The effect of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women (original) (raw)
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Nutrition of Indonesian women during pregnancy and lactation: a focus on vitamin A and iron
2001
Nutrition during pregnancy is important for women's health, outcome of pregnancy and child survival. A community-based study was conducted in a rural area of West Java, Indonesia to investigate 1) the effect of weekly vitamin A and iron supplementation during pregnancy on iron and vitamin A status of women near term and on postpartum and pregnancy outcomes, 2) whether weekly iron supplementation was as effective as the ongoing national iron supplementation program in improving iron status. Women from 5 villages, 16-20 weeks pregnant, aged 17-35 years, parity <6, and with hemoglobin concentrations 80-140 g/L, were randomly allocated on an individual basis to receive a weekly supplement either with 120 mg iron as Fe 2 S0 4 and 500 ug folic acid (n = 121) or the same amount of iron and folic acid plus 4,800 RE vitamin A (n = 122). A third group participating in the ongoing national iron supplementation program in which women are advised to take iron tablets daily during pregnancy ("daily" group) was recruited at the same time from 4 neighboring villages (n = 123). At near term, the iron status of pregnant women in the group supplemented weekly with iron (n = 66) was not different from the "daily" group (n = 53). However, iron status decreased with daily iron supplementation if <50 iron tablets were ingested. Hemoglobin concentrations in the group supplemented weekly with iron and vitamin A (n = 71) increased but serum ferritin concentrations decreased significantly, suggesting that vitamin A improved utilization of iron for hematopoiesis. Concentrations of serum transferrin receptor increased significantly in all groups. Serum retinol concentrations remained constant in the weekly iron and vitamin A group but decreased significantly in the other two groups. At ~4 months postpartum, compared with the weekly iron group (n = 88), the weekly iron and vitamin A group (n = 82) had significantly fewer subjects with serum retinol concentrations <0.70 umol/L. The iron status of women in the weekly iron and vitamin A group did not differ from that of women in the weekly iron group. The concentrations of iron and retinol in transitional milk (4-7 days postpartum) was almost double than that in mature milk (3 months postpartum). Compared with the weekly iron group, the weekly iron and vitamin A group had significantly higher concentrations of retinol in transitional milk (as umol/L) and in mature milk (as umol/g fat). Neonatal weight (3094 ± 440 g) and length (49.1 ± 2.0 cm) did not differ among the three groups (n = 296). Iron and vitamin A status during pregnancy did not influence neonatal weight and length. Gestational age, maternal weight at the beginning of the second trimester and infant gender were the main predictors of neonatal weight and length. The proportion of women with a body mass index <21.0 kg/m 2 was 37% at the beginning of the second trimester of pregnancy and 52% at ~4 months postpartum. Low nutritional status of the women was associated with household characteristics reflecting a lower socioeconomic status. In conclusion, compared with weekly supplementation with iron alone, supplementation with vitamin A and iron given at the time when women entered their second trimester of pregnancy prevented the deterioration of vitamin A status near term and ~4 month postpartum, and increased retinol concentration in breast milk. The performance of weekly iron supplementation did not differ from the ongoing daily iron supplementation program in improving the iron status during pregnancy and lactation. Intervention did not influence weight and length of the neonates. It is recommended to include vitamin A in the iron supplementation program. Contents Chapter 1 Introduction 9 Chapter Weekly supplementation with iron and vitamin A 29 during pregnancy increases hemoglobin concentration but decreases serum ferritin concentration in Indonesian pregnant women
ABSTRAK Latar belakang: Nutrisi maternal sebelum dan saat hamil penting untuk luaran kehamilan yang sehat. Berdasarkan Riset Kesehatan Dasar (Riskesdas) 2013, sebesar 24,2% ibu hamil memiliki risiko kurang energi kronis (KEK), dan 37,1% menderita anemia. Tujuan dari penelitian ini adalah untuk mengetahui asupan nutrisi dan status mikronutrien dalam serum wanita hamil di Jakarta pada trimester pertama. Metode: Studi deskriptif dilakukan pada 234 wanita hamil pada trimester pertama (<14 minggu). Asupan nutrisi didapat dari konversi frequency food questionnaire (FFQ) semi kuantitatif menggunakan Nutrisurvey. Serum maternal diperiksa untuk menilai kadar nutrisi. Hasil: Rerata asupan energi maternal harian adalah 1.256,1 kkal. Sebagian besar subjek memiliki asupan nutrisi di bawah rekomendasi Institute of Medicine (IOM) dan angka kecukupan gizi (AKG) 2013 yaitu energi (88,9%), protein (80,8%), besi (85%), asam folat (74,8%), kalsium (90,6%), and seng (94,9%). Sebaliknya, 70,5% subjek memiliki asupan tinggi vitamin A. Pemeriksaan serum maternal menunjukkan sebagian besar subjek mengalami defisiensi vitamin A (69,7%), vitamin D (99,6%), and seng (81,2%). Tidak ditemukan korelasi antara asupan nutrisi maternal dengan status nutrisi maternal. Kesimpulan: Pada trimester pertama, sebagian besar ibu hamil di Jakarta memiliki asupan energi dan nutrisi maternal yang rendah, kecuali vitamin A. Selain itu, sebagian besar ibu juga memiliki kadar serum vitamin A, vitamin D, dan seng maternal yang rendah. ABSTRACT Background: Maternal nutrition before and during pregnancy is important for a healthy pregnancy outcome. According to National Basic Health Research (Riskesdas) 2013, 24.2% of pregnant women are at risk of chronic malnutrition and 37.1% of them suffer from anemia. The aim of this study was to obtain information about the nutrient intake and serum micronutrient status in the first trimester of pregnant women in Jakarta.
Assessment of micronutrient status during pregnancy attending at Kanpur, Uttar Pradesh, India
International Journal of Research in Medical Sciences, 2018
Background: This impression of multiple micronutrients during pregnancy emphasizes to relatively neglected issues. Objectives was to evaluate the status and benefits of multiple micronutrient during pregnancy.Methods: Total 180 healthy pregnant women were included, first trimester 60 cases, second trimester 60 cases and third trimester 60 cases in the age group of 18-40 years. Haemoglobin was estimated by cyanmethemoglobin method, estimation of iron was done by ferrozine method, for zinc colorimetric method, estimation of calcium OCPC method and estimation of urinary iodine was done by ammonium persulfate oxidation method.Results: Haemoglobin are found to be in the Ist trimester 11.3g/dl, in the IInd trimester of haemoglobin 10.5g/dl, and in the IIIrd trimester it was 11g/dl and Serum iron was 71.9ug/dl in Ist trimester, 74.8 ug/dl during IInd trimester, 80.9ug/dl in IIIrd trimester. The mean serum calcium during Ist trimester was found to be 8.0 ug/dl, in the IInd trimester 7.2 ug/...
Anaemia and Iron Deficiency Anaemia in Pregnancy : Association With Protein and Micronutrient Intake
2015
Anaemia is still a serious health problem among pregnant women. Iron is regarded as one of the micronutrients contributed to the occurrence of anaemia. Deficiency of iron in advanced stage can cause anaemia, called iron deficiency anaemia. This study aims to analyze the difference between protein and micronutrient intake and calculate the odd ratio (OR) of anaemia and iron deficiency anaemia due to protein and micronutrient intake among pregnant women in the study area. This was an analysis of the first year data of Child Growth and Development cohort studies conducted in Kebon Kalapa and Ciwaringin Villages, Bogor District that analysed with case control design. There are 47 pregnant mothers as the sample. Anaemia was categorized as the hemoglobin (Hb) level ≤ 11 g / dL. Iron deficiency categorized when serum transferrin receptor (sTfR) above 4.4 mg / L. Iron deficiency anemia categorized if they had hemoglobin levels <11 g / dL and sTfr> 4.4 mg / L. One way anova was used to...
High protein and iron-folate crackers supplementation on the iron status of pregnant women
Medical Journal of Indonesia, 2003
Penelitian-penelitian terdahulu telah mengajukan beberapa faktor yang dapat menyebabkan mengapa suplementasi besi pada wanita hamil masih belum memuaskan hasilnya. Faktor-faktor tersebut adalah distribusi yang tidak memadai, hasil jangkauan dan ketaatan berobat yang rendah, dan juga penyerapan usus yang rendah. Penelitian ini bertujuan untuk mengukur status besi wanita hamil setelah konsumsi biskuit yang mengandung bubuk ikan dan preparat besi-folat. Penelitian ini dilakukan di Purworejo, Jawa Tengah, dari bulan Pebruari sampai Oktober 2002. Tujuh-puluh wanita hamil dalam trimester kedua-ketiga dengan umur kehamilan antara 2-3 bulan ikut dalam penelitian yang menggunakan randomized controlled trial (RCT). Sepuluh wanita mengundurkan diri dan sisanya dibagi dalam dua kelompok yang terdiri dari 28 wanita yang diberikan biskuit yang diperkaya dengan proteinzat besi (kelompok PIEC) dan 32 wanita diberikan biskuit yang diperkaya dengan zat besi (kelompok IEC). Pemberian biskuit dilakukan selama 12 minggu. Dari hasil penelitian didapatkan peningkatan kadar hemoglobin (Hb) dan reseptor transferin serum (sTfR) pada kedua kelompok. Selain itu terdapat penurunan kadar serum feritin (SF) di kedua kelompok. Namun demikian, pada akhir penelitian, peningkatan kadar Hb dan sTfR kedua kelompok ini berbeda bermakna, sedangkan penurunan SF tidak berbeda bermakna. Protein hewani berupa bubuk ikan cendrung meningkatkan absorpsi zat besi non-heme sehingga dapat meningkatkan kadar Hb dan sTfR pada wanita hamil.
The consumption of protein, zinc, and vitamin a associated with ferritin levels in pregnancy
Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics)
ABSTRAKLatar Belakang: Permasalahan gizi dalam kehamilan berupa defisiensi makronutrien, mikronutrien, dan anemia. Kejadian anemia defisiensi besi pada ibu hamil di Indonesia berdasarkan data WHO tahun 2019 dan Riskesdas 2018 adalah 44,2% dan 48,9%. Persentase kasus anemia pada ibu hamil di Sumatera Barat dan Kota Padang tahun 2019 adalah 18,10% dan 11,2% dengan penyebab antara lain defisiensi makronutrien dan mikronutrien dan pola konsumsi. Defisiensi besi dapat diidentifikasi dengan pemeriksaan kadar ferritin. Tujuan: Penelitian ini bertujuan mengetahui hubungan asupan protein, asupan zink, dan vitamin A dengan kadar ferritin ibu hamil trimester III.Metode: Penelitian analitik cross sectional ini dilaksanakan di Puskesmas Lubuk Kilangan dan Laboratorium Biomedik Universitas Andalas pada November 2021-Juli 2022. Subjek penelitian sebanyak 64 orang ibu hamil trimester III dan teknik sampling menggunakan total sampling. Asupan protein, zink, dan vitamin A diperoleh melalui wawancar...
European Journal of Nutrition & Food Safety, 2015
Exclusive breastfeeding within the first six months of life, provides sufficient infant nutrients, but remains a challenge for the postnatal women. Maternal pregnancy nutrient deficiency has long-term infant complications: heart disease; heart attacks; deaths; and irreversible cognitive challenges. Half of under five morbidity and mortality are associated with under nourishment. The study introduced multiple micronutrients to promote maternal nutrition to try and influence sustained exclusive breastfeeding to support neonatal and infant health. The study defined sub-populations at risk of nutritional deficiencies and provided opportunities for early intervention to support the known benefit of multiple micronutrients on breastfeeding outcomes up to six weeks (42 days) post delivery. The study determined variations on breastfeeding intervals and period among the Multiple Micronutrients (MMs) and Iron Folic Acid (IFA) groups. This was a Block Randomized Controlled study; treatment arm was administered with MMs while the control arm continued with the usual standard care of IFA. A structured Questionnaire with open and closed ended questions was employed to answer the research questions. Focus group discussions were conducted to collect qualitative data on impact of prenatal multiple micronutrients among the infants. The study demonstrated a significant difference in breast milk amounts and substitution between the treatment and control arm and assumed non-equal variances with a Levene's test <0.10 (f=7.379, p=0.009): breast feeding was initiated immediately at 100% for MMs and 68.8% for IFA; breast milk was available within 30 minutes post delivery in 86.3% of MMs and 25% for IFA (t,-4.8 p =0.000); breast milk amount was sufficient at 100% for MMs and 60.7% for IFA (-3.697, p=0.001); and no breast milk substitution was effected at 100% for the MMs, while breast milk was substituted in 18.5% of the IFAs within 42 days post delivery (t,-2.190, p=0.033). The study demonstrated significant benefits in micronutrient supplementation to promote infant health compared to the Iron folic acid use by enhancing exclusive breastfeeding practice.
Maternal anemia remains a public health problem in Indonesia. The purpose of this study is to compare the effect of multiple micronutrient and iron folic acid supplementation on hemoglobin and ferritin serum levels of pregnant women who suffer from anemia. The study was a randomized controlled trial conducted in Maros Regency, South Sulawesi Indonesia from June to December 2012. The subjects were 70 pregnant women with anemia were randomly allocated into two equal groups. The first group (n=35) received a multiple micronutrient supplement daily, second group (n=35) received a iron folic acid tablet daily, respectively for 12 consecutive weeks. Hemoglobin and ferritin serum were measured before and after the supplementation. Independent T and Paired T tests were used as appropriated. Mean hemoglobin levels increased significantly after the supplementation of multiple micronutrient (0.92±1.18 g/dl; p=0.000) whereas iron folic acid supplement did not increase significantly (0.39±1.17 g/dl; p=0.099), ferritin serum levels of the two groups were not significantly decreased after supplementation multiple micronutrient (8.18±29.77ng/ml; p=0.130) and iron folic acid (10.52±26.48 ng/ml; p=0.058). It can be concluded that multiple micronutrient is better than iron folic acid supplement to improved hemoglobin levels, but it has not been able to improve maternal iron stores. Thus, pregnant women who use iron folic acid supplements could not affectively overcome the anemia problems. Further research is needed to increase the duration of the intervention multiple micronutrient supplements, including multiple micronutrient supplementation from pre-conception through pregnancy, with a larger number of sample.
Factors associated with receiving iron supplements during pregnancy among women in Indonesia
Electronic journal of general medicine, 2023
Anemia during pregnancy is a significant threat to health and safety of mothers and children. Objective: This study aimed to investigate factors associated with receiving iron supplements during pregnancy among women in Indonesia. Methods: This study used data from the Indonesian demographic and health survey 2017. The dataset used was individual data with a target population of women aged 15-49. A total of 14,564 women aged from 15 to 49 years were included in the analysis. A binary logistic regression model explored associations between the independent variables and the received iron supplements. Results: In this study, most interviewed women (n=12,939; 88.84%) received iron supplements during pregnancy. Factors found to be associated with receiving iron supplements during pregnancy included pregnant women aged >35 years (AOR=2.20; 95% CI=1.34-3.61), lived in the eastern and middle part of Indonesia (AOR=1.71; 95% CI=1.20-2.42; AOR=1.75; 95% CI=1.49-2.06), attended antenatal care consultations (AOR=1.40; 95% CI=1.18-1.65), had blood tests (AOR=1.52; 95% CI=1.32-1.76), knew the signs and symptoms of danger of pregnancy complications (AOR=1.56; 95% CI=1.29-1.89), had vaginal bleeding during pregnancy (AOR=1.25; 95% CI=1.03-1.50), had 1-2 total children ever born (AOR=1.18; 95% CI=1.00-1.40), and were exposed to information via the Internet (AOR=1.18; 95% CI=1.00-1.39) and newspapers or magazines (AOR=1.17; 95% CI=1.01-1.35). Conclusions: The study highlighted that despite free access to iron supplementation during pregnancy, some women failed to receive iron supplements during pregnancy. Also, women of reproductive age living in the eastern part of Indonesia, who did not have blood tests, were absent from attending antenatal care and did not know the signs and symptoms of dangerous pregnancy complications were among those who failed to receive iron supplements during pregnancy. Thus, identifying and promoting awareness of those at high risk of not receiving iron supplements should be a priority for the government and health workers in providing health services.