Prevalence of multiple micronutrient deficiencies amongst pregnant women in a rural area of Haryana.
Deficiencies of micronutrients (zinc, iron, folic acid and iodine) during pregnancy are known causes of Low Birth Weight (LBW). Studies have documented status of one or two micronutrients amongst pregnant women (PW). However, no attempt has been made to concurrently assess the prevalence of multiple micronutrient deficiencies and the factors associated with them amongst PW.


OBJECTIVE
The present study was undertaken to assess the prevalence of multiple micronutrient deficiencies amongst PW in a rural area.


METHODS
A community based cross sectional survey was conducted in six villages of a rural area of district Faridabad in Haryana state, India during November 2000 and October 2001. All PW aged 18 years or more, with pregnancy duration of more than 28 weeks were enrolled. Data were collected on socio-economic status and other demographic parameters. Serum zinc, copper and magnesium levels were estimated by utilizing the Atomic absorption spectrophotometry (AAS); serum ferritin and folate was estimated by Enzyme Linked Immuno Sorbent Assay (ELISA) method and the Radio-Immuno Assay (RIA) method, respectively and serum thyroid stimulating hormone (TSH) level was estimated by the Abbot AxSYM System. Serum zinc, copper, magnesium, ferritin, and folate levels less than 70.0 microg/dl, 80.0 microg/dl, 1.80 mg/dl, 15 ng/ml, and 3 ng/ml, respectively were considered as indicative of deficiency for respective micronutrients. The TSH levels of 4.670 and more indicated iodine deficiency status. Dietary intake of micronutrients was assessed utilizing 1-day 24-hour dietary recall methodology. Food consumption pattern was assessed utilizing the food frequency questionnaire methodology.


RESULTS
Nearly 73.5, 2.7, 43.6, 73.4, 26.3, and 6.4 percent PW were deficient in zinc, copper, magnesium, iron, folic acid and iodine, respectively. The highest concurrent prevalence of two, three, four and five micronutrient deficiency was of zinc and iron (54.9%); zinc, magnesium and iron (25.6%); zinc, magnesium, iron and folic acid (9.3%) and zinc, magnesium, iron, folic acid and iodine (0.8%), respectively. No pregnant woman was found to have concomitant deficiencies of all the six micronutrients. Dietary intake data revealed an inadequate nutrient intake. Over 19% PW were consuming less than 50% of the recommended calories. Similarly, 99, 86.2, 75.4, 23.6, 3.9 percent of the PW were consuming less than 50% of the recommended folic acid, zinc, iron, copper, and magnesium. The consumption of food groups rich in micronutrients (pulses, vegetables, fruits, nuts and oil seeds, animal foods) was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of nutrients, low frequency of consumption of food groups rich in micronutrients and increased reproductive cycles with short interpregnancy intervals were important factors leading to micronutrient deficiencies.


CONCLUSIONS
There was a high prevalence of micronutrient deficiencies amongst the PW of the area, possibly due to the poor dietary intake of food and low frequency of consumption of food groups rich in micronutrients. The concurrent prevalence of two, three, four and five micronutrient deficiencies were common.
Pathak
Priyali
P
Department of Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110-029, India.
Kapil
Umesh
U
Kapoor
Suresh Kumar
SK
Saxena
Renu
R
Kumar
Anand
A
Gupta
Nandita
N
Dwivedi
Sada Nand
SN
Singh
Rajvir
R
Singh
Preeti
P
D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000453:epidemiology; D003300:Copper / Q000172:deficiency / Q000627:therapeutic use; D003906:Developing Countries; D019587:Dietary Supplements; D005260:Female; D048070:Fetal Nutrition Disorders / Q000517:prevention & control; D005494:Folic Acid Deficiency / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008275:Magnesium Deficiency / Q000188:drug therapy / Q000517:prevention & control; D044342:Malnutrition / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018977:Micronutrients / Q000172:deficiency* / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population; D015032:Zinc / Q000172:deficiency / Q000627:therapeutic use
D018977:Micronutrients; D003300:Copper; D015032:Zinc