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
. 2015 Apr 23;10(4):e0121552.
doi: 10.1371/journal.pone.0121552. eCollection 2015.

Multivitamin and iron supplementation to prevent periconceptional anemia in rural tanzanian women: a randomized, controlled trial

Nilupa S Gunaratna  1 , Honorati Masanja  2 , Sigilbert Mrema  2 , Francis Levira  2 , Donna Spiegelman  3 , Ellen Hertzmark  4 , Naomi Saronga  5 , Kahema Irema  2 , Mary Shuma  2 , Ester Elisaria  2 , Wafaie Fawzi  6
Affiliations
Randomized Controlled Trial

Multivitamin and iron supplementation to prevent periconceptional anemia in rural tanzanian women: a randomized, controlled trial

Nilupa S Gunaratna et al. PLoS One. .

Abstract

Objective: Women's nutritional status during conception and early pregnancy can influence maternal and infant outcomes. This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce the prevalence of anemia during the periconceptional period among rural Tanzanian women and adolescent girls.

Design: A double-blind, randomized controlled trial was conducted in which participants were individually randomized to receive daily oral supplements of folic acid alone, folic acid and iron, or folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance (RDA) doses for six months.

Setting: Rural Rufiji District, Tanzania.

Subjects: Non-pregnant women and adolescent girls aged 15-29 years (n = 802).

Results: The study arms were comparable in demographic and socioeconomic characteristics, food security, nutritional status, pregnancy history, and compliance with the regimen (p>0.05). In total, 561 participants (70%) completed the study and were included in the intention-to-treat analysis. Hemoglobin levels were not different across treatments (median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65). However, compared with the folic acid arm (28%), there was a significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm (17%, RR: 0.61, 95% CI: 0.42-0.90, p = 0.01) and the folic acid, iron, and multivitamin arm (19%, RR: 0.66, 95% CI: 0.45-0.96, p = 0.03). Inverse probability of treatment weighting (IPTW) to adjust for potential selection bias due to loss to follow-up did not materially change these results. The effect of the regimens was not modified by frequency of household meat consumption, baseline underweight status, parity, breastfeeding status, or level of compliance (in all cases, p for interaction>0.2).

Conclusions: Daily oral supplementation with iron and folic acid among women and adolescents prior to pregnancy reduces risk of anemia. The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies.

Trial registration: ClinicalTrials.gov NCT01183572.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of study participants.
See this image and copyright information in PMC

References

    1. Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: Systematic review and meta-analysis. British Medical Journal. 2013;346:f3443 10.1136/bmj.f3443 - DOI - PMC - PubMed
    1. Stoltzfus RJ, Mullany L, Black RE. Chapter 3. Iron-deficiency anemia In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. 1 Geneva: World Health Organization; 2004. p. 163–209.
    1. Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. The Lancet. 2011;378:2123–35. 10.1016/S0140-6736(10)62304-5 - DOI - PubMed
    1. Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutrition Reviews. 2011;69:S23–S9. 10.1111/j.1753-4887.2011.00429.x - DOI - PMC - PubMed
    1. Bothwell TH. Iron requirements in pregnancy and strategies to meet them. American Journal of Clinical Nutrition. 2000;72:257S–64S. - PubMed

Publication types

Associated data