Tran Thach Duc, Fisher Jane, Hanieh Sarah, Tran Tuan, Simpson Julie Anne, Tran Ha, Biggs Beverley-Ann
Research and Training Centre for Community Development, Hanoi, Vietnam; Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
PLoS One. 2015 Apr 30;10(4):e0125740. doi: 10.1371/journal.pone.0125740. eCollection 2015.
Little evidence about the effects of antenatal iron supplementation on infant anaemia is available. The aim was to compare effects on six-month-old infants' Haemoglobin (Hb) concentration and anaemia of daily iron-folic acid (IFA), twice-weekly IFA with or without other micronutrients (MMN) and usual antenatal care in rural Vietnam.
Secondary data analysis from: a prospective population-based observational study (OS) which examined effects of antenatal psychosocial factors, anaemia and iron deficiency on infant development and health; and a three-arm cluster randomised trial (CRT) of different antenatal iron supplementation regimens. In the OS 497 women (<20 weeks gestation) from 50 randomly-selected communes participated, and in the CRT 1,258 pregnant women (<16 weeks gestation) in 104 communes were allocated randomly to trial arms. The main outcome was six-month-old infant Hb concentration. Baseline data included women's socio-demographic characteristics, reproductive health, Hb and serum ferritin. Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models, controlling for baseline differences and clustering, using robust standard errors. Infant anaemia prevalence was 68.6% in the OS, 47.2% daily IFA, 53.5% weekly IFA, and 50.3% MMN conditions. After adjustment, mean infant haemoglobin levels in daily IFA (mean difference = 0.95 g/dL; 95%CI 0.7-11.18); weekly IFA (0.91; 95%CI 0.69-1.12) and MMN (1.04; 95%CI 0.8-1.27) were higher than in the OS. After adjustment there were lower odds ratios of anaemia among infants in the daily IFA (OR = 0.31; 95% CI 0.22-0.43), weekly IFA (0.38; 95%CI 0.26-0.54) and MMN (0.33; 95%CI 0.23-0.48) groups than in the OS.
Infant anaemia is a public health problem in Vietnam and other resource-constrained countries. All supplementation regimens could have clinically significant benefits for Hb and reduce anaemia risk among six-month-old infants. Universal provision of free intermittent iron supplements is warranted.
关于产前铁补充剂对婴儿贫血影响的证据很少。目的是比较在越南农村地区，每日补充铁叶酸（IFA）、每周两次补充铁叶酸（无论是否添加其他微量营养素）以及常规产前护理对6个月大婴儿血红蛋白（Hb）浓度和贫血的影响。
二次数据分析来自：一项基于人群的前瞻性观察性研究（OS），该研究考察了产前心理社会因素、贫血和缺铁对婴儿发育与健康的影响；以及一项关于不同产前铁补充方案的三臂整群随机试验（CRT）。在OS中，来自50个随机选择公社的497名妊娠小于20周的妇女参与研究，在CRT中，104个公社的1258名妊娠小于16周的孕妇被随机分配至各试验组。主要结局是6个月大婴儿的Hb浓度。基线数据包括妇女的社会人口学特征、生殖健康、Hb和血清铁蛋白。通过多变量回归模型计算CRT各试验组与OS组之间婴儿Hb的平均差异以及婴儿贫血的比值比，并使用稳健标准误控制基线差异和聚类情况。OS组婴儿贫血患病率为68.6%，每日补充IFA组为47.2%，每周补充IFA组为53.5%，补充多种微量营养素（MMN）组为50.3%。调整后，每日补充IFA组（平均差异 = 0.95 g/dL；95%置信区间0.7 - 11. .18）、每周补充IFA组（0.91；95%置信区间0.69 - 1.12）和MMN组（1.04；95%置信区间0.8 - 1.27）婴儿的平均血红蛋白水平均高于OS组。调整后，每日补充IFA组（比值比 = 0.31；95%置信区间0.22 - 0.43）、每周补充IFA组（0.38；95%置信区间0.26 - 0.54）和MMN组（0.33；95%置信区间0.23 - 0.48）婴儿贫血的比值比均低于OS组。
婴儿贫血在越南和其他资源有限的国家是一个公共卫生问题。所有补充方案对Hb均可能有临床显著益处，并可降低6个月大婴儿的贫血风险。有必要普遍提供免费的间歇性铁补充剂。
