Match!

Prenatal Zinc and Vitamin A Reduce the Benefit of Iron on Maternal Hematologic and Micronutrient Status at Delivery in Tanzania.

Published on Oct 16, 2019in Journal of Nutrition4.416
· DOI :10.1093/jn/nxz242
Ramadhani A. Noor10
Estimated H-index: 10
(Harvard University),
Ajibola I. Abioye8
Estimated H-index: 8
(Harvard University)
+ 8 AuthorsWafaie W. Fawzi65
Estimated H-index: 65
(Harvard University)
Abstract
BACKGROUND: Zinc and vitamin A supplementation have both been shown to affect iron status, hemoglobin (Hb) concentration, and anemia in animal and human studies. However, evidence on their combined use in pregnancy, in the context of iron-folic acid (IFA) supplementation, remains limited. OBJECTIVE: This study determined the effects of prenatal zinc, vitamin A, and iron supplementation on maternal hematologic and micronutrient status at delivery in Tanzania. METHODS: We analyzed 2 large randomized controlled trials, using generalized estimating equations, and examined the effect of daily zinc (25 mg) and vitamin A (2500 IU) supplementation starting in the first trimester of pregnancy compared with placebo (n = 2500), and separately evaluated the safety and efficacy of daily iron (60 mg) supplementation among iron-replete pregnant women (n = 1500). Blood samples from baseline and delivery were tested for Hb, serum ferritin, soluble transferrin receptor, plasma zinc, and zinc protoporphyrin. RESULTS: Zinc and vitamin A supplementation were associated with lower Hb concentrations at delivery of -0.26 g/dL (95% CI: -0.50, -0.02 g/dL) and -0.25 g/dL (95% CI: -0.49, -0.01 g/dL), respectively. Vitamin A increased mean ferritin concentrations at delivery (14.3 mug/L, 95% CI: 1.84, 29.11 mug/L), but was associated with increased risk of severe anemia (RR: 1.41; 95% CI: 1.06, 1.88). Among women who were iron replete at baseline, iron supplementation reduced the risk of iron depletion at delivery by 47% (RR: 0.53; 95% CI: 0.43, 0.65). There was no effect of zinc or iron supplements on plasma zinc concentrations. CONCLUSIONS: Our findings support existing WHO guidelines on prenatal iron, vitamin A, and zinc supplementation among pregnant women. In this setting, scaling uptake of prenatal iron supplements is warranted, but prenatal zinc and vitamin A supplementation did not benefit maternal hematologic status at delivery. In settings where vitamin A deficiency is endemic, the efficacy and safety of the WHO recommended prenatal vitamin A supplementation require further evaluation.
  • References (52)
  • Citations (0)
📖 Papers frequently viewed together
199459.10The Lancet
1 Author (Clara Menéndez)
3 Citations
2013
1 Author (Garima Singh)
2017
1 Author (Michelle Livock)
78% of Scinapse members use related papers. After signing in, all features are FREE.
References52
Newest
#1Marcela de Sá Barreto da Cunha (UnB: University of Brasília)H-Index: 5
#2Natália Aboudib Campos Hankins (UnB: University of Brasília)H-Index: 1
Last. Sandra Fernandes Arruda (UnB: University of Brasília)H-Index: 14
view all 3 authors...
ABSTRACTAnemia is a worldwide public health problem that can be related to many causes, including vitamin A deficiency. The aim of this study was to assess and estimate the effect of vitamin A supp...
5 CitationsSource
#1Martin N. Mwangi (Maseno University)H-Index: 6
#2Andrew M. Prentice (Lond: University of London)H-Index: 88
Last. Hans Verhoef (Lond: University of London)H-Index: 21
view all 3 authors...
Summary The World Health Organization recommends universal iron supplementation of 30–60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of malaria and other infectious diseases. We reviewed the evidence on the safety and efficacy of antenatal iron supplementation in low-income countries. We found no evidence that daily supplementation ...
13 CitationsSource
#1Anne Marie Darling (Harvard University)H-Index: 6
#2Ferdinand Mugusi (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 30
Last. Wafaie W. Fawzi (Harvard University)H-Index: 65
view all 13 authors...
Vitamin A and zinc are important for immune function and may improve host defense against malaria and reduce the risk of adverse pregnancy outcomes. Our objective was to determine whether daily oral supplementation with either or both nutrients starting in the first trimester reduces the risk of placental malaria and adverse pregnancy outcomes. We undertook a randomized, double‐blind placebo‐controlled trial with a factorial design among 2,500 human immunodeficiency virus–negative primigravid or...
5 CitationsSource
#1Emily R. Smith (Harvard University)H-Index: 32
#2Alfa MuhihiH-Index: 11
Last. Wafaie W. Fawzi (Harvard University)H-Index: 65
view all 9 authors...
: Neonatal vitamin A supplementation (NVAS) is an intervention hypothesized to reduce infant morbidity and mortality. The objective of this study was to assess the efficacy of neonatal vitamin A supplementation in reducing infant morbidity and mortality and assess potential sources of heterogeneity of the effect of NVAS.: We completed an individually randomized, double-blind, placebo-controlled trial in Tanzania. Infants were randomized within 3 days of birth to a single dose of vitamin A (50 00...
4 CitationsSource
#1Rosalind S. Gibson (University of Otago)H-Index: 43
#2Janet C. King (Children's Hospital Oakland Research Institute)H-Index: 48
Last. Nicola M Lowe (UCLan: University of Central Lancashire)H-Index: 19
view all 3 authors...
Background:Large discrepancies exist among the dietary zinc recommendations set by expert groups.Objective:To describe the basis for the differences in the dietary zinc recommendations set by the World Health Organization, the US Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency.Methods:We compared the sources of the data, the concepts, and methods used by the 4 expert groups to set the physiological requirements for absorbed zinc, th...
14 CitationsSource
#1Ajibola I. AbioyeH-Index: 8
#2Said AboudH-Index: 27
Last. Wafaie W. FawziH-Index: 65
view all 13 authors...
Iron deficiency is a highly prevalent micronutrient abnormality and the most common cause of anemia globally, worsening the burden of adverse pregnancy and child outcomes.We sought to evaluate the response of hematologic biomarkers to iron supplementation and to examine the predictors of the response to iron supplementation among iron-deficient pregnant women.We identified 600 iron-deficient (serum ferritin ≤12 μg/L) pregnant women, aged 18-45 y, presenting to 2 antenatal clinics in Dar es Salaa...
12 CitationsSource
#1Alison D. Gernand (PSU: Pennsylvania State University)H-Index: 11
#2Kerry J Schulze (Johns Hopkins University)H-Index: 26
Last. Parul Christian (Johns Hopkins University)H-Index: 41
view all 5 authors...
Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences for the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zin...
87 CitationsSource
#1Mary McCauley (LSTM: Liverpool School of Tropical Medicine)H-Index: 3
#2Nynke van den Broek (LSTM: Liverpool School of Tropical Medicine)H-Index: 26
Last. Mohammad Othman (Al Baha University)H-Index: 1
view all 4 authors...
Background The World Health Organization recommends routine vitamin A supplementation during pregnancy or lactation in areas with endemic vitamin A deficiency (where night blindness occurs), based on the expectation that supplementation will improve maternal and newborn outcomes including mortality, morbidity and prevention of anaemia or infection. Objectives To review the effects of supplementation of vitamin A, or one of its derivatives, during pregnancy, alone or in combination with other vit...
72 CitationsSource
#1Gian Carlo Di Renzo (University of Perugia)H-Index: 28
#2Filippo Spano (University of Perugia)H-Index: 1
Last. Luis Cabero RouraH-Index: 6
view all 6 authors...
Anemia is the most frequent derailment of physiology in the world throughout the life of a woman. It is a serious condition in countries that are industrialized and in countries with poor resources. The main purpose of this manuscript is to give the right concern of anemia in pregnancy. The most common causes of anemia are poor nutrition, iron deficiencies, micronutrients deficiencies including folic acid, vitamin A and vitamin B12, diseases like malaria, hookworm infestation and schistosomiasis...
11 CitationsSource
#1Analee J. Etheredge (Harvard University)H-Index: 7
#2Zul Premji (MUHAS: Muhimbili University of Health and Allied Sciences)H-Index: 35
Last. Wafaie W. Fawzi (Harvard University)H-Index: 65
view all 12 authors...
−0.7 g/dL, P < .001) and serum ferritin (41.3 vs 11.3 μg/L, P < .001). Iron supplementation significantly decreased the risk of anemia at delivery by 40% (RR, 0.60; 95% CI, 0.51-0.71) but not severe anemia (RR, 0.68; 95% CI, 0.41-1.14). Iron supplementation significantly reduced the risk of maternal iron deficiency at delivery by 52% (RR, 0.48; 95% CI, 0.32-0.70) and the risk of iron deficiency anemia by 66% (RR, 0.34; 95% CI, 0.19-0.62). CONCLUSIONS AND RELEVANCE Prenatal iron supplementation a...
19 CitationsSource
Cited By0
Newest