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Community and International Nutrition

Multiple Micronutrient Supplements during Pregnancy Do Not Reduce Anemia or Improve Iron Status Compared to Iron-Only Supplements in Semirural Mexico^1,2

Usha Ramakrishnan^*,3, Lynnette M. Neufeld, Teresa González-Cossío, Salvador Villalpando, Armando García-Guerra, Juan Rivera and Reynaldo Martorell^*

^* Department of International Health, Rollins School of Public Health, Emory University, Atlanta, GA; and Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico

³To whom correspondence should be addressed. E-mail: uramakr{at}sph.emory.edu.

The impact of iron-only supplements (FE) versus multiple micronutrient supplements containing iron (MM) during pregnancy on iron status was assessed in a subsample (n = 453) of women who participated in a randomized double-blind trial in Mexico. Compliance, monitored by observation, was high (>85%). The two groups were similar at recruitment (<13 wk gestation) for various sociodemographic characteristics and for mean hemoglobin (Hb) concentrations and prevalence of anemia (Hb < 110 g/L; 11%). However, mean serum ferritin was higher (P < 0.05) in the MM group (n = 142) compared to the FE group (n = 148) and the prevalence of iron deficiency (serum ferritin < 12 µg/L) was lower in the MM group (44.4%) compared to the FE group (57.4%). By the third trimester, almost half the women were anemic in both groups, and mean Hb (g/L) was lower for the MM group (104.2; 95% CI: 102.5, 106.0) compared to the FE group (108.1; 95% CI: 106.4, 109.8) after adjusting for baseline serum ferritin. In contrast, there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum (90.9 and 45.1% for the MM group; 92.6 and 47.3% for the FE group, respectively). In conclusion, rather than improve Hb or iron status relative to FE-only supplements as hypothesized, MM supplements may have slightly reduced Hb concentrations during pregnancy. Neither supplement was able to meet iron needs as evidenced by dramatic increases in anemia and iron deficiency by the end of pregnancy.

KEY WORDS: • iron • multivitamin-mineral • supplements • pregnancy • anemia

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