Impact of multiple micronutrient versus iron-folic acid supplements on maternal anemia and micronutrient status in pregnancy

Lindsay H. Allen, Janet M. Peerson, Pierre Adou, Victor M. Aguayo, Zulfiqar Ahmed Bhutta, Parul Christian, Shaonong Dang, Gwenola Desplats, Michael Dibley, Shams El Arifeen, Caroline Fall, David Fisher, Henrik Friis, Exnevia Gomo, Batool Azra Haider, Adi Hidayat, Alan Jackson, Abbas Jahari, Pernille Kaestel, Patrick KolsterenKusharisupeni, Aissa Mamadoultaibou, Dharma Sharna Mandandhar, Barrie Margetts, David Osrin, Lars Ake Persson, Usha Ramakrishnan, Dominique Roberfroid, Carine Ronsmans, Anuraj H. Shankar, Subarkah, Sunawang, Budi Otomo, Anjana Vaidya, Hong Yan, Noel Zagre, Lingxia Zeng

Research output: Contribution to journalArticle

Abstract

Background. Multiple micronutrient supplements could increase hemoglobin and improve micronutrient status of pregnant women more than iron supplements alone or iron with folic acid. Objective. To compare the effects of multiple micro-nutrients with those of iron supplements alone or iron with folic acid, on hemoglobin and micronutrient status of pregnant women. Methods. Studies were identified in which pregnant women were randomized to treatment with multiple micronutrients, or with iron with or without folic acid. A pooled analysis was conducted to compare the effects of these supplements on maternal hemoglobin, anemia, and micronutrient status. Effect size was calculated for individual and combined studies, based on mean change from baseline to final measure in the group receiving iron, with or without folic acid, minus the mean change in the group, divided by the pooled standard deviation of the two groups. The effect on the relative risk of anemia or iron deficiency was calculated as the probability of anemia or iron deficiency in the group receiving multiple micronutrients divided by the probability in the group receiving iron, with or without folic acid. Results. Multiple micronutrient supplements had the same impact on hemoglobin and iron status indicators as iron with or without folic acid. There was no overall effect on serum retinol or zinc. In the only study in which status of other micronutrients was analyzed, a high prevalence of multiple deficiencies persisted in the group receiving multiple micronutrients provided with daily recommended intakes of each nutrient. Conclusions. Multiple micronutrient supplements increased hemoglobin synthesis to the same extent as supplementation with iron with or without folic acid, although often they contained lower amounts of iron. The amount of supplemental iron and other nutrients that can enable pregnant women with micronutrient deficien- cies to achieve adequate status remains to be determined.

Original languageEnglish (US)
Pages (from-to)S527-S532
JournalFood and nutrition bulletin
Volume30
Issue number4 SUPPL.
StatePublished - Dec 1 2009

    Fingerprint

Keywords

  • Folic acid
  • Iron
  • Multiple micronutrients
  • Pregnancy
  • Supplements

ASJC Scopus subject areas

  • Food Science
  • Geography, Planning and Development
  • Nutrition and Dietetics

Cite this

Allen, L. H., Peerson, J. M., Adou, P., Aguayo, V. M., Bhutta, Z. A., Christian, P., Dang, S., Desplats, G., Dibley, M., Arifeen, S. E., Fall, C., Fisher, D., Friis, H., Gomo, E., Haider, B. A., Hidayat, A., Jackson, A., Jahari, A., Kaestel, P., ... Zeng, L. (2009). Impact of multiple micronutrient versus iron-folic acid supplements on maternal anemia and micronutrient status in pregnancy. Food and nutrition bulletin, 30(4 SUPPL.), S527-S532.