Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2013;10(6):e1001470.
doi: 10.1371/journal.pmed.1001470. Epub 2013 Jun 18.

The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Viet Nam: a cluster randomised trial

Sarah Hanieh  1 , Tran T Ha, Julie A Simpson, Gerard J Casey, Nguyen C Khuong, Dang D Thoang, Tran T Thuy, Sant-Rayn Pasricha, Thach D Tran, Tran Tuan, Terence Dwyer, Jane Fisher, Beverley-Ann Biggs
Affiliations
Randomized Controlled Trial

The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Viet Nam: a cluster randomised trial

Sarah Hanieh et al. PLoS Med. 2013.

Abstract

Background: Anemia affects over 500 million women, and in pregnancy is associated with impaired maternal and infant outcomes. Intermittent antenatal iron supplementation is an attractive alternative to daily dosing; however, the impact of this strategy on infant outcomes remains unclear. We compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Viet Nam.

Methods and findings: This cluster randomised trial was conducted in Ha Nam province, Viet Nam. 1,258 pregnant women (< 16 wk gestation) in 104 communes were assigned to daily iron-folic acid (IFA), twice weekly IFA, or twice weekly multiple micronutrient (MMN) supplementation. Primary outcome was birth weight. Mean birth weight was 3,148 g (standard deviation 416). There was no difference in the birth weights of infants of women receiving twice weekly IFA compared to daily IFA (mean difference [MD] 28 g; 95% CI -22 to 78), or twice weekly MMN compared to daily IFA (MD -36.8 g; 95% CI -82 to 8.2). At 32 wk gestation, maternal ferritin was lower in women receiving twice weekly IFA compared to daily IFA (geometric mean ratio 0.73; 95% CI 0.67 to 0.80), and in women receiving twice weekly MMN compared to daily IFA (geometric mean ratio 0.62; 95% CI 0.57 to 0.68), but there was no difference in hemoglobin levels. Infants of mothers who received twice weekly IFA had higher cognitive scores at 6 mo of age compared to those who received daily IFA (MD 1.89; 95% CI 0.23 to 3.56).

Conclusions: Twice weekly antenatal IFA or MMN did not produce a clinically important difference in birth weight, when compared to daily IFA supplementation. The significant improvement in infant cognitive outcomes at 6 mo of age following twice weekly antenatal IFA requires further exploration, and provides additional support for the use of intermittent, rather than daily, antenatal IFA in populations with low rates of iron deficiency.

Trial registration: Australia New Zealand Clinical Trials Registry 12610000944033.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Trial profile.
Late neonatal death was defined as death after the first 24 h and before 24 d of life.
See this image and copyright information in PMC

References

    1. World Health Organization (2008) Worldwide prevalence of anaemia: 1993–2005: WHO global database on anaemia. Geneva: World Health Organization.
    1. World Health Organization (2001) Iron deficiency anaemia: assessment, prevention and control—a guide for programme managers. Geneva: World Health Organization.
    1. International Anemia Consultative Group Symposium (2002) Report of the 2001 International Anemia Consultative Group Symposium. Why is iron important and what to do about it: a new perspective. Washington (District of Columbia): International Anemia Consultative Group Symposium. 50 p.
    1. World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization.
    1. Murphy JF, O'Riordan J, Newcombe RG, Coles EC, Pearson JF (1986) Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet 1: 992–995. - PubMed

Publication types

MeSH terms