Choudhury Nuzhat, Aimone Ashley, Hyder S M Ziauddin, Zlotkin Stanley H
Research and Evaluation Division, Bangladesh Rural Advancement Committee, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Food Nutr Bull. 2012 Jun;33(2):142-9. doi: 10.1177/156482651203300208.
Iron deficiency is a major cause of anemia and the most prevalent nutrient deficiency among pregnant women in developing countries. The use of iron and folic acid supplements to treat and prevent iron-deficiency anemia has limited effectiveness, mainly due to poor adherence. Home fortification with a micronutrient powder for pregnant women may be an effective and acceptable alternative to traditional drug models.
To determine whether home fortification with micronutrient powders is at least as efficacious as iron and folic acid tablets for improving hemoglobin concentration in pregnant women.
A cluster-randomized noninferiority trial was conducted in the rural subdistrict of Kaliganj in central Bangladesh. Pregnant women (gestational age 14-22 weeks, n=478), were recruited from 42 community-based Antenatal Care Centres. Each centre was randomly allocated to receive either a micronutrient powder (containing iron,folic acid, vitamin C, and zinc) or iron and folic acid tablets. Changes in hemoglobin from baseline were compared across groups using a linear mixed-effects regression model.
At enrolment, the overall prevalence of anemia was 45% (n = 213/478). After the intervention period, the mean hemoglobin concentrations among women receiving the micronutrient powder were not inferior to those among women receiving tablets (109.5 ± 12.9 vs. 112.0 ± 11.2 g/L; 95% CI, -0.757 to 5.716). Adherence to the micronutrient powder was lower than adherence to tablets (57.5 ± 22.5% vs. 76.0 ± 13.7%; 95% CI, -22.39 to -12.94); however, in both groups, increased adherence was positively correlated with hemoglobin concentration.
The micronutrient powder was at least as efficacious as the iron and folic acid tablets in controlling moderate to severe anemia during pregnancy.
缺铁是贫血的主要原因，也是发展中国家孕妇中最普遍的营养缺乏症。使用铁和叶酸补充剂来治疗和预防缺铁性贫血效果有限，主要是因为依从性差。为孕妇提供微量营养素粉进行家庭强化补充可能是传统药物模式的一种有效且可接受的替代方法。
确定微量营养素粉家庭强化补充在提高孕妇血红蛋白浓度方面是否至少与铁和叶酸片一样有效。
在孟加拉国中部卡里根杰农村分区进行了一项整群随机非劣效性试验。从42个社区产前保健中心招募了孕妇（孕周14 - 22周，n = 478）。每个中心被随机分配接受微量营养素粉（含 铁、叶酸、维生素C和锌）或铁和叶酸片。使用线性混合效应回归模型比较各组从基线开始的血红蛋白变化。
入组时，贫血的总体患病率为45%（n = 213/478）。干预期后，接受微量营养素粉的女性平均血红蛋白浓度不低于接受片剂的女性（109.5±12.9 vs. 112.0±11.2 g/L；95% CI，-0.757至5.716）。对微量营养素粉的依从性低于对片剂的依从性（57.5±22.5% vs. 76.0±13.7%；95% CI，-22.39至-12.94）；然而，在两组中，依从性增加与血红蛋白浓度呈正相关。
微量营养素粉在控制孕期中度至重度贫血方面至少与铁和叶酸片一样有效。
