妊娠妇女贫血和铁缺乏与钩虫、疟疾和维生素A缺乏有关

发展中国家妊娠期妇女贫血和铁缺乏流行的原因尚不完全清楚。本文作者对尼泊尔一社区样本的 336名妊娠期妇女贫血和铁缺乏的发生率和严重性及其与蠕虫、疟疾和维生素 A缺乏之间的关联进行了评估。血红蛋白、红细胞原卟啉 (EP)和血清铁蛋白用静脉血样检测。贫血妇女 (血红蛋白 <110 g/L )占 72 .6 % ,其中中度或重度贫血(血红蛋白 <90 g/L )占 19.9% ,铁缺乏 (EP>70μmol/mol血红素或血清铁蛋白 <10 μg/L)占 80 .6 %。贫血为铁缺乏性的占88%。一半以上 (5 4.2 % )的妇女血清维生素A浓度低 (<1.0 5μmol/L ) ,74.4%的妇女感染钩虫 ,19.8%…     

350名学龄前儿童体格生长和营养水平现状调查

目的了解重庆近郊学龄前儿童的体格生长和营养状况,为进一步在该地区实施营养素干预提供科学依据。方法采用分层与整群抽样相结合的方法,在重庆市巴南鱼洞镇7所规模﹥200名的幼儿园中随机选取3所中的所有3~6岁符合纳入标准的350名学龄前儿童;对纳入儿童的体格生长以及营养状况进行调查和评价。结果 34.26%学龄前儿童很少喝奶及奶制品(﹤2d/周),72.00%基本不吃内脏。低体重、生长迟缓、消瘦及超重或肥胖的儿童比例分别为3.14%,5.71%,6.86%和5.85%。儿童血红蛋白水平为(117.33±9.77)g/L,贫血发生率为25.14%。维生素A浓度为(1.23±0.25)μmol/L,维生素A缺乏及边缘型维生素A缺乏分别为1.14%和22.32%;儿童血清锌浓度为(12.22±7.00)g/L,儿童锌不足(血清Zn﹤10.7μmol/L)发生率为25.14%。维生素A水平与血红蛋白浓度呈显著性正相关(r=0.12,P=0.02),维生素A缺乏的儿童贫血发生率是维生素A水平正常儿童的2.32倍。结论该地区学龄前儿童典型的维生素A缺乏及中、重度贫血已不多见,但边缘型维生素A缺乏及轻度贫血发病率仍较高,儿童体格生长仍处较低水平。     

2010—2012年中国农村孕妇贫血及维生素A、维生素D营养状况

目的分析2010—2012年中国农村孕妇血红蛋白水平、维生素A和维生素D水平,评价该人群贫血患病率的变化,并评估其维生素A和维生素D的营养状况。方法数据来自2010—2012年中国居民营养与健康状况监测。调查对象为我国45个普通农村和30个贫困农村的孕妇。采用氰化高铁法检测1763例孕妇血红蛋白的浓度;采用高效液相色谱法检测601例血清视黄醇的水平;采用酶联免疫法测定979例25-羟基维生素D水平。计算血红蛋白水平及贫血患病率;维生素A水平及缺乏率和边缘缺乏率;维生素D水平及严重缺乏率、缺乏率和不足率。结果2010—2012年中国农村孕妇血红蛋白水平为123.60(113.80~133.50)g/L,普通农村[123.10(114.00~132.20)g/L]显著低于贫困农村[125.40(113.30~136.80)g/L](P=0.020)。中国农村孕妇贫血率为17.58%,贫困农村(20.19%)显著高于普通农村(16.10%)(P=0.029)。农村孕妇维生素A水平为1.53(1.18~1.98)μmol/L,维生素A缺乏率为3.49%,边缘缺乏率为12.81%。农村孕妇维生素D水平为15.55(11.94~19.90)ng/m L,维生素D缺乏严重,维生素D缺乏率(包括缺乏与严重缺乏)高达75.38%,普通农村缺乏率(65.36%)显著低于贫困农村(87.42%)(P<0.001)。结论 2010—2012年中国农村孕妇贫血患病率较10年前有所改善,但仍高于其他人群。孕妇普遍存在较为严重的维生素D缺乏,同时存在一定比例的维生素A边缘缺乏。     

补充维生素A对集体学龄前儿童血红蛋白的影响

【目的】　为探讨血清维生素 (VA)浓度对儿童血红蛋白的影响。　【方法】　对集体学龄前贫血儿童投维生素A每日 2 0 0 0IU ,观察治疗前后血红蛋白、血清铁、血清VA浓度的变化。　【结果】　亚临床状态VA缺乏占 31.6 % ,可疑缺乏占 5 8% ,仅 10 .4 %的儿童血清VA浓度正常 ;贫血组儿童血清VA量明显低于非贫血组 (P <0 .0 1)。给贫血组儿童投VA 2 0 0 0U/d ,3个月后 ,血红蛋白、血清铁、血清VA浓度明显提高 (P <0 .0 1) ,对照组无明显改变。　【结论】　亚临床状态VA缺乏在儿童中已是很重要的营养问题 ,并与贫血有一定关系 ,补充维生素A对儿童血红蛋白、血清铁、血清VA浓度有一定的影响     

中、晚期孕妇缺铁性贫血的调查分析

目的 了解广州城区中、晚期孕妇缺铁性贫血患病率及膳食影响因素.方法 测定699名孕妇的血红蛋白、平均红细胞体积、平均红细胞血红蛋白含量、血清铁及铁蛋白,进行24小时膳食调查,并对数据进行分析.结果 孕妇血红蛋白平均为115.8±11.2g/L.按血红蛋白<105g/L诊断标准,孕妇缺铁性贫血患病率为18.3%,中、晚期患病率分别为13.9%和28.6%,经比较有显著性差异(χ2=21.123,P<0.05).贫血孕妇膳食铁摄入不足,以植物性铁为主,肉类、蛋类、奶类等动物性食物和水果摄入量显著低于对照组(均P<0.05),促进铁吸收的营养素(蛋白质、维生素A、核黄素、维生素C、锌)显著低于对照组(均P<0.05).结论 广州城区中、晚期孕妇铁缺乏问题仍然突出,与膳食结构不合理、不良的饮食习惯密切相关;合理膳食指导是防治缺铁性贫血的有效措施.     

北京6~35月龄流动儿童营养性贫血及其与维生素A相关性研究

目的 探讨北京市6~35月龄流动儿童营养性贫血现况及其与维生素A关联分析,为有效地预防流动儿童营养性贫血提供科学依据。方法 采用方便整群抽样方法,2017年从北京市流动人口聚居区(朝阳、海淀、昌平)的308例6~35月龄的流动儿童及家长进行问卷调查,同时采集流动儿童末梢血进行血红蛋白、维生素A测定。结果 6~35月龄流动儿童贫血患病率为27.92%,其中男童为29.19%,女童为26.53%。贫血患病率在不同年龄组和区域间的差异有统计学意义(P<0.001),6~11月龄婴幼儿贫血患病率最高(52.63%)。食用配方奶、瘦肉与动物肝脏类食物对儿童贫血有显著影响(P<0.05或<0.01)。贫血儿童维生素A的含量显著低于非贫血儿童(P<0.001)。Logistic回归分析显示居住地区、年龄、维生素A含量是6~35月龄流动儿童营养性贫血的影响因素(P<0.05或<0.01)。结论 北京市6～35月龄流动儿童的营养性贫血患病率较高,尤其6～11 月龄儿童最高,VA含量在贫血儿童体内较低,应加强对流动儿童家长普及科学喂养知识,指导其合理调整膳食结构。     

广西农村儿童维生素A和铁缺乏营养状况关系的调查研究

目的了解广西农村3～12岁儿童血浆维生素A(VA)营养状况、VA缺乏率、VA边缘缺乏率、铁营养状况,分析VA营养状况与铁缺乏的关系。方法分析2002年“中国居民营养与健康状况调查”广西316名3～12岁农村儿童的血浆VA、血红蛋白(Hb)含量。结果广西农村儿童的血浆VA平均含量为(0.91±0.27)μmol/L,Hb平均含量为(127.26±14.50)g/L。VA缺乏与边缘缺乏率分别为25.0%、43.9%;VA含量与Hb含量成正相关(P<0.05,r=0.143);随着VA含量水平降低,贫血患病率升高。结论广西农村儿童VA严重缺乏,同时伴随缺铁性贫血,应引起政府部门的高度重视。在防治儿童缺铁性贫血的同时,还应相应补充VA。     

陕西农村0～18月龄婴幼儿贫血状况及影响因素调查

目的:了解陕西农村贫血状况及其影响因素,为合理防止提供科学依据。方法:采取整群分层抽样的方法对陕西省19个自然村336名0～18月龄婴幼儿进行问卷调查和血红蛋白的测定。结果:该地区0～18月龄婴幼儿贫血患病率为35.12%,0～18个月婴幼儿中0～3月龄组贫血患病率最低,为13.33%,随月龄增大贫血患病率逐渐增高,至13～18月龄组达最高(50.82%)。出生时低体重(<2 500 g)、家庭经济状况差以及母亲的教育程度低均为婴幼儿患贫血的危险因素。结论:陕西农村地区0～18月龄婴幼儿贫血患病率明显高于全国水平和大多数省市婴幼儿的贫血患病率,处于较高的水平,应广泛开展健康教育,加强孕期保健,提高母亲的喂养技术,预防和改善婴幼儿贫血。     

6月龄～6岁儿童贫血与全血中铁、钙、铜、铅、镁、锌水平的相关分析

目的分析6月龄~6岁儿童贫血与全血中铁、钙、铜、铅、镁、锌水平相关性,为预防儿童营养性贫血提供依据。方法选取2015年3月—2017年3月到丽水市中心医院门诊体检的6月龄~6岁城区儿童1 804人,采集静脉血进行血常规和铁、钙、铜、铅、镁、锌含量检测,分析贫血与这6种元素含量的相关性。结果丽水城区6月龄~6岁儿童贫血患病率为7.32%,贫血类型以轻度贫血为主,占全部贫血例数的69.70%;6月龄~3岁儿童贫血患病率最高(10.50%)。贫血组儿童缺铁率为41.67%,缺钙率为24.24%,缺铜率为3.03%,均高于非贫血组儿童(P0.05)。全血铁的水平与血红蛋白、红细胞平均体积、红细胞平均血红蛋白量和红细胞平均血红蛋白浓度呈正相关,而与红细胞分布宽度呈负相关(均P0.05)。低铁组儿童钙、铜和锌缺乏率分别为34.43%,1.64%和35.25%,均高于高铁组(P0.05)。结论丽水城区儿童贫血主要发生在6月龄~3岁年龄段,以轻度贫血为主,缺铁是造成儿童贫血的主要原因。     

驻北疆部队官兵子女血清微量元素水平分析

目的调查驻北疆高寒地区部队官兵的子女血清微量元素的含量 ,为调整儿童的微量元素营养状况提供依据。方法采用化学显色法检测 ,5～ 7岁学龄前儿童血清铁、铜、锌含量 ,用氧化高铁血红蛋白法测定血红蛋白含量。结果 132名学龄前儿童血清铁、铜、锌的含量分别为(9.92± 3.14 ) μmol·L 1、(12 .6 3± 3.75 ) μmol·L 1、(14 .4 5± 5 .0 3) μmol·L 1,其中低于正常参考值下限者分别占 2 2 .73%、15 .91%、12 .12 % ;血红蛋白的含量为 (112 .9± 6 .2 5 )g·L 1,处于正常水平。其中 ,血红蛋白含量低于 110g·L 1者 31人 ,贫血的发生率为 2 3.4 8%。贫血儿童血清铁、铜、锌含量分别为 (8.6 2± 2 .32 ) μmol·L 1、(11.36± 3.84 ) μmol·L 1、(12 .82± 4 .32 ) μmol·L 1,明显低于正常儿童 (P <0 .0 5 ,P <0 .0 1)。结论北疆高寒地区部分学龄前儿童的贫血发生情况及血清铁、铜、锌等微量元素水平不容乐观 ,应引起足够的重视。     

Co-existing micronutrient deficiencies among stunted Cambodian infants and toddlers

The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia, and diarrhea and pneumonia are the leading causes of death among children. Whether these adverse health outcomes are associated with co-existing micronutrient deficiencies is uncertain. We have determined the prevalence of anaemia, as well as iron, zinc, and vitamin A deficiency and their co-existence among stunted children (77 females; 110 males) aged 6-36 mos. Non-fasting morning venipuncture blood samples were taken and analyzed for haemoglobin (Hb), serum ferritin (via IMx system), retinol (via HPLC), and Zn (via AAS), C-reactive protein (CRP) (via turbidimetry) and Hb type (AA, AE, or EE) (via Hb gel electrophoresis). Children with CRP>or=5.0 mg/L (n=34) were excluded. Zinc deficiency defined as serum Zn<9.9 micromol/L had the highest prevalence (73.2%), followed by anaemia (71%) (Hb<110 g/L), and then vitamin A deficiency (28.4%) (serum retinol<0.70 micromol/L). Of the anaemic children, only 21% had iron deficiency anaemia, and 6% had depleted iron stores. Age, log serum ferritin, and Hb type were significant predictors of Hb in the AA and AE children. Serum retinol was unrelated to haemoglobin or serum zinc. The prevalence of two or more micronutrient deficiencies (low Hb, serum retinol, and/or serum zinc) was 44%. Nearly 10% had low values for all three indices, and 18% had just one low value. In conclusion, anaemia, and deficiencies of iron, zinc, and vitamin A are severe public health problems among these stunted Cambodian children. Intervention strategies addressing multiple micronutrient deficiencies are needed.     

The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia

Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West Java or East Java. Considering that maternal postpartum Hb reflects Hb during pregnancy, that anemia among mothers in this population is due mainly to iron deficiency, and that children born to anemic mothers are at higher risk of a low Hb, we hypothesize that low infant Hb in this population is due to iron deficiency. Intervention studies in iron deficient populations should test this hypothesis.     

Multiple micronutrient deficiencies persist during early childhood in Mongolia

Data on the prevalence of micronutrient deficiencies in children in Mongolia is limited. We therefore determined the prevalence of anaemia, iron deficiency anaemia (IDA), and deficiencies of iron, folate, vitamin A, zinc, selenium, and vitamin D among young Mongolian children. Anthropometry and non-fasting morning blood samples were collected from 243 children aged 6-36 months from 4 districts in Ulaanbaatar and 4 rural capitols for haemoglobin (Hb), serum ferritin, folate, retinol, zinc, selenium, and 25-hydroxyvitamin D (25-OHD) assays. Children with alpha-1-glycoprotein >1.2mg/L (n=27) indicative of chronic infection were excluded, except for folate, selenium, and 25-hydroxyvitamin D assays. Of the children 14.5% were stunted and none were wasted. Zn deficiency (serum Zn <9.9 micromol/L) had the highest prevalence (74%), followed by vitamin D deficiency 61% (serum 25-OHD<25 nmol/L). The prevalence of anaemia (24%) and iron deficiency anaemia (IDA) (16%) was lower, with the oldest children (24-36 mos) at lowest risk. Twenty one percent of the children had low iron stores, and 33% had vitamin A deficiencies (serum retinol < 0.70 micromol/L), even though two thirds had received vitamin A supplements. Serum selenium values were low, perhaps associated with low soil selenium concentrations. In contrast, no children in Ulaanbaatar and only 4% in the provincial capitols had low serum folate values (<6.8 nmol/L). Regional differences (p<0.05) existed for anaemia, deficiencies of vitamin A, folate, and selenium, but not for zinc or IDA. Of the children, 78% were at risk of > or = two coexisting micronutrient deficiencies emphasizing the need for multimicronutrient interventions in Mongolia.     

Iron and zinc interactions among pregnant Nepali women

Few studies have examined the biologic impact of iron and zinc when given at a ratio of 2:1 during pregnancy. We examined the change in serum zinc after 3 weeks among night blind Nepali pregnant women who were randomly assigned to receive zinc (25 mg) or placebo, stratified by whether they received iron (60 mg) - folate (400 μg) or not. Further, we looked at change in hemoglobin (Hb) and serum ferritin concentrations by whether women had received iron or not, stratified by supplementation group (zinc or placebo). Women who received iron were anemic (Hb < 110 g/L) at baseline. The treatment groups were comparable on serum zinc and ferritin and Hb concentration at baseline. There was a mean increase of ∼1.6 μmol/L (p < 0.05) in the serum zinc concentration in women receiving zinc relative to a decline of ∼0.5 μmol/L in the placebo group, which was similar both in women who received iron or not. Similarly, treatment with iron resulted in significant increases in Hb of 4.8 g/L and 7.8 g/L, and in serum ferritin of 12.2 μg/L and 13.6 μg/L among those in the zinc and placebo groups, respectively. However, there was some evidence that zinc supplementation may adversely effect iron status among women with initial Hb of <85 g/L. This analysis shows an overall lack of a negative iron-zinc interaction when given at a ratio of 2:1.     

义乌市学龄前儿童血清微量营养素水平调查

目的了解学龄前儿童血清微量营养素水平,为进一步改善学龄前儿童营养状况提出合理建议。方法对学龄前期儿童开展抽样调查,并检测其血清微量营养素水平,使用SPSS 17.0统计软件进行结果分析。结果调查对象的血清维生素A、铜、锌、钙、镁、铁的中位数分别为(1.90±1.05)μmol/L,(23.3±3.64)mmol/L,(84.3±39.4)μmol/L,(1.66±0.33)mmol/L,(1.59±0.46)mmol/L,(8.90±2.48)mmol/L。血清维生素A、铜、锌、钙、镁、铁在参考值范围内的儿童分别占65.92%、99.53%、89.94%、95.15%、96.92%和97.87%。血清维生素A在各年龄组的参考值范围内的分布差异、在城镇和农村的参考值范围内的分布差异均有统计学意义(P<0.05)。结论应根据儿童不同的年龄段,适时开展微量营养素水平检测,以期早发现、早预防学龄前儿童的微量营养素缺乏,及时有效地补给各种营养素。     

The multiple vitamin status of Chinese pregnant women with anemia and nonanemia in the last trimester

Iron-deficiency or anemia in pregnancy is a major public health problem in China. This cross-sectional study was carried out to observe the association between iron status and multiple vitamin levels of Chinese pregnant women in the third trimester. We measured iron, ascorbic acid, retinol, folate and vitamin B12 in serum, and riboflavin in urine specimens of 1,163 pregnant women in four sites throughout rural and city areas in China. Based on hemoglobin concentrations (Hb), the subjects were divided into an anemia group with Hb < 110 g/L or Hb < or = 100 g/L as severe anemia group, and nonanemia group with Hb > or = 110 g/L. Results showed that 41.58% of the population with serum iron < 700 microg/L and 51.04% of the population with ferritin < 12 microg/L in the anemia group, percentages that were much higher than those in the nonanemia group. Relationships between five vitamins and hemoglobin concentrations of all subjects were observed. There was a lower level of serum ascorbic acid (291.05 microg/dL) in the Hb < or = 100 g/L group than in the Hb > or = 120 g/L group (487.79 microg/dL) (p < 0.001). Serum levels of vitamin B12 and folate were 445.67 pg/mL and 5.94 ng/mL in the Hb < or = 100 g/L group, whose levels were much lower than the levels of 502.01 pg/mL (p < 0.012) and 8.07 ng/mL (p < 0.010) respectively in the Hb > or = 120 g/L group. Further, cross-sectional analysis showed positive correlations between abnormal hematological results and prevalences of vitamin deficiencies. The subjects with iron-deficiency anemia had much higher rates of vitamin C, folate and vitamin B12 deficiencies than those in the nonanemic subjects, and especially in the deficient rates of ascorbic acid and folate in the anemia (Hb < 110 g/L) group, which reached 64.04% and 22.70% respectively. Moreover, we observed that the decreasing trends of hemoglobin concentrations were accompanied by the decreases of serum levels of vitamin A, ascorbic acid, folate and vitamin B12. In conclusion, multiple vitamin deficiencies, especially ascorbic acid, retinol and folic acid, may be associated with anemia or iron deficiency in pregnant women in the last trimester. The study suggested that anemic pregnant women in China should be supplemented with iron and multiple vitamins simultaneously.     

A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc

Micronutrient-fortified, cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries, but their nutritional quality is not always optimal. In a double-blind randomized trial, we compared the efficacy of a locally produced porridge based on maize, beans, bambaranuts, and groundnuts fortified with 19 (rich) or 9 (basal) micronutrients. Infants aged 6 mo from Lusaka, Zambia were randomized to receive the richly fortified (n = 373) or basal (n = 370) porridge daily for 12 mo along with routine vitamin A supplements. Baseline and final micronutrient status and inflammation (based on α-1-glycoprotein) were assessed using nonfasting blood samples. Baseline prevalence of anemia (39%) and zinc deficiency (51%) were a public health concern. There were overall treatment effects on hemoglobin (Hb) (P = 0.001), serum transferrin receptor (P < 0.001), serum ferritin (P < 0.001), and serum selenium (P = 0.009); biomarker responses for iron and zinc were modified by baseline concentrations, and for Hb and iron by socioeconomic status. At 18 mo, the adjusted odds of anemia, iron deficiency anemia (Hb <105 g/L and transferrin receptor > 11.0 mg/L), and iron deficiency were 0.37 (95% CI = 0.25, 0.55), 0.18 (0.09, 0.35), and 0.30 (0.18, 0.50) times those in the basal group, respectively. The rich level of fortification had no overall treatment effect on serum zinc (1.09; 0.66, 1.80) but improved serum zinc in children with lower Hb concentrations at baseline (P = 0.024). A locally produced cereal- and legume-based infant food richly fortified with micronutrients reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants.     

Exclusive breast-feeding for 6 months, with iron supplementation, maintains adequate micronutrient status among term, low-birthweight, breast-fed infants in Honduras

There is little information on the risk of micronutrient deficiencies during the period of exclusive breast-feeding. We evaluated this among term, low-birthweight (LBW; 1500-2500 g) infants in Honduras. Mother-infant pairs were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, infants were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or be given iron-fortified complementary foods (rice, chicken, fruits, and vegetables) from 4 to 6 mo while continuing to breast-feed (SF, n = 60). Blood samples were collected at 2, 4, and 6 mo and analyzed for hemoglobin (Hb), hematocrit, plasma ferritin, % transferrin saturation, vitamin A, vitamin B-12, folate, zinc, and erythrocyte folate. Infants with Hb < 100 g/L at 2 or 4 mo were given medicinal iron supplements for 2 mo; the proportion administered iron drops did not differ significantly between groups. There was no significant effect of complementary foods on indices of vitamin A, B-12, folate, or zinc status. Among infants not given medicinal iron at 4-6 mo, iron status was higher in the SF group than the EBF group. In those given medicinal iron at 4-6 mo, iron status was higher in the EBF group, suggesting that complementary foods interfered with iron utilization. About half of the infants were anemic by 2 mo, before the age when complementary foods would be recommended. This supports the recommendation that LBW infants should receive iron supplementation in early infancy. Given that infants given iron supplements did not benefit from complementary foods at 4-6 mo, we conclude that exclusive breast-feeding for 6 mo (with iron supplementation) can be recommended for term, LBW infants.     

Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal

Iron deficiency is one of the main causes of anemia during pregnancy, although other micronutrient deficiencies may play a role. We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on maternal hematologic indicators in a double-masked randomized controlled community trial. Communities, called sectors, were randomly assigned to supplementation with folic acid (400 microg), folic acid plus iron (60 mg), folic acid plus iron and zinc (30 mg) and folic acid plus iron, zinc and 11 other micronutrients, each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate (1000 microg retinol equivalent), or vitamin A alone as the control group. Hemoglobin (Hb) and indicators of iron status were assessed at baseline and at 32 wk of gestation. At 6-wk postpartum, Hb assessment was repeated using a finger stick. Severely anemic women (Hb < 70 g/L) were treated according to WHO recommendations. Folic acid alone had no effect on maternal anemia or iron status. Hb concentrations were 14 g/L, [95% confidence limits (CL), 8.3-19.2], 10.0 g/L (CL, 5.2-14.8) and 9.4 g/L (CL, 4.7-14.1) higher in the groups receiving folic acid plus iron, folic acid plus iron and zinc and folic acid plus iron, zinc and multiple micronutrients, respectively, relative to the control. Anemia in the third trimester was reduced by 54% with folic acid plus iron, by 48% with folic acid plus iron and zinc and by 36% with folic acid plus iron, zinc and multiple micronutrients supplementation, relative to the control (P < 0.05). Thus, the combinations of folic acid plus iron and zinc and folic acid plus iron, zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron. The level of compliance and baseline Hb concentrations modified the effect of iron.     

Comparison of serum levels of iron, zinc and copper in anaemic and non-anaemic pregnant women in China

Zinc and copper deficiency is associated with anaemia or iron deficiency and affects fetus growth and pregnant women during pregnancy. To examine iron, zinc and copper status of Chinese pregnant women with and without anaemia in the third trimester, 1185 subjects were enrolled for measurements of Hb, ferritin, transferrin, soluble transferrin receptor (sTfR), and serum iron, zinc and copper. The results showed that there were lower levels of ferritin (14.1 microg/L) and transferrin (3.33 g/L) in subjects with Hbor=101 g/L. sTfR levels in subjects with Hbor=120 g/L (38.5 nmol/L vs. 25.04 nmol/L, P<0.001). Serum iron was lower in subjects with Hbor=120 g/L (871 microg/L vs. 990 microg/L, P<0.01). Lower levels of serum iron and zinc were also found in anaemic (Hb<110 g/L) as compared with non-anaemic women (Hb>or=110 g/L). Frequencies of marginal deficiencies in serum iron and zinc were 41.58% and 51.05% respectively higher in anaemic than in non-anaemic subjects. Distribution of serum zinc and iron showed a decreasing trend as Hb decreased. Few anaemic as well as non-anaemic subjects had copper deficiency although copper and Hb levels were found inversely correlated and the ratio of copper/iron was higher in anaemic than in non-anaemic group. In conclusion, a lower level of serum zinc in anaemic pregnant women might be related to anaemia and iron deficiency during pregnancy. Therefore, combined zinc and iron supplementation should be recommended to Chinese pregnant women, especially those with anaemia.