Antenatal Iron Supplementation Regimens for Pregnant Women in Rural Vietnam and Subsequent Haemoglobin Concentration and Anaemia among Their Infants.
BACKGROUND
Little evidence about the effects of antenatal iron supplementation on infant anaemia is available. The aim was to compare effects on six-month-old infants' Haemoglobin (Hb) concentration and anaemia of daily iron-folic acid (IFA), twice-weekly IFA with or without other micronutrients (MMN) and usual antenatal care in rural Vietnam.


RESULTS
Secondary data analysis from: a prospective population-based observational study (OS) which examined effects of antenatal psychosocial factors, anaemia and iron deficiency on infant development and health; and a three-arm cluster randomised trial (CRT) of different antenatal iron supplementation regimens. In the OS 497 women (<20 weeks gestation) from 50 randomly-selected communes participated, and in the CRT 1,258 pregnant women (<16 weeks gestation) in 104 communes were allocated randomly to trial arms. The main outcome was six-month-old infant Hb concentration. Baseline data included women's socio-demographic characteristics, reproductive health, Hb and serum ferritin. Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models, controlling for baseline differences and clustering, using robust standard errors. Infant anaemia prevalence was 68.6% in the OS, 47.2% daily IFA, 53.5% weekly IFA, and 50.3% MMN conditions. After adjustment, mean infant haemoglobin levels in daily IFA (mean difference = 0.95 g/dL; 95%CI 0.7-11.18); weekly IFA (0.91; 95%CI 0.69-1.12) and MMN (1.04; 95%CI 0.8-1.27) were higher than in the OS. After adjustment there were lower odds ratios of anaemia among infants in the daily IFA (OR = 0.31; 95% CI 0.22-0.43), weekly IFA (0.38; 95%CI 0.26-0.54) and MMN (0.33; 95%CI 0.23-0.48) groups than in the OS.


CONCLUSIONS
Infant anaemia is a public health problem in Vietnam and other resource-constrained countries. All supplementation regimens could have clinically significant benefits for Hb and reduce anaemia risk among six-month-old infants. Universal provision of free intermittent iron supplements is warranted.
Research and Training Centre for Community Development, Hanoi, Vietnam; Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Thach Duc
TD
Tran
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Jane
J
Fisher
Department of Medicine (RMH/WH), The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Sarah
S
Hanieh
Research and Training Centre for Community Development, Hanoi, Vietnam.
Tuan
T
Tran
Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Julie Anne
JA
Simpson
Research and Training Centre for Community Development, Hanoi, Vietnam.
Ha
H
Tran
Department of Medicine (RMH/WH), The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Beverley-Ann
BA
Biggs
D000328:Adult; D000740:Anemia / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D019587:Dietary Supplements; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007501:Iron / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
D006454:Hemoglobins; D007501:Iron