Department of Public Health Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Kuala Lumpur, Malaysia.
Am J Trop Med Hyg. 2024 Feb 13;110(3):576-587. doi: 10.4269/ajtmh.23-0411. Print 2024 Mar 6.
The Indonesian government has provided iron-folic acid (IFA) supplementation in response to maternal pregnancy iron-deficiency anemia. However, community-based cohorts on IFA's effects on maternal and infant anemia are limited. A mixed-method study design with a primary longitudinal cohort was used to observe the association between IFA and anemia in mothers and infants. Iron-folic acid supplementation was observed throughout pregnancy. Anemia status was based on a single hemoglobin assessment using HemoCue Hb 201 + in the second or third trimester of pregnancy for the mother and at birth for the infant. Qualitative data were collected via in-depth interviews (IDIs) and a forum group discussion (FGD). Iron-folic acid supplementation with > 180 tablets throughout pregnancy was associated with lower pregnancy anemia (adjusted relative risk [aRR] = 0.25, 95% CI: 0.092-0.664, P = 0.006) after adjusting for potential confounding variables. Supplementation with IFA was not associated with infant anemia (RR = 1.033, 95% CI: 0.70-1.54, P = 0.873 for 90-180 tablets and RR = 1.07, 95% CI 0.70-1.63, P = 0.774 for > 180 tablets). The IDIs and FGD suggested that IFA and multivitamin content knowledge, IFA consumption monitoring, and paternal involvement were important in IFA supplementation and effectiveness in reducing anemia. Iron-folic acid supplementation was associated with reduced maternal but not infant anemia. Because maternal anemia is associated with infant anemia, an anemia monitoring program for women in early pregnancy is vital in addressing infant health. Paternal involvement was also identified as a major factor in maternal and child health.
印度尼西亚政府提供了铁叶酸（IFA）补充剂，以应对孕妇缺铁性贫血。然而，基于社区的 IFA 对母婴贫血影响的队列研究有限。本研究采用混合方法设计，包括一个主要的纵向队列，观察 IFA 与母亲和婴儿贫血之间的关联。整个孕期都观察 IFA 补充情况。根据母亲在妊娠第二或第三孕期和婴儿出生时使用 HemoCue Hb 201+ 进行的单次血红蛋白评估来确定贫血状态。使用深入访谈（IDIs）和论坛小组讨论（FGD）收集定性数据。在调整潜在混杂变量后，整个孕期补充超过 180 片 IFA 与妊娠贫血降低相关（调整后的相对风险 [aRR] = 0.25，95%CI：0.092-0.664，P = 0.006）。补充 IFA 与婴儿贫血无关（RR = 1.033，95%CI：0.70-1.54，P = 0.873，90-180 片；RR = 1.07，95%CI：0.70-1.63，P = 0.774，超过 180 片）。IDIs 和 FGD 表明，IFA 和多种维生素含量知识、IFA 消费监测和父亲参与对 IFA 补充和降低贫血的有效性很重要。IFA 补充与母亲贫血降低有关，但与婴儿贫血无关。由于母亲贫血与婴儿贫血有关，因此在早期妊娠中针对妇女开展贫血监测计划对于解决婴儿健康问题至关重要。父亲参与也被确定为母婴健康的一个主要因素。
