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Weekly Supplementation with Iron and Vitamin A during Pregnancy Increases Hemoglobin Concentration but Decreases Serum Ferritin Concentration in Indonesian Pregnant Women¹

Siti Muslimatun^*,, Marjanka K. Schmidt^*,, Werner Schultink^**, Clive E. West^,2, Joseph G.A.J. Hautvast, Rainer Gross and Muhilal

^* SEAMEO TROPMED Regional Center for Community Nutrition, University of Indonesia, Jakarta, Indonesia; Division of Human Nutrition and Epidemiology, Wageningen University, The Netherlands; ^** UNICEF, New York, NY; Department of Gastroenterology, University Medical Center Nijmegen, The Netherlands; German Agency for Technical Cooperation (GTZ), Eschborn, Germany; and Nutrition Research and Development Center, Bogor, Indonesia

²To whom correspondence should be addressed. Division of Human Nutrition and Epidemiology, Wageningen University, PO Box 8129, 6700 EV Wageningen, The Netherlands. E-mail: Clive.West{at}staff.nutepi.wau.nl.

We investigated whether weekly iron supplementation was as effective as the national daily iron supplementation program in Indonesia in improving iron status at near term in pregnancy. In addition, we examined whether weekly vitamin A and iron supplementation was more efficacious than weekly supplementation with iron alone. One group of pregnant women (n = 122) was supplemented weekly with iron (120 mg Fe as FeSO₄) and folic acid (500 µg); another group (n = 121) received the same amount of iron and folic acid plus vitamin A [4800 retinol equivalents (RE)]. A third ("daily") group (n = 123), participating in the national iron plus folic acid supplementation program, was also recruited. Data on subjects with complete biochemical data are reported (n = 190). At near term, hemoglobin concentrations increased, whereas serum ferritin concentrations decreased significantly in the weekly vitamin A and iron group, suggesting that vitamin A improved utilization of iron for hematopoiesis. Iron status in the weekly iron group was not different from that of the "daily" group. However, iron status decreased with daily supplementation if <50 iron tablets were ingested. Serum transferrin receptor concentrations increased in all groups (P < 0.01). Serum retinol concentrations were maintained in the weekly vitamin A and iron group, but decreased in the other two groups (P < 0.01). Thus, delivery of iron supplements on a weekly basis can be as effective as on a daily basis if compliance can be ensured. Addition of vitamin A to the supplement improved hemoglobin concentration.

KEY WORDS: • iron • vitamin A • pregnant women • weekly supplementation

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