and late pregnancy . Children born to the women who participated in the trial were visited at 6 - 8 y of age . Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment ( HOMA-IR ) . Children whose mothers were deficient in vitamin B-12 ( < 148 pmol/L , 27 % ) during early pregnancy had a 26.7 % increase in HOMA-IR ( P = 0.02 ) , but there was no association with maternal folate status . Among children born to women who were vitamin B-12 deficient at baseline , the percent difference in HOMA-IR compared to the control group was 15.1 % ( 95 % CI : -35.9 , 106.4 ) , 4.9 % ( -41.6 , 88.5 ) , 3.3 % ( -38.4 , 73.5 ) , and 18.1 % ( -29.0 , 96.7 ) in the folic acid , folic acid-iron , folic acid-iron-zinc , and multiple micronutrient supplementation groups , respectively , none of which were significant . Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance , but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring Objective Preconception 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 . Methods We conducted a double blind r and omized 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 ) . Results At 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 ] ) . Conclusion Preconception supplementation with MM or IFA result ed 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 Registration Clinical Trials . Gov Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron BACKGROUND Iron supplements are often prescribed during pregnancy despite the lack of intervention trials that have assessed the effects of supplementation in pregnancy on childhood development . OBJECTIVE The objective was to determine whether iron supplementation during pregnancy influences  childhood intelligence quotient ( IQ )  in an industrialized country . DESIGN Pregnant women ( n = 430 ) were r and omly allocated to receive iron ( 20 mg/d ) or placebo from 20 wk gestation until delivery , and the women and their children were followed up over the long term ( 4 y ) . Seventy percent of these families participated in the follow-up . The proportion of women with iron deficiency anemia at the end of pregnancy was 1 % ( 2 of 146 ) in the iron group and 11 % ( 15 of 141 ) in the placebo group . The primary outcome was the IQ of the children at 4 y of age , as assessed by the Stanford-Binet Intelligence Scale . Secondary outcomes included child behavior and the general health of the mothers . RESULTS The mean IQ was not significantly different ( P = 0.980 ) between the children of the iron-supplemented mothers ( 109 + /- 11 ; n = 153 ) and the children of the mothers in the placebo group ( 109 + /- 11 ; n = 149 ) . However , the percentage of children with an abnormal behavior score was higher in the iron group ( 24 of 151 , or 16 % ) than in the placebo group ( 12 of 149 , or 8 % ) ; the relative risk was 1.97 ( 95 % CI : 1.03 , 3.80 ; P = 0.037 ) . There was no significant difference in the health of the mothers between groups , as assessed by the SF-36 Health Survey . CONCLUSIONS Prenatal iron supplementation that reduces the incidence of iron deficiency anemia from 11 % to 1 % has no effect on the IQ of the offspring at 4 y of age An iron supplementation trial versus placebo was performed in double blind on 191 attending at 3 month the antenatal clinic of Poissy maternity . Iron status of mothers and newborns was assessed at 3 , 5 , 7 month , during the delivery and 2 months after the delivery , using biochemical indicators ( hemoglobin level , serum ferritin ) . The compliance was good in 165 pregnant women ( 86 % of the initial sample ): 81 in the iron group , 84 in the placebo group . Among the placebo group , anemia ( Hb less than 11 g/dl ) was observed at the end of the pregnancy in 30 % of women . Depletion of iron stores started at 5 month . In the iron group , hemoglobin level increased significantly during the pregnancy and anemia was observed only in 3 % of women at the delivery . Iron status of newborns and two months after delivery was related to mothers iron status at delivery and particularly at the 7th month of pregnancy The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy BACKGROUND Adolescents are more likely than adults to consume energy-dense , micronutrient-poor diets and to experience adverse pregnancy outcomes . OBJECTIVES The objectives were to assess micronutrient intake  and  blood biomarkers  prospect ively in pregnant adolescents recruited to the About Teenage Eating ( ATE ) Study and to determine associations with pregnancy outcome . DESIGN Pregnant adolescents ( n = 500 ) were recruited from 2 UK inner city population s.  Dietary intake was assessed with three 24-h dietary recalls , and micronutrient status was assessed by measurement of third trimester blood biomarkers . Pregnancy outcomes included small-for-gestational age ( SGA ) birth and preterm delivery . RESULTS Median iron and folate intakes were lower than UK and US recommended amounts . Folate and vitamin B-12 status were lower in smokers , despite no differences in dietary intake . Serum folate was < 7.0 nmol/L in 12 % of subjects , and serum total homocysteine ( tHcy ) was elevated ( > 10 micromol/L ) in 20 % of subjects . Fifty-two percent of the subjects had iron deficiency anemia , and 30 % had serum 25-hydroxyvitamin D concentrations < 25 nmol/L. The incidence of SGA birth was higher in subjects with poorer folate status ( red blood cell folate , P = 0.003 ; serum folate , P = 0.02 ; tHcy , P = 0.01 ; simple regression ) and those with low folate intakes , regardless of the inclusion ( P = 0.021 ) or exclusion ( P = 0.049 ) of intake from supplements ( simple regression ) . Adjustment for confounding variables confirmed the independence of these associations . The risk of SGA birth was also higher in subjects with low food iron intake ( P = 0.049 ) , but not when intake included iron from supplements ( P = 0.21 ) . The risk of SGA birth was lower in subjects with iron deficiency anemia ( P = 0.002 ) . CONCLUSION Poor micronutrient intake and status increase the risk of SGA births in pregnant adolescents Knowledge about the impact of maternal food and micronutrient supplementation on infant micronutrient status is limited . We examined the effect of maternal food and micronutrient supplementation on infant micronutrient status in the Maternal and Infant Nutrition Interventions in Matlab Trial . Pregnant women ( n = 4436 ) were r and omized to Early or Usual promotion of enrollment in a food supplementation program . In addition , they were r and omly allocated to 1 of the following 3 types of daily micronutrient supplements provided from wk 14 of gestation to 3 mo postpartum : 1 ) folic acid and 30 mg iron ( Fe30Fol ) ; 2 ) folic acid and 60 mg iron ; or 3 ) a multiple micronutrient including folic acid and 30 mg iron ( MMS ) . At 6 mo , infant blood sample s ( n = 1066 ) were collected and analyzed for hemoglobin and plasma ferritin , zinc , retinol , vitamin B-12 , and folate . The vitamin B-12 concentration differed between the micronutrient supplementation groups ( P = 0.049 ) . The prevalence of vitamin B-12 deficiency was lower in the MMS group ( 26.1 % ) than in the Fe30Fol group ( 36.5 % ) ( P = 0.003 ) . The prevalence of zinc deficiency was lower in the Usual food supplementation group ( 54.1 % ) than in the Early group ( 60.2 % ) ( P = 0.046 ) . There were no other differential effects according to food or micronutrient supplementation groups . We conclude that maternal multiple micronutrient supplementation may have a beneficial effect on vitamin B-12 status in infancy OBJECTIVE The goal of this study was to assess the effectiveness of multivitamins with iron as prophylaxis against  iron deficiency and anemia in infancy . METHODS The study was a double-blinded , r and omized , pragmatic , clinical trial conducted at 3 urban primary care clinics . Subjects included healthy , full-term infants who were enrolled at their 6-month well-child visit . Infants were r and omly assigned to receive st and ard-dose multivitamins with or without iron ( 10 mg/day ) . Parents administered multivitamins by mouth daily for 3 months . Laboratory results at 9 months of age were analyzed for the presence of anemia and /or iron deficiency . Anemia was defined as hemoglobin level < 11.0 g/dL. Iron deficiency was initially defined as any abnormal laboratory value of the following : mean corpuscular volume combined with red cell distribution width or zinc protoporphyrin ( with blood lead level < 10 microg/dL ) for most subjects and ferritin , transferrin saturation , or reticulocyte hemoglobin content for a subset . Subsequent analyses defined iron deficiency as any 2 abnormalities of the above laboratory outcomes , except hemoglobin . RESULTS The control ( n = 138 ) and intervention ( n = 146 ) groups were equivalent with respect to all important sociodemographic and nutritional variables . At 9 months of age , anemia was found in 21 % of infants ( n = 58 ) . A total of 229 ( 81 % ) had iron deficiency on the basis of 1 abnormal laboratory indicator and 139 ( 49 % ) on the basis of 2 abnormal laboratory indicators . No difference existed in the occurrence of anemia and iron deficiency between the intervention and control groups . In the intervention group , 22 % and 78 % of 138 , respectively , were anemic or had 1 abnormal laboratory outcome indicative of iron deficiency . In the control group , 19 % and 84 % of 144 were anemic or iron deficient . When stratified by adherence , no differences in hematologic outcomes between groups were noted . However , in multivariate logistic regression , infants whose mothers were anemic during pregnancy were 2.15 times more likely than others to have any laboratory abnormality ( 95 % confidence interval : 1.14 - 4.07 ) . Increasing adherence , regardless of group assignment , was associated with a 0.56 times reduced risk of any abnormality ( 95 % confidence interval : 0.41 - 0.76 ) . CONCLUSION On the basis of intention-to-treat analysis , multivitamins with iron was not effective in preventing iron deficiency or anemia in 9-month-old infants . However , effective prevention and treatment of maternal anemia during pregnancy and giving multivitamins with or without additional iron during infancy may prove to be important approaches to the prevention of iron deficiency among high-risk children . Because of the consequences of iron deficiency and its high prevalence among low-income infants , additional investigation in these areas is warranted Higher folate needs are present during pregnancy , which may lead to tissular deficiency in the mother and to depleted newborn folate reserves . The aim of this work was to assess the prevalence of folate deficiency and to establish the rates of serum and red cell folate in two groups of mothers and newborn infants , one receiving only iron and the other iron and folate during pregnancy .  The rates of serum and red cell folate found at the end of pregnancy were significantly higher in the group which received folate ; however , the percentage of cases with tissular folate deficiency was low in both groups , with no significant difference ( 3.8 % and 1.3 % , respectively ) . These findings , along with the lack of effect of supplemental folate on erythropoiesis , pose some questions on the usefulness of supplemental folate during pregnancy in our country Three studies conducted in Indonesia will be described . Soewondo ( 12 ) investigated the relation of iron deficiency and cognitive function and impact of iron supplementation on verbal intelligence , attention and concept learning among iron deficient children without anemia and iron deficient anemic children . Half of 176 children , aged 3 - 6 years , received elemental Fe for 8 weeks and the other half received  placebo . There were significant changes from pre to post intervention evaluations in ferritin , transferrin saturation , free erythrocyte protoporphyrin , and hemoglobin in the iron deficient anemic children . Pre and post treatment psychological test data showed that iron deficiency anemia produced alterations in cognitive processes related to visual attention and concept acquisition . These alterations can be reversed with iron treatment . Idjradinata ( 4 ) assessed the impact of iron supplementation on iron deficient infant 's mental and psychomotor development . Hundred twenty six subjects aged 12 to 18 month were r and omly assigned to either iron treatment or placebo intervention . After 4 months of iron supplementation , the hemoglobin , ferritin and transferrin saturation changed significantly in the iron deficient infants . A developmental delay was observed in the iron deficient anemic infants before intervention and the conditions were reversed after 4 months of iron treatment . Soemiarti ( 8) examined the effectiveness of a  training course  given to mothers of children aged 12 to 24 month on the rearing environment and consequently to the child 's development .  The subjects were 69 mothers of 20 - 35 years old . The training lasted for 21 days by giving mothers training using the program " Ibu Maju Anak Bermutu " . The rearing environment improved , also the child 's mental and psychomotor development
Conclusion Applying the CHERG rules , we recommend a 73 % reduction in anemia at term with daily iron ( alone ) supplementation or iron/folate ( combined ) vs. no intervention or placebo ; for inclusion in the LiST model .
Introduction Iron deficiency is the most prevalent nutrient deficiency in the world , particularly during pregnancy .
According to the literature , anemia , particularly severe anemia , is associated with increased risk of maternal mortality .
It also puts mothers at risk of multiple perinatal complications .
Numerous studies in the past have evaluated the impact of supplementation with iron and iron-folate but data regarding the efficacy and quality of evidence of these interventions are lacking .
This article aims to address the impact of iron with and without folate supplementation on maternal anemia and provides outcome specific quality according to the Child Health Epidemiology Reference Group ( CHERG ) guidelines .