Effect of the maternal betaE-globin gene on hematologic responses to iron supplementation during pregnancy

BACKGROUND: It is customary in Southeast Asia to treat pregnant anemic women with iron supplements, but anemia in this region may be complicated by thalassemia and hemoglobinopathies, which lead to an ineffective response. OBJECTIVE: The aim was to determine whether routine iron supplementation during pregnancy in this area, which has a high prevalence of thalassemia and hemoglobinopathies, is an effective control strategy for iron deficiency anemia. DESIGN: A prospective study was conducted. Seventy-six pregnant women, including 43 who were heterozygous for the hemoglobin E (Hb E) gene, 20 who were heterozygous for Hb E and had alpha-thalassemia, and 13 who were homozygous Hb E, as well as 77 pregnant women who had no thalassemia gene, participated in this investigation. All pregnant women received a daily dose of 120 mg elemental Fe for an average of 133.5 d. Hematologic variables and serum ferritin concentrations were measured before supplementation and after supplementation at the gestational age of 28-32 wk. Differences in hematologic variables and serum ferritin were assessed. RESULTS: Significant differences in hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin responses were found between the nonthalassemia group and the 3 groups with the Hb E gene after adjustment for the following baseline values: age, body mass index, duration of iron supplementation, and ferritin concentration. Significant differences in the improvements in mean corpuscular volume and mean corpuscular hemoglobin values between the 3 groups indicate a poorer response at the cellular level in the pregnant women with the Hb E gene. Further analysis showed a significant difference in the hemoglobin response only for women who were homozygous for Hb E. CONCLUSION: Iron supplementation during pregnancy is not beneficial for pregnant women who are homozygous for Hb E, but a routine intervention should not cause iron overload, as judged from this short observation period.     

孕期补充铁剂联合心理护理干预对孕妇妊娠贫血、不良妊娠结局、心理状态及健康管理质量的影响

目的探讨孕期补充铁剂联合心理护理干预在孕妇妊娠贫血中的预防效果及对孕妇妊娠贫血、不良妊娠结局、心理状态及健康管理质量的影响。方法选择2019年8月至2021年6月于巴彦淖尔市医院进行产检并建册的102例孕妇作为研究对象,按随机数字表法分为对照组(n=51例)和观察组(n=51例)。对照组孕期补充铁剂干预,观察组在对照组基础上联合心理护理,护理3个月后对两组的效果进行评估,比较两组孕妇妊娠期贫血发生率、不良妊娠结局、心理状态及健康管理质量。结果观察组孕妇的贫血发生率及胎膜早破、胎儿窘迫、产后出血等不良妊娠结局总发生率低于对照组,差异有统计学意义(P<0.05)。两组护理后广泛性焦虑障碍量表(GAD7)和抑郁症筛查量表(PHQ9)评分低于护理前,差异有统计学意义(P<0.05);观察组护理后GAD7和PHQ9评分低于对照组,差异有统计学意义(P<0.05)。两组护理后健康管理质量、健康知识掌握度及依从性评分高于护理前,差异有统计学意义(P<0.05);观察组护理后健康管理质量、健康知识掌握度及依从性评分高于对照组,差异有统计学意义(P<0.05)。结论孕期补充铁剂联合心理护理干预能降低孕妇妊娠贫血发生率,有助于降低不良妊娠结局发生率,减轻并缓解孕妇不良情绪,提高孕妇健康管理质量,值得推广应用。     

补充铁剂对上海育龄妇女缺铁性贫血改善效果研究

目的了解缺铁性贫血育龄妇女补充铁剂的效果,探讨维持育龄妇女正常铁营养状况的总铁摄入量。方法招募贫血的育龄妇女74名,年龄21～45岁,按血红蛋白随机分成干预组和对照组,每日分别口服一包铁营养包(主要成分为焦磷酸铁和富马酸亚铁,含铁元素8mg)和安慰剂,连续服用6个月观察效果。干预前、3个月及6个月后两组均进行缺铁性贫血相关指标检查、膳食频率调查及24 h膳食回顾调查。结果干预6个月后干预组血红蛋白和血清铁蛋白均显著高于对照组(P<0.01),干预组和对照组血红蛋白值达标人数分别为15人(44.1%)和5人(14.3%),P<0.01;血清铁蛋白达标人数分别为11人(35.5%)和4人(12.1%),P<0.05。膳食铁的平均摄入量为14.0mg/d。总铁摄入量(膳食铁加补充的铁)与血红蛋白值的改变呈正相关(r=0.57,P﹤0.01)。膳食纤维摄入多和月经量多则是危险因素(P<0.05)。结论连续6个月每日补充8mg铁能有效改善育龄妇女缺铁性贫血,育龄妇女每日摄入23.2mg铁可维持正常铁储存状况。     

Anemia in pregnancy at South Sharqiya health centers, Oman

Despite the improvement in some indicators of maternal health, the rate of anemia in pregnancy in South Sharqiya Region, Oman was not satisfactory. The aim of this work was to study the correlates of anemia in pregnancy and its outcomes at the ANC clinics in South Sharqiya health centers. A health facility-based follow up study was designed in 1998. In randomly selected 5 health centers representing all wilayats of South Sharqiya Region, Oman, a form for monthly data collection from the ANC registers was used to follow up 852 pregnant women till their pregnancies ended. Hemoglobin estimation was done four times monthly apart for pregnant women and data was entered into the computer using EPI info program. The data of 852 pregnant females was analyzed where 43.6% of the sample were anemic. Logistic Regression showed that mother age and weight were significantly associated with anemia in pregnancy. Follow up of pregnant anemic women was not satisfactory. Anemic pregnant women showed response to iron supplement and folic acid received. No significant association between anemia in pregnancy whatever its grade and LBW or still birth. The follow-up system of anemia in pregnancy should be stricter. Good dietary history has to be taken from pregnant females for better nutritional education and to rule out unhealthy nutritional practices.     

Nutrition intervention program for the management of iron‐deficiency anemia in a group of pregnant women in Jordan

The impact of a nutrition education intervention program on the prevention of iron deficiency anemia in a group of pregnant Jordanian women was evaluated. The program was based on planned meals from local food sources in combination with nutritional counseling as an alternative approach to more costly iron supplementation.

Data on dietary intake, anthropometric measures, iron status indices and nutrition knowledge were used in evaluation of program effectiveness.

The treatment group showed increased nutrition knowledge, more adequate nutrient intake, normal weight gain and better iron status than the control group, which received only usual care including limited nutrition counseling.

Results of the study indicate the feasibility of the nutrition intervention program in the management of iron‐deficiency and prevention of anemia in women from communities of low socio‐economic status.     

Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: a prospective study

OBJECTIVE: We evaluated the effect of iron supplementation on biochemical indicators of iron status, namely hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptor (sTfR), during pregnancy. METHODS: A prospective study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 microg of folic acid for 100 d from 19 wk of gestation. The indicators of iron status (Hb, SF, and sTfR) at 19, 27, and 35 wk of gestation were analyzed. The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic (n = 35) and non-anemic (n = 38) at 19 wk. RESULTS: All three indicators of iron status during supplementation (27 and 35 wk) were similar to the presupplementation status. The sTfR as an indicator correlated negatively with presupplementation Hb levels (r = -0.417). Based on sTfR level in iron-adequate pregnant women, a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy. When the response was tested in anemic pregnant women, iron supplementation improved mean Hb (P < 0.05) at the end of 35 wk (96 +/- 8.8 to 110 +/- 20.2 g/L) of gestation, with no change in SF. Conversely, non-anemic pregnant women showed a significant increase in SF and a decrease in Hb (122 +/- 11.6 to 112 +/- 15.2 g/L) at 35 wk of gestation. A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women. CONCLUSIONS: These observations suggest that, during pregnancy, sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator.     

Control of anaemia among pregnant women by iron supplementation

The results of iron supplementation among 171 pregnant women registered at the maternal and child health (MCH) clinic of the Urban Health Training Center of Preventive and Social Medicine, S.M.S. Medical College, Jaipur, are reported. The registration of pregnant women was done at home visits. Initial hemoglobin level was estimated with Sahli's hemoglobinometer and 2 tablets of iron folic acid, each containing 60 mg of elemental iron and 0.5 mg folic acid were given each day for 90 days. Hemoglobin estimation was repeated every month. The regularity of intake was ensured by the MCH staff and women who consumed up to 75% of the period were considered as regular. Most of the women receiving iron supplementation were between 21-30 years of age, accounting for 62.6%. 29.2% of the women were under age 20. 51.5% were registered in their 2nd trimester and 1/3 in the 1st trimester. 14.6% were registered as late as the 3rd trimester. Only 9.4% had normal hemoglobin levels; the remaining 90.6% were anemic, 83% mild to moderate anemia and 7.6% severe anemia. The prevalence was highest in the 2nd trimester, in which 95.8% of the women were anemic. The prevalence was marginally lower in 1st and 3rd trimester, being 86.2% and 88.9%. Severity of anemia increased with increasing gestational age. The proportion of severely anemic women was as much as 25.9% in women in the 3rd trimester as compared to women in the 2nd trimester (8%) and none in the 1st trimester. The mean hemoglobin levels were almost similar in various trimesters, but the lowest mean levels were recorded in the 3rd trimester. The maximum changes were recorded in the 1st trimester, when the mean hemoglobin level increased but not significantly. Practically no change in mean hemoglobin was observed in the 2nd trimester, and there was a slight increase in the 3rd trimester after completion of iron supplementation. Trials are now on to fortify the common food commodity, particularly in wheat flour and common salt for continued iron supplementation.     

Effect of iron supplementation among pregnant women at mother-and-baby clinic of Sidi Bel Abbès, West Algeria

Iron deficiency is the most prevalent nutritional disorder worldwide, especially in developing countries. It occurs when iron absorption does not equal iron requirements plus iron loss. Because iron requirements are especially high in pregnant women, infants, young children, and adolescents, these groups run a high risk of iron-deficiency anemia. In this controlled prospective and longitudinal study of 83 pregnant women, we explored the correlations between various epidemiological characteristics and the onset of anemia. We also looked at the effect of iron supplementation on the hematological parameters among pregnant women with anemia. Blood counts during the first trimester of pregnancy (3 months +/- 2 weeks' gestation) revealed that 31 of the 83 subjects (37.3%) women had anemia (Hb < 11 g/100 ml): 16 moderate (7 g/dl < or = Hb < 10 g/dl) and 15 mild (10 g/dl < or = Hb < 11 g/dl). We detected no cases of severe anemia in our study. Nor did we find a clear correlation between anemia and such factors as age (r = 0.09), number of pregnancies (r = - 0.30), interval between pregnancies (r = 0.03), or number of abortions (r = - 0.18). Nonetheless, iron supplementation of 30 mg/day, prescribed for four months for all the women with anemia (n = 31), improved some of these hematological parameters, increasing hemoglobin and serum iron levels in particular. These two parameters were strongly positively correlated (r = 0.89). We also noted that the red blood cell count (RBC) and the mean corpuscular hemoglobin concentration (MCHC) both increased significantly (p < 0.05) among the anemic women receiving iron supplements. The prevalence of anemia fell from 34.1% in the first trimester, before supplementation, to 6.3% in the third trimester. This finding suggests that the supplementation prevented the fall in hemoglobin and serum iron that occurred among the women without anemia. We think that iron supplementation is a good strategy for treating and preventing anemia during pregnancy.     

参与式孕期健康宣教对产妇认知及生理指标的影响

目的通过对比研究了解参与式孕期健康宣教对产妇孕期保健知识及生理指标的影响。方法选取年分娩量>2000例的14家省市级妇幼保健机构,每家机构按随机和自愿原则各选取150例孕妇作为试验组和对照组,试验组进行参与式健康宣教,对照组进行常规授课宣教。孕妇分娩后了解其生理指标及保健知识的掌握情况。结果试验组孕妇孕期保健和儿童养育知识平均得分分别较对照组高0.24分和0.30分,孕末血色素水平平均高1.2g/L,且孕期体重较对照组少增长0.57kg。结论参与式孕期健康宣教有利于产妇对妇幼保健相关知识的掌握及孕期贫血的预防,各地可尝试推广普及。     

Iron deficiency anemia: Pregnancy outcomes with or without iron supplementation

Objective

To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes.

Methods

Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities.

Results

Of 22 843 cases with congenital abnormalities, 3242 (14.2%), while of 38 151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation.

Conclusion

A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements.     

Community Mobilization and Social Marketing to Promote Weekly Iron-Folic Acid Supplementation in Women of Reproductive Age in Vietnam: Impact on Anemia and Iron Status

The community mobilization and social marketing program promoting a preventive approach of weekly iron-folic acid supplementation in women of reproductive age improved iron status of non-pregnant women in Vietnam. Three to six months of weekly pre-pregnancy supplementation and regular weekly intake of supplements during pregnancy allowed women to achieve good iron and hemoglobin status during the two first trimesters of pregnancy. In the third trimester, iron deficiency and anemia were notably present but low birth weight prevalence was low. This demonstrates the effectiveness and safety of the preventive approach as implemented here to prevent and control iron deficiency and anemia in women of reproductive age before and during pregnancy.     

A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women

BACKGROUND: Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia. However, 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective. OBJECTIVE: We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation. DESIGN: In a prospective, partially randomized study, 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid, and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly. One hundred women in each group completed the study. Changes in hemoglobin, iron indicators, pregnancy outcomes, and birth weight were compared between the 2 groups. RESULTS: Hemoglobin and iron indicators improved significantly with both treatments. The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment. No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed. Systemic side effects were more common in the parenteral iron group, whereas gastrointestinal side effects were more common in the oral iron group. CONCLUSIONS: The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who cannot tolerate oral administration of iron. However, intramuscular administration of iron is appropriate only in hospital settings well equipped to treat anaphylactic crises.     

Multiple contributors to iron deficiency and anemia in Senegal

Abstract

Background Anemia, especially due to iron deficiency early in pregnancy, has adverse consequences on pregnancy outcomes.

Methods A cross-sectional study of 480 pregnant women in their second trimester was conducted in Senegal's capital, Dakar. Eighty women were selected per health center. Parasitological, dietary, and genetic factors were assessed to ascertain their relationship to anemia status and etiology.

Results Thirty-nine percent of the women were anemic; only 12–13% of the women had any parasite. Daily heme iron was reported in 35% of women, but intake amounts were low. Intakes of iron inhibitors were frequently consumed. Mean hemoglobin and serum ferritin levels were significantly higher and erythrocyte protoporphyrin levels were lower in women who consumed iron inhibitors less frequently.

Conclusions Results of this study can improve the current antenatal program in Senegal and similar West African countries. Educating about dietary iron inhibitors and encouraging patient compliance can be significant contributors to reducing anemia in pregnancy.     

初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素分析

目的探讨初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素。方法回顾性分析2016年1月至2019年12月我院收治的980例初次妊娠孕妇的临床资料,依据是否出现缺铁性贫血分为对照组(未出现缺铁性贫血,800例)和观察组(出现缺铁性贫血,180例)。根据病情严重程度将观察组分为轻度组(血红蛋白100~109 g/L, 100例)、中度组(血红蛋白70~99g/L, 60例)和重度组(血红蛋白40~69 g/L, 20例),分析四组孕妇的临床特点,以及初次妊娠孕妇妊娠期缺铁性贫血与贫血程度的影响因素。结果两组的孕次、文化程度、家庭人均月收入水平比较差异无统计学意义(P>0.05)。轻度组、中度组、重度组年龄≥35岁、膳食铁摄入差、孕前保健<3次占比均高于对照组(P <0.05)。经Logistic多因素分析显示,年龄≥35岁、膳食铁摄入差、孕前保健<3次均为妊娠期缺铁性贫血发生的危险因素(OR>1, P <0.05)。结论高龄、膳食铁摄入差、孕前保健次数少是引发妊娠期缺铁性贫血的危险因素。     

Prevention of iron-deficiency anemia in pregnancy using early iron supplementation: a controlled trial

An iron supplementation trial versus placebo was performed in double blind on 191 attending at 3 month the antenatal clinic of Poissy maternity. Iron status of mothers and newborns was assessed at 3, 5, 7 month, during the delivery and 2 months after the delivery, using biochemical indicators (hemoglobin level, serum ferritin). The compliance was good in 165 pregnant women (86% of the initial sample): 81 in the iron group, 84 in the placebo group. Among the placebo group, anemia (Hb less than 11 g/dl) was observed at the end of the pregnancy in 30% of women. Depletion of iron stores started at 5 month. In the iron group, hemoglobin level increased significantly during the pregnancy and anemia was observed only in 3% of women at the delivery. Iron status of newborns and two months after delivery was related to mothers iron status at delivery and particularly at the 7th month of pregnancy.     

Effectiveness of iron supplementation compared to iron treatment during pregnancy

This study presents the evaluation of an iron supplementation program in a community by comparing 478 pregnant women who received iron supplementation from the 4th month of pregnancy, with 392 pregnant women who received iron treatment only if their Hb level was less than 12 gm/dl, and had no supplementation. In the supplementation group, no statistically significant associations were found between compliance with age, education, social class or parity. Pregnant women of European-American origin showed higher rates of good compliance than those of Asian-African origin. The mean decrease of haemoglobin (Hb) and haematocrit (Hct) between the second and third trimester of pregnancy was smaller in the supplementation group (-0.9 gm/dl Hb, -2.1% Hct) than in the treatment group (-1.1 gm/dl Hb; -3.3% Hct). The differences between the two groups were significant only for the Hct levels (P = 0.022). The mean Hb and Hct levels during the third trimester of pregnancy were higher for good compliers (11.7 gm/dl Hb; 33.6% Hct) than for poor compliers (11.4 gm/dl Hb, 32.6% Hct).     

北京市孕妇缺铁性贫血的研究

作者对北京市宣武区妇幼保健院645名产前健康检查孕妇进行了缺铁性贫血的调查研究。对其中44名用24小时回顾法进行了膳食调查,发现铁摄取量超过供给标准。从645名各期孕妇血红蛋白含量、红细胞数及血球压积测定结果,发现孕妇贫血患病率随妊娠而有明显增加,末期最高。膳食中铁吸收利用不良可能是缺铁的主要原因。33例贫血孕妇每天补充元素铁平均12.4mg,维生素C66mg,1个月后血红蛋白水平明显升高,说明这些孕妇贫血原因主要是铁的不足所引起。对贫血孕妇补充铁剂是必要的,作者认为在摄入适当的维生素C时,每日给贫血孕妇补充元素铁10mg左右是适宜的。     

Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh.

BACKGROUND: Iron deficiency is the most common micronutrient deficiency and affects >2 billion persons worldwide, leading to anemia in >40% of women of reproductive age in the developing world. OBJECTIVE: The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant. DESIGN: Participants with a hemoglobin concentration of 80-120 g/L were entered into a randomized, double-blind, placebo-controlled trial and received supplements of placebo, vitamin A, iron + folic acid, or iron + folic acid + vitamin A weekly for 12 wk. The supplements contained 2.42 mg vitamin A (retinol) as retinyl palmitate, 120 mg elemental Fe as ferrous sulfate, and 3.5 mg folic acid. RESULTS: Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone. There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid, but the additional effect disappeared after adjustment for baseline hemoglobin, serum vitamin A, and ferritin and the number of supplements taken. Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin. Compared with the placebo, iron + folic acid + vitamin A reduced anemia by 92%, iron deficiency by 90%, and vitamin A deficiency by 76%. CONCLUSION: There may be significant health benefits from a program that enhances the nutritional status of iron, folate, and vitamin A in poor urban young women before they become pregnant.     

产褥期贫血患病率及预后影响因素分析

目的:了解产后3 d产妇贫血患病状况及产后42 d恢复情况,探讨与贫血恢复有关的影响因素,并提出干预措施。方法:于产后3 d对400例产妇进行血红蛋白筛查,贫血产妇共167例,产后42 d追踪贫血恢复情况。共追踪到145例,按照42 d血红蛋白水平分为贫血组(病例组)50例和血红蛋白正常组(对照组)95例。进行产褥期贫血未恢复影响因素的单因素分析及Logistic回归分析。结果:产后3 d贫血的患病率41.8%(167/400),至产后42 d复诊者恢复率为65.5%(95/145)。影响贫血恢复的相关因素为:水果摄入过少和产褥期未服用抗贫血药为产褥期贫血未恢复的危险因素,其OR值分别为2.470(95%C I:1.115~5.468)和2.343(95%C I:1.025~5.357);而孕期血红蛋白≥100 g/L、产后3 d血红蛋白≥100 g/L及人工喂养为保护因素,其OR值分别为0.328(95%C I:0.144~0.747)、0.419(95%C I:0.181~0.969)和0.024(95%C I:0.031~0.778)。结论:产褥初期产妇贫血患病率较高,且超过1/3的患者到产褥末期未恢复。因此妇幼保健工作者应重视产褥期保健工作,要针对影响贫血恢复的主要因素进行预防和控制,以提高产褥期贫血的恢复率。     

Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania

BACKGROUND: Anemia is a frequent complication among HIV-infected persons and is associated with faster disease progression and mortality. OBJECTIVE: We examined the effect of multivitamin supplementation on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children. DESIGN: HIV-1-infected pregnant women (n = 1078) from Dar es Salaam, Tanzania, were enrolled in a double-blind trial and provided daily supplements of preformed vitamin A and beta-carotene, multivitamins (vitamins B, C, and E), preformed vitamin A and beta-carotene + multivitamins, or placebo. All women received iron and folate supplements only during pregnancy according to local standard of care. The median follow-up time for hemoglobin measurement for mothers was 57.3 mo [interquartile range (IQR): 28.6-66.8] and for children it was 28.0 mo (IQR: 5.3-41.7). RESULTS: During the whole period, hemoglobin concentrations among women who received multivitamins were 0.33 g/dL higher than among women who did not receive multivitamins (P=0.07). Compared with placebo, multivitamin supplementation resulted in a hemoglobin increase of 0.59 g/dL during the first 2 y after enrollment (P=0.0002). Compared with placebo, the children born to mothers who received multivitamins had a reduced risk of anemia. In this group, the risk of macrocytic anemia was 63% lower than in the placebo group (relative risk: 0.37: 95% CI: 0.18, 0.79; P=0.01). CONCLUSION: Multivitamin supplementation provided during pregnancy and in the postpartum period resulted in significant improvements in hematologic status among HIV-infected women and their children, which provides further support for the value of multivitamin supplementation in HIV-infected adults.