title: Anemia in Brazilian pregnant women before and after flour fortification with iron.
abstract: OBJECTIVE
  To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron.
  
  
  METHODS
  A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Student's t tests, and logistic regression, with a significance level of 5%.
  
  
  RESULTS
  In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05).
  
  
  CONCLUSIONS
  Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.
authors: Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Elizabeth
authors: E
authors: Fujimori
authors: Ana Paula Sayuri
authors: AP
authors: Sato
authors: Sophia Cornbluth
authors: SC
authors: Szarfarc
authors: Gloria Valeria da
authors: GV
authors: Veiga
authors: Valterlinda Alves de
authors: VA
authors: Oliveira
authors: Célia
authors: C
authors: Colli
authors: Regilda Saraiva dos Reis
authors: RS
authors: Moreira-Araújo
authors: Ilma Kruze Grande de
authors: IK
authors: Arruda
authors: Taqueco Teruya
authors: TT
authors: Uchimura
authors: Gisela Soares
authors: GS
authors: Brunken
authors: Lucia Kiyoko Ozaki
authors: LK
authors: Yuyama
authors: Pascoal Torres
authors: PT
authors: Muniz
authors: Silvia Eloiza
authors: SE
authors: Priore
authors: Maria Alice
authors: MA
authors: Tsunechiro
authors: Andréa das Graças Ferreira
authors: Ad
authors: Frazão
authors: Cynthia R Matos Silva
authors: CR
authors: Passoni
authors: Claudia Regina Marchiori Antunes
authors: CR
authors: Araújo
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D001938:Brazil / Q000453:epidemiology; D003695:Delivery of Health Care; D003710:Demography / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D005433:Flour; D005527:Food, Fortified / Q000032:analysis*; D005865:Gestational Age; D006441:Hemoglobin A / Q000032:analysis*; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000178:diet therapy / Q000453:epidemiology*; D011295:Prenatal Care
chemical_list: D019266:Iron, Dietary; D006441:Hemoglobin A