The effects of weekly iron supplementation with folic acid, vitamin A, vitamin C on iron status of Indonesian adolescents. Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women. Impact of nutrition counselling and supplements on the mineral nutriture of rural pregnant women and their neonates. Influence of folate status and polyphenol intake on thiamin status of Irish women. Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in The Netherlands: the Generation R study. A Village-Based Intervention: Promoting Folic Acid Use among Rural Chinese Women Effect of supplementation with folic acid throughout pregnancy on plasma homocysteine concentration. Modifying effects of wealth on the response to nutrient supplementation in pregnancy on birth weight, duration of gestation and perinatal mortality in rural western China: double-blind cluster randomized controlled trial. Fortification of flour with folic acid Low-Dose folic acid supplementation decreases plasma homocysteine concentrations: a randomised trial. Effect of nutrition education on the nutritional status of low-income pregnant women of Mexican descent. Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes Multivitamin and Iron Supplementation to Prevent Periconceptional Anemia in Rural Tanzanian Women: A Randomized, Controlled Trial [Changes in plasma zinc and folic acid concentrations in pregnant adolescents submitted to different supplementation regimens]. Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women. Short-Term Evaluation of the Impact of a Fortified Food Aid Program on the Micronutrient Nutritional Status of Argentinian Pregnant Women Intermittent iron supplementation regimens are able to maintain safe maternal hemoglobin concentrations during pregnancy in Venezuela. Pregnancy intendedness and the use of periconceptional folic acid. Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial
The goal of the study was to determine whether the addition of vitamins A and C and extra folate to the commonly distributed iron-folate supplement administered on a weekly basis would result in improved iron status in anaemic and non-anaemic female adolescents . Subjects ( n=84 ) were selected if their haemoglobin concentration in venous blood was < = 140g/L. Subjects were r and omly allocated into 2 groups . One group received 60 mg iron , 500 m g folic acid , 20 000 IU vitamin A and 60 mg vitamin C weekly , while the other group received 60 mg iron and 250 m g folic acid weekly for a period of 5 weeks . Before and after treatment , haemoglobin , serum ferritin and body height and weight were determined . All subjects received anthelmintic drugs before supplementation . A complete data set was obtained from 42 young women in the group supplemented with  iron , folic acid , vitamin A and vitamin C and from 40 young women in the group supplemented with iron and folic acid . Haemoglobin , mean cell volume and serum ferritin increased significantly in both groups ( p<0.05 ) . Among anaemic adolescents , the rise in haemoglobin concentration in the multisupplement group was higher than that in the iron folate group . The result confirms that weekly supplementation is effective in improving iron status in a short time ( 5 weeks ) and that supplementation with vitamins as well as iron results in an additional improvement in haemoglobin concentration OBJECTIVE Fewer than one third of American women take folic acid daily , although many women report that they would take folic acid if their physicians advised them to do so . This study determined the impact of a physician intervention during routine gynecologic visits on folic acid supplementation . STUDY DESIGN Patients were assigned r and omly to receive brief folic acid counseling , a reminder phone call , and 30 folic acid tablets ( n = 162 women ; intervention group ) or to receive counseling about other preventive health behaviors and a folic acid informational pamphlet ( n = 160 women ; control group ) . Self-reported folic acid use was compared at baseline and at 2 months . RESULTS Of the 279 patients who completed the study , weekly folic acid intake increased in the intervention group by 68 % , compared with 20 % in the control group ( P = .008 ) . No significant differences were found in daily intake . The women who were most influenced by the intervention were black and lower income and not planning pregnancies . CONCLUSION With little effort expended to encourage folic acid use , gynecologists could potentially reduce the risk of folate-preventable birth defects among their patients by as much as 11 % Sixty six young women from low and lower middle income groups selected from 8 villages of Ludhiana district in the first trimester of pregnancy were divided equally into Experimental ( E ) and Control ( C ) Groups , out of which only 60 subjects reached to the term .  Folifer and calcium tablets were supplied to E group from second trimester till delivery along with regular medical supervision and nutrition education about additional nutrient needs . Intake of all the nutrients were less than the Recommended Dietary Allowances in the E and C groups during the third trimester . However , the requirement of iron , calcium , folic acid , vitamin B12 , Vitamin D and ascorbic acid were met in group E due to supplementation . The Fe , Ca and Cu levels improved significantly during the third trimester in group E. The cord serum levels of Fe , Ca and Cu were also significantly higher in Group E. The relationships between maternal and cord blood levels of Fe , Ca and Cu were also significantly higher in Group E. The relationships between maternal and cord blood levels of Fe , Ca , Cu and Zn were significant , the co-efficients of correlation being 0.67 , 0.92 , 0.97 and 0.43 , respectively . Serum Mn had an insignificant correlation with other minerals . The results indicated that 86.7 , 94.7 and 44.8 % variation ( r2 ) in cord serum Ca , Cu and Fe levels was determined by the corresponding maternal serum levels . It is concluded that regular medical supervision , supplementation and nutrition education significantly improved the nutriture of the pregnant women and their neonates The relationship of folate status and polyphenol intake to thiamin status was studied in 80 r and omly selected elderly and young Irish women , with key variables affecting thiamin nutrition controlled for .  Folate , thiamin , and polyphenol intakes  were measured during a 4-wk baseline ( elderly and young ) and 6-wk double-blind ( elderly ) supplementation period . Only elderly subjects were r and omly assigned to placebo , folic acid ( 400 micrograms ) , thiamin ( 10 mg ) , or folic-acid-plus-thiamin groups .  Thiamin status ( TPP effect ) was not affected by folate status ( plasma and erythrocyte folate ) during the baseline period or with folic acid supplementation alone . Polyphenol intake was not correlated with thiamin status . Only thiamin intake and thiamin supplementation significantly affected thiamin status . Because the majority of subjects ( 102 of 160 ) were initially thiamin deficient , enrichment of Irish grain products with thiamin is recommended OBJECTIVE Recommendations on folic acid use to prevent neural tube defects have been launched in several countries . Adequate folic acid use seems to be low . This study assesses the prevalence of folic acid use and identifies its determinants . METHODS The study was embedded in the Generation R Study Rotterdam , the Netherl and s , a population -based prospect i ve cohort study between 2002 and 2006 . Complete information of 6940 women was available . Information on folic acid use and potential determinants was obtained by question naires and physical examination . RESULTS Of all women 37 % adequately used folic acid during the preconception period . Most important risk factors for inadequate use were unplanned pregnancy ( OR 9.5 , CI 7.2 - 12.4 , p<0.001 ) , low educational level ( OR 2.5 , CI 1.8 - 3.6 , p<0.001 ) and non-western ethnicity , ( OR 3.5 , CI 2.9 - 4.3 , p<0.001 ) . After stratification for ethnicity , unplanned pregnancy remained the most important risk factor for inadequate use . Other risk factors for inadequate use were younger age , single marital status , smoking , multiparity ( all p<0.001 ) and alcohol use ( p<0.05 ) . In contrast , previous spontaneous abortion decreased the risk of inadequate folic acid use ( p<0.001 ) . CONCLUSION Adequate preconception folic acid supplementation is still too low . Implementation of preconception programs and other public health strategies are strongly needed Background : Folic acid supplementation is effective in reducing the risk of neural tube defects ( NTDs ) . However , the use of folic acid is low among rural women in China . Nutrition education can provide information about folic acid and encourage its use . The primary objective of this study was to test the effectiveness of a village-based nutrition intervention on folic acid use among rural women . Methods : Sixty villages were r and omly selected using multiple-stage sampling and were divided into control and intervention groups . The intervention included nutritional education at village clinics , written material s , and text messages ( SMS ) .  Folic acid use knowledge and behavior was assessed at baseline and after the intervention . Results : Self-reported compliance with folic acid supplement use increased from 17.0%–29.2 % at baseline to 41.7%–59.2 % one year post-intervention . During the same period , the folic acid knowledge score in the intervention group increased from 3.07 to 3.65 , significantly higher than the control group ( 3.11 to 3.35 ) . Multivariate binary logistic regression showed that the women who received folic acid education and SMS intervention were more likely to comply with folic acid supplement recommendations . Conclusions : The results indicated that an integrated village-based folic acid education intervention may be an effective way of promoting folic acid use for the prevention of NTDs in rural women It is well established that folic acid supplementation in early pregnancy significantly reduces the incidence of neural tube defects ( NTDs ) [ 1 ] . Consistent with national guidelines [ 2 ] , it is current practice in the UK to advise pregnant women to take folic acid supplementation until 12 weeks gestation . A recent report , however , suggests that supplementation with folic acid throughout pregnancy may effect a reduction in adverse pregnancy outcomes [ 3 ] , although this is not yet confirmed . If folic acid supplementation throughout pregnancy led to a reduction in such outcomes , it would be a safe , simple , and inexpensive therapeutic intervention BACKGROUND There have been few reports of differential responses to nutrition interventions in women and children from poor households . Women from poor households have greater nutritional risks and are potentially a target group for programmes . We assessed the modifying effects of household wealth on responses to micronutrient supplements in pregnancy on newborn anthropometry and perinatal mortality . METHODS A cluster r and omized double-blind controlled trial conducted in two rural counties in northwestern China . All pregnant women in villages were r and omly allocated from enrolment until delivery to daily supplementation with folic acid ( control ) , iron/folic acid or multiple micronutrients ( MMNs ) with a recommended allowance of 15 vitamins and minerals . Wealth was based on a score from an inventory of household assets . RESULTS In the pregnant women from the poorest one-third of the households , MMN supplements significantly increased birth weight by 68 g [ 95 % confidence interval ( CI ) 4 - 131 g ] , reduced low birth weight by 60 % [ relative risks ( RRs ) 0.40 , 95 % CI 0.21 - 0.78 ] and tended to reduce early neonatal mortality by 52 % ( RR 0.48 , 95 % CI 0.17 - 1.36 ) compared with folic acid . Iron/folic acid significantly increased the duration of gestation by 0.41 weeks ( 95 % CI 0.18 - 0.65 ) , reduced pre-term birth by 45 % ( RR 0.55 , 95 % CI 0.32 - 0.93 ) and significantly reduced early neonatal mortality by 90 % ( RR 0.10 , 95 % CI 0.01 - 0.79 ) compared with folic acid . Iron/folic acid and MMN supplements had no significant effects in women from wealthier households . CONCLUSIONS In rural China , women from the poorest households had the largest perinatal outcome responses to micronutrient supplementation . In these women , st and ard iron/folic acid provided more protection for neonatal survival than MMN supplements Thirty three years ago Hibbard and Smithells linked folate deficiency in pregnancy with neural tube defects.1 Smithells then led a series of observational and intervention studies which showed that improving folic acid status early in the pregnancy of mothers who had previously had a child with neural tube defects reduced the recurrence in that pregnancy.2 A r and omised trial by Britain 's Medical Research Council confirmed that finding3 and a Hungarian trial showed a reduction in the first occurrence too . 4 To reach almost all women in the very early stages of pregnancy , when few would be sure they were pregnant , folic acid fortification of a staple food has been advocated , and a Department of Health committee has now recommended universal fortification of flour in the United Kingdom . Though the benefits are clear , the possible harms of such a policy are not . We need to be cautious in implementing a universal policy . After the initial British and Hungarian studies several others gave mostly similar results . 5 6 As a result a campaign led by the Health Education Authority in the UK aim ed to improve folate status from before conception to 12 weeks of pregnancy by increasing folic acid intake from foods and supplements . A third of An elevated plasma total homocysteine concentration is a risk factor for cardiovascular disease and neural tube defects . A high daily intake of supplemental folic acid is known to decrease total homocysteine concentrations . We studied the effect of low-dose folic acid administration ( 250 or 500 microg/day for 4 weeks on plasma total homocysteine concentrations and folate status . We also investigated whether total homocysteine concentrations and blood folate concentrations returned to baseline after an 8-week washout period . In this placebo-controlled study , 144 healthy women aged 18 - 40 years received 500 microg folic acid per day , 500 microg folic acid every second day ( 250 microg/day ) , or a placebo tablet with their habitual diet ( mean dietary folate intake 280 microg/day ) . Administration of 250 and 500 microg folic acid per day for four weeks significantly increased folate concentrations in plasma ( p<0.001 ) and red blood cells ( p<0.01 ) . Total homocysteine concentrations decreased significantly ( p<0.001 ) in women ( n=50 ) who took 250 microg folic acid daily [ mean ( + /- SEM ) deviation from baseline -11.4 + /-1.98 % ] and in women ( n=45 ) who took 500 microg folic acid daily ( -21.8 + /- 1.49 % ) . Eight weeks after the end of the intervention period ( week 12 ) , plasma total homocysteine concentrations in the folic acid-supplemented groups had not returned to baseline ( week 0 ) . In conclusion , doses of folic acid as low as 250 microg daily , on an average , in addition to usual dietary intakes of folate , significantly decreased plasma total homocysteine concentrations in healthy , young women . An 8-week washout period was not sufficient for blood folate and plasma total homocysteine concentrations to return to baseline Low-income pregnant women of Mexican descent were studied to determine whether their food habits could be improved by nutrition education . Biochemical indices of nutritional status were also investigated . Twenty-four-hour dietary recalls were obtained at an initial interview and again at a final interview after a nutrition education program , which was offered to a r and omly selected treatment group . At the initial interview , the mean nutrient intakes that were most often below two-thirds of the Recommended Dietary Allowance ( RDA ) were iron , vitamin A , thiamin , and calcium . The mean energy value of the diets was also frequently below the RDA . At the final intakes , although the mean energy values and the calcium and carbohydrate of both the control and treatment groups increased significantly , the following improvements in dietary intakes were seen only within the treatment group : 1 ) there were significant increases in the mean intake of protein , ascorbic acid , niacin , riboflavin , and thiamin , 2 ) there were significant decreases in the percentage of intakes below two-thirds of the RDA for ascorbic acid and riboflavin , and 3 ) there was a significant decrease in the incidence of multiple low nutrient intakes . These dietary improvements , which occurred only in the treatment group , suggest the effectiveness of the nutrition education program . The most common biochemical deficiencies were of folic acid , thiamin , and riboflavin . Except for an improvement in mean serum folate levels , the biochemical indices for the treatment group did not appear to be influenced by the nutrition education . It is possible that the vitamin and mineral supplements which were taken by 80 % of the women could have obscured improvements in biochemical indices which may have been due to the education program 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 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 Women ’s nutritional status during conception and early pregnancy can influence maternal and infant outcomes . This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce the prevalence of anemia during the periconceptional period among rural Tanzanian women and adolescent girls . Design A double-blind , r and omized controlled trial was conducted in which participants were individually r and omized to receive daily oral supplements of folic acid alone , folic acid and iron , or folic acid , iron , and vitamins A , B-complex , C , and E at approximately single recommended dietary allowance ( RDA ) doses for six months . Setting Rural Rufiji District , Tanzania . Subjects Non-pregnant women and adolescent girls aged 15–29 years ( n = 802 ) . Results The study arms were comparable in demographic and socioeconomic characteristics , food security , nutritional status , pregnancy history , and compliance with the regimen ( p>0.05 ) . In total , 561 participants ( 70 % ) completed the study and were included in the intention-to-treat analysis . Hemoglobin levels were not different across treatments ( median : 11.1 g/dL , Q1-Q3 : 10.0–12.4 g/dL , p = 0.65 ) . However , compared with the folic acid arm ( 28 % ) , there was a significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm ( 17 % , RR : 0.61 , 95 % CI : 0.42–0.90 , p = 0.01 ) and the folic acid , iron , and multivitamin arm ( 19 % , RR : 0.66 , 95 % CI : 0.45–0.96 , p = 0.03 ) . Inverse probability of treatment weighting ( IPTW ) to adjust for potential selection bias due to loss to follow-up did not material ly change these results . The effect of the regimens was not modified by frequency of household meat consumption , baseline underweight status , parity , breastfeeding status , or level of compliance ( in all cases , p for interaction>0.2 ) . Conclusions Daily oral supplementation with iron and folic acid among women and adolescents prior to pregnancy reduces risk of anemia . The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies . Trial Registration Clinical Trials.gov Zinc and folic acid nutritional status was evaluated in 74 low-income pregnant adolescents ranging from 13 to 18 years of age who received prenatal care at the Evangelina Rosa Maternity Hospital in Teresina , Piau State , Brazil . In order to evaluate the effects of different supplementation regimens on nutritional status , the adolescents were distributed into five groups . Groups I and II received equal amounts of folic acid ( 250 micro;g ) and different doses of iron ( ferrous sulfate ) , 120 and 80 mg , respectively . Groups III and IV received equal amounts of folic acid ( 250 micro;g ) associated with zinc sulfate and iron at doses of 120 and 80 mg , respectively , while group V received only 120 mg of iron ( routine dosage ) . There was a reduction in the zinc plasma concentration , and this decline was significant only in those groups which did not receive zinc supplementation . In relation to combination iron/folic acid and iron/folic acid/zinc  , an excellent response was observed for folic acid , and this effect was larger in the groups that received folic acid combined with zinc , suggesting a possible role for zinc in folic acid metabolism BACKGROUND Vitamin A deficiency remains a global public health problem . Daily supplementation with a lipid-based nutrient supplement ( LNS ) has potential for increasing milk vitamin A concentrations . OBJECTIVE The objective of this study was to determine whether daily supplementation with approximately the recommended daily intake of vitamin A in an LNS or a multiple-micronutrient supplement ( MMN ) during pregnancy and the first 6 mo postpartum has an effect on breast milk retinol concentration at 6 mo postpartum . METHODS Women ≤20 wk pregnant ( n = 1320 ) were r and omly assigned to receive either the MMN providing 18 micronutrients , including 800 μg retinol equivalents of vitamin A , or the LNS with the same nutrients as the MMN group , plus 4 minerals and macronutrients , until 6 mo postpartum ; a control group received iron and folic acid during pregnancy and a placebo ( calcium tablet ) during the first 6 mo postpartum . Breast milk sample s collected at 6 mo postpartum were analyzed for retinol and fat concentrations by HPLC and creamatocrit , respectively , in a sub sample of 756 women . RESULTS The breast milk retinol concentration was ( mean ± SD ) 56.3 ± 2.1 nmol/g fat , with no significant differences between groups [ iron and folic acid ( n = 243 ) : 59.1 ± 2.8 ; MMN ( n = 260 ) : 55.4 ± 2.5 ; LNS ( n = 253 ) : 54.7 ± 2.5 nmol/g fat ; P = 0.45 ] , regardless of whether the woman had or had not received a high-dose vitamin A supplement ( 200,000 IU ) soon after childbirth . Around 17 % of participants had low milk retinol ( ≤28 nmol/g fat ) . We estimated that 41 % of infants were potentially receiving vitamin A at amounts above the Tolerable Upper Intake Level ( 600 μg retinol activity equivalents/d ) , with no group differences in percentages with low or high milk retinol concentration . CONCLUSION Daily consumption of approximately the recommended intake of vitamin A did not increase breast milk retinol concentrations in this sample of Ghanaian women . This trial was registered at clinical trials.gov as NCT00970866 We studied the impact of a food supplementation program ( Plan Más Vida ( PMV ) ) on the micronutrient nutritional condition of pregnant women from low-income families 1 year after its implementation . The food program provided supplementary diet ( wheat and maize — fortified flour , rice or sugar , and fortified soup ) . We performed a prospect i ve , nonexperimental , cross-sectional study in the province of Buenos Aires , Argentina , evaluating pregnant women at baseline ( n = 164 ) and 1 year after PMV implementation ( n = 108 ) .  Biochemical tests ( hemogram , ferritin , vitamin A , zinc , and folic acid ) , anthropometric assessment s ( weight and height ) , and dietary surveys ( 24 h recall ) were performed at the two study points . One year after PMV implementation , no significant changes in anthropometric values were observed . Folic acid deficiency and the risk of vitamin A deficiency ( retinol , 20–30 μg/dl ) decreased significantly ( 35.8 to 6.1 % and 64 to 41 % , respectively ; p < 0.000 ) . Anemia and prevalence of iron and zinc deficiency values did not change . Diet survey results showed that although nutrient intake increased significantly , it was still below recommendations . Implementation of the PMV and of the government nutritional strategies had a high impact on the prevalence of folic acid deficiency . We also observed a decrease in the risk of vitamin A deficiency , and no impact on iron and zinc nutritional status . Adherence to the specific fortified food ( soup ) was not good and intra-family dilution and distribution of food was high Daily iron supplementation programs for pregnant women recommend amounts of iron that are considered by some to be excessive , and either lower-dose or less frequent iron supplementation regimens have been proposed . A r and omized , placebo-controlled study was performed to assess and compare the relative effectiveness of a weekly ( WS ) or twice weekly ( TW ) iron supplementation schedule in maintaining or achieving hemoglobin ( Hb ) levels at term considered to carry minimal maternal and fetal risk ( 90 - 130 g/L ) . Pregnant women ( n = 116 ) at wk 10 - 30 of gestation ( 63 WS and 53 TW ) were enrolled in the study ( 52 in WS and 44 TW completed the study ) . Women were r and omly allocated to receive a 120-mg oral dose of iron as ferrous sulfate and 0.5 mg of folic acid weekly ( n = 52 ) or 60 mg iron and 0.25 mg folic acid and a placebo twice weekly ( n = 44 ) . Hb , hematocrit , serum ferritin , and transferrin saturation were estimated at baseline and at 36 - 39 wk of gestation . Baseline dietary data and the presence and intensity of intestinal helminthic infections were assessed . The duration of supplementation was 14 + /- 4 wk and the median level of adherence was 60.5 % . Hb concentrations improved in women following the TW regimen and in women following WS who had low baseline Hb levels . About 89 % of WS women and 95 % of TW women maintained Hb levels at term ( between 90 g/L and 130 g/L ) , a range associated with optimal pregnancy outcomes . One woman in the TW group exhibited higher Hb levels that potentially carried perinatal risk ( > 130 g/L ) . Intermittent iron and folic acid supplementation may be a valid strategy when used as a preventive intervention in prenatal care setting OBJECTIVE Periconceptional use of folic acid can prevent birth defects , including at least 50 % of neural tube defects . This study used an ongoing surveillance system to explore the association between pregnancy intendedness and women taking periconceptional folic acid .  METHODS Oregon Pregnancy Risk Assessment Monitoring System ( PRAMS ) surveys a stratified r and om sample of women after a live birth . In 1998 - 1999 , 1867 women completed the survey ( 64.0 % response rate ) ; responses were weighted for nonresponse . Women were asked whether they took folic acid most days in the month before becoming pregnant . RESULTS Overall , 33.2 % of women took  folic acid most days in the month before becoming pregnant , and 39.9 % said that their pregnancy was unintended .  Adolescent mothers were less likely to take periconceptional folic acid  ( 9.2 % ) and more likely to report unintended pregnancy ( 62.0 % ) than older women . Overall , women who said that their pregnancy was intended were more likely to report that they had taken periconceptional folic acid  ( odds ratio : 4.75 ; 95 % confidence interval : 3.16 - 7.14 ) ; after controlling for maternal age and income the odds ratio was 3.70 ( 95 % confidence interval : 2.38 - 5.56 ) . CONCLUSIONS Women whose pregnancies were intended were more likely to have been taking  periconceptional folic acid  than women whose pregnancies were unintended . The importance of fertile women 's taking daily multivitamins that contain 400 microg ( 0.4 mg ) of folic acid should be stressed among women who are not contemplating pregnancy , especially adolescents and low-income women INTRODUCTION Iron deficiency is widespread in the developing world and is especially common in young children who live on the Indian subcontinent . Supplementation with iron and folic acid alleviates severe anaemia and enhances neurodevelopment in deficient population s , but little is known about the risks of mortality and morbidity associated with supplementation . METHODS We did a community-based , cluster-r and omised , double-masked , placebo-controlled , 2x2 factorial trial in children aged 1 - 36 months and residing in southern Nepal . We r and omly assigned children daily oral supplementation to age 36 months with : iron ( 12.5 mg ) and folic acid ( 50 microg ; n=8337 ) , zinc alone ( 10 mg ) , iron , folic acid , and zinc ( n=9230 ) , or placebo ( n=8683 ) ; children aged 1 - 11 months received half the dose . Our primary outcome measure was all-cause mortality , and our secondary outcome measures included cause-specific mortality and incidence and severity of diarrhoea , dysentery , and acute respiratory illness . Analyses were by intention to treat . This study is registered at , number NCT00109551 . FINDINGS The iron and folic acid-containing groups of the study were stopped early in November , 2003 , on the recommendation of the data and safety monitoring board ; mortality in these groups did not differ from placebo and there was low power to detect positive or negative effects by the time enrollment was completed . We continued to enroll children to the placebo and zinc alone groups . 25,490 children participated and analyses are based on 29,097.3 person-years of follow-up . There was no difference in mortality between the groups who took iron and folic acid without or with zinc when compared with placebo ( HR 1.03 , 95 % CI 0.78 - 1.37 , and 1.00 , 0.74 - 1.34 , respectively ) . There were no significant differences in the attack rates for diarrhoea , dysentery , or respiratory infections between groups , although all the relative risks except one indicated modest , non-significant protective effects . INTERPRETATION Daily supplementation of young children in southern Nepal with iron and folic acid with or without zinc has no effect on their risk of death , but might protect against diarrhoea , dysentery , and acute respiratory illness 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 Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus , thus supplements are recommended . Adherence to current tablet-based supplements is documented to be poor . Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence . However , before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy , the bioavailability of the iron needs to be determined . Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women . Methods Eighteen healthy pregnant women ( 24 – 32 weeks gestation ) were r and omized to receive the supplements in a crossover design . Following ingestion of each supplement , the changes ( over baseline ) in serum iron and folate over 8 hours were determined . The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid ; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid . Results Overall absorption of iron from the powdered supplement was significantly lower than the tablet ( p = 0.003 ) . There was no difference in the overall absorption of folic acid between supplements . Based on the differences in the area under the curve and doses , the relative bioavailability of iron from powdered supplement was lower than from the tablet ( 0.22 ) . Conclusion The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports . However , since pills and capsules are known to be poorly accepted by some women during pregnancy , it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose .Trial Registration Clinical Trials.gov Abstract Objective : To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women . Design : Double blind cluster r and omised controlled trial . Setting : Rural community in south eastern Nepal . Participants : 4926 pregnant women and 4130 live born infants . Interventions : 426 communities were r and omised to five regimens in which pregnant women received daily supplements of folic acid , folic acid-iron , folic acid-iron-zinc , or multiple micronutrients all given with vitamin A , or vitamin A alone ( control ) . Main outcome measures : Birth weight , length , and head and chest circumference assessed within 72 hours of birth . Low birth weight was defined < 2500 g. Results : Supplementation with maternal folic acid alone had no effect on birth size . Folic acid-iron  increased mean birth weight by 37 g ( 95 % confidence interval −16 g to 90 g ) and reduced the percentage of low birthweight babies ( < 2500 g ) from 43 % to 34 % ( 16 % ; relative risk=0.84 , 0.72 to 0.99 ) . Folic acid-iron-zinc had no effect on birth size compared with controls . Multiple micronutrient supplementation  increased birth weight by 64 g ( 12 g to 115 g ) and reduced the percentage of low birthweight babies by 14 % ( 0.86 , 0.74 to 0.99 ) . None of the supplement combinations reduced the incidence of preterm births . Folic acid-iron and multiple micronutrients increased head and chest circumference of babies , but not length . Conclusions : Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight . Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk . What is already known on this topic Deficiencies in micronutrients are common in women in developing countries and have been associated with low birth weight and preterm delivery What this study adds In rural Nepal maternal supplementation with folic acid-iron reduced the incidence of low birth weight by 16 % A multiple micronutrient supplement of 14 micronutrients , including folic acid , iron , and zinc , reduced low birth weight by 14 % , thus conferring no advantage over folic
There were factors that are particularly associated with lower rates of use of folic acid supplements .
One of the most important of these is the link with unintended pregnancy , followed by age , socio-economic and ethnic group .
Integrated campaigns can increase the use of folic acid supplements to some extent .
Research trials indicated that : ( i ) printed re sources and the mass media used in isolation are not effective in the longer term ; and ( ii ) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available .
Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use .
However , even high- quality campaigns that increase use result in under half of women in the target group taking supplements
OBJECTIVE To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK , particularly among low-income and young women .