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This Article Full Text Full Text (PDF) All Versions of this Article: 90/5/1295    most recent ajcn.2009.28350v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Khambalia, A. Z Articles by Zlotkin, S. H PubMed PubMed Citation Articles by Khambalia, A. Z Articles by Zlotkin, S. H Agricola Articles by Khambalia, A. Z Articles by Zlotkin, S. H

Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh^1,2,3,4

¹ From the Department of Nutritional Sciences (AZK DLOSHZ) the Department of Pediatrics (SHZCM)the Dalla Lana School of Public Health (SHZ) University of Toronto Toronto Canada; the Department of PediatricsResearch Institute Hospital for Sick Children Toronto Canada (AZK DLO ADSHZ);the Bloorview Research Institute Toronto Canada (CMAD).

² The sources of funding for the research (Foundation of the Hospital for Sick Children and HJ Heinz Company Foundation) had no input into the design, analysis or interpretation of the data.

³ Supported by the Foundation of the Hospital for Sick Children and the HJ Heinz Company Foundation for studies on micronutrient deficiencies and the use of the micronutrient powder, Sprinkles, to treat and prevent micronutrient deficiencies (to SHZ). AZK was supported by the Enid Walker Award and the Helen Marion Walker Award from the Women's College Research Institute and the Danone Doctoral Award in Education and Communication from the Danone Institute.

⁴ Address correspondence and requests for reprints to SH Zlotkin. Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, 555 University Avenue, Suite 8260 Toronto, ON, Canada M5G1X8. E-mail: stanley.zlotkin{at}sickkids.ca.

Background: There is a growing interest in periconceptional iron supplementation in developing countries by researchers and policy makers; however, there are no randomized controlled trials that examine the effectiveness of this strategy in decreasing anemia during pregnancy.

Objective: The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy.

Design: A randomized, double-blind, controlled trial was conducted in rural Bangladesh. Married, nulliparous women were randomly assigned to receive daily iron and folic acid (IFA; 60 mg ferrous fumarate and 400 µg folic acid) (n = 134) or folic acid (FA; 400 µg) (n = 138) in the form of a powdered supplement added to food. Women were followed until pregnancy or the end of 9 mo. Primary outcomes included hemoglobin, plasma ferritin, and plasma transferrin receptor concentrations.

Results: Among 88 pregnant women, periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation. However, each 1% increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline (P = 0.03), and those who initiated supplementation at a mean (±SD) time of 72.9 ± 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 ± 12.3 d after conception (P = 0.01). Among 146 nonpregnant women, IFA decreased anemia (odds ratio: 0.19; 95% CI: 0.04, 0.95) and improved iron stores (P = 0.001) more than did FA.

Conclusion: Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy. This trial was registered at www.clinicaltrials.gov as NCT00953134.