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Daily Maternal Lipid-Based Nutrient Supplementation with 20 mg Iron, Compared with Iron and Folic Acid with 60 mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh.
J Nutr. 2018 10 01; 148(10):1615-1624.JN

Abstract

Background

Maternal anemia and iron deficiency are prevalent in low- and middle-income countries.

Objective

We aimed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on hemoglobin (Hb), anemia, and iron status (nonprimary outcomes) at 36 weeks of gestation (women) and 6 mo postpartum (women and infants).

Methods

The Rang-Din Nutrition Study, a cluster-randomized effectiveness trial, enrolled 4011 Bangladeshi pregnant women at ≤20 weeks of gestation to receive either daily LNS-PL (20 mg Fe) during pregnancy and the first 6 mo postpartum, or iron and folic acid (IFA, 60 mg Fe + 400 µg folic acid) daily during pregnancy and every other day during the first 3 mo postpartum. Biochemical measurements from a subsample of women (n = 1128) and their infants (n = 1117) included Hb (g/L), serum ferritin (µg/L), and soluble transferrin receptor (sTfR; mg/L). Anemia was defined as maternal Hb <110 g/L at 36 weeks of gestation, <120 g/L at 6 mo postpartum, or infant Hb <105 g/L; iron deficiency (ID) was defined as ferritin <12 µg/L or elevated sTfR (>8.3 mg/L for women and >11 mg/L for infants).

Results

Compared with the IFA group, women in the LNS-PL group had lower ferritin (-6.2 µg/L; P < 0.001) and higher sTfR concentrations (+0.5 mg/L; P < 0.001), and higher risk of ID (OR = 1.93; P < 0.05) at 36 weeks of gestation but not at 6 mo postpartum, whereas no consistent differences were observed for Hb or anemia. Among infants at 6 mo, there were no group differences except for a lower risk of elevated sTfR (OR = 0.61; P < 0.05) in the LNS-PL group than in the IFA group.

Conclusions

Provision of LNS-PL including a lower dose of iron than what is recommended during pregnancy resulted in differences in maternal iron status in late pregnancy that disappeared by 6 mo postpartum, and caused no undesirable effects regarding anemia or iron status of infants. This trial was registered at clinicaltrials.gov as NCT01715038.

Authors+Show Affiliations

Department of Nutrition, University of California, Davis, Davis, CA.Department of Nutrition, University of California, Davis, Davis, CA. James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.Department of Nutrition, University of California, Davis, Davis, CA.Consultant, Dhaka, Bangladesh.Department of Nutrition, University of California, Davis, Davis, CA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

30204885

Citation

Matias, Susana L., et al. "Daily Maternal Lipid-Based Nutrient Supplementation With 20 Mg Iron, Compared With Iron and Folic Acid With 60 Mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh." The Journal of Nutrition, vol. 148, no. 10, 2018, pp. 1615-1624.
Matias SL, Mridha MK, Young RT, et al. Daily Maternal Lipid-Based Nutrient Supplementation with 20 mg Iron, Compared with Iron and Folic Acid with 60 mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh. J Nutr. 2018;148(10):1615-1624.
Matias, S. L., Mridha, M. K., Young, R. T., Hussain, S., & Dewey, K. G. (2018). Daily Maternal Lipid-Based Nutrient Supplementation with 20 mg Iron, Compared with Iron and Folic Acid with 60 mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh. The Journal of Nutrition, 148(10), 1615-1624. https://doi.org/10.1093/jn/nxy161
Matias SL, et al. Daily Maternal Lipid-Based Nutrient Supplementation With 20 Mg Iron, Compared With Iron and Folic Acid With 60 Mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh. J Nutr. 2018 10 1;148(10):1615-1624. PubMed PMID: 30204885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Daily Maternal Lipid-Based Nutrient Supplementation with 20 mg Iron, Compared with Iron and Folic Acid with 60 mg Iron, Resulted in Lower Iron Status in Late Pregnancy but Not at 6 Months Postpartum in Either the Mothers or Their Infants in Bangladesh. AU - Matias,Susana L, AU - Mridha,Malay K, AU - Young,Rebecca T, AU - Hussain,Sohrab, AU - Dewey,Kathryn G, PY - 2018/01/29/received PY - 2018/07/02/accepted PY - 2018/9/12/pubmed PY - 2019/5/6/medline PY - 2018/9/12/entrez SP - 1615 EP - 1624 JF - The Journal of nutrition JO - J. Nutr. VL - 148 IS - 10 N2 - Background: Maternal anemia and iron deficiency are prevalent in low- and middle-income countries. Objective: We aimed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on hemoglobin (Hb), anemia, and iron status (nonprimary outcomes) at 36 weeks of gestation (women) and 6 mo postpartum (women and infants). Methods: The Rang-Din Nutrition Study, a cluster-randomized effectiveness trial, enrolled 4011 Bangladeshi pregnant women at ≤20 weeks of gestation to receive either daily LNS-PL (20 mg Fe) during pregnancy and the first 6 mo postpartum, or iron and folic acid (IFA, 60 mg Fe + 400 µg folic acid) daily during pregnancy and every other day during the first 3 mo postpartum. Biochemical measurements from a subsample of women (n = 1128) and their infants (n = 1117) included Hb (g/L), serum ferritin (µg/L), and soluble transferrin receptor (sTfR; mg/L). Anemia was defined as maternal Hb <110 g/L at 36 weeks of gestation, <120 g/L at 6 mo postpartum, or infant Hb <105 g/L; iron deficiency (ID) was defined as ferritin <12 µg/L or elevated sTfR (>8.3 mg/L for women and >11 mg/L for infants). Results: Compared with the IFA group, women in the LNS-PL group had lower ferritin (-6.2 µg/L; P < 0.001) and higher sTfR concentrations (+0.5 mg/L; P < 0.001), and higher risk of ID (OR = 1.93; P < 0.05) at 36 weeks of gestation but not at 6 mo postpartum, whereas no consistent differences were observed for Hb or anemia. Among infants at 6 mo, there were no group differences except for a lower risk of elevated sTfR (OR = 0.61; P < 0.05) in the LNS-PL group than in the IFA group. Conclusions: Provision of LNS-PL including a lower dose of iron than what is recommended during pregnancy resulted in differences in maternal iron status in late pregnancy that disappeared by 6 mo postpartum, and caused no undesirable effects regarding anemia or iron status of infants. This trial was registered at clinicaltrials.gov as NCT01715038. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/30204885/Daily_Maternal_Lipid_Based_Nutrient_Supplementation_with_20_mg_Iron_Compared_with_Iron_and_Folic_Acid_with_60_mg_Iron_Resulted_in_Lower_Iron_Status_in_Late_Pregnancy_but_Not_at_6_Months_Postpartum_in_Either_the_Mothers_or_Their_Infants_in_Bangladesh_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.1093/jn/nxy161 DB - PRIME DP - Unbound Medicine ER -