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Community and International Nutrition

Periconceptional Iron and Folate Status Is Inadequate among Married, Nulliparous Women in Rural Bangladesh^1,2

³ Department of Nutritional Sciences, ⁴ Department of Paediatrics, and ⁵ Dalla Lana School of Public Health, University of Toronto and The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada

Recent evidence suggests that poor fetal growth is associated with preconception anemia and first trimester iron deficiency. Periconceptional iron and folate supplementation may improve the effectiveness of iron supplementation programs during pregnancy by treating preexisting anemia, building iron stores, and reducing risk of neural tube defects. Our objective in this study was to describe the iron and folate status of married, nulliparous women in rural Bangladesh from March to May 2007. Of 272 women, 37% were anemic (hemoglobin <120 g/L), 13% were folate deficient (plasma folate 10 nmol/L), 15% were iron deficient (plasma ferritin <12 µg/L or tranferrin receptor >4.4 mg/L), 11% were iron deficient and anemic, and 81% were estimated to have <500 mg of iron stores. Risk of anemia was 4 times greater among nonstudents than students (95% CI: 1.23, 14.69), twice as likely among women with a previous miscarriage compared with those who had never been pregnant (95% CI: 1.04, 5.47), and 6 times greater among iron-deficient compared to iron-replete women (95% CI: 2.76, 11.81). Adolescents (19 y) had lower mean plasma ferritin concentration (38.3 ± SD vs. 49.1 ± SD µg/L; P = 0.004) and body iron stores [3.4 ± 5.2 mg/kg vs. 4.3 ± 5.6 mg/kg (0.06 ± 0.09 mmol/kg vs. 0.08 ± 0.10 mmol/kg); P = 0.006] compared with adults. An unacceptably high percentage of nulliparous women in rural Bangladesh have inadequate iron and folate status. As they enter pregnancy, more than one-third will be anemic, >80% will have inadequate iron stores, and more than one-tenth will be folate deficient. Further research is needed on risk factors of poor nutritional status before the start of a woman's childbearing years.

^* To whom correspondence should be addressed. E-mail: stanley.zlotkin{at}sickkids.ca.

Manuscript received 12 December 2008. Initial review completed 3 January 2009. Revision accepted 29 March 2009.

Published online 29 April 2009.

This article has been cited by other articles:

				A. Z Khambalia, D. L O'Connor, C. Macarthur, A. Dupuis, and S. H Zlotkin Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh Am. J. Clinical Nutrition, November 1, 2009; 90(5): 1295 - 1302. [Abstract] [Full Text] [PDF]