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在撒哈拉以南非洲地区,铁补充剂与婴儿死亡率是否相关,出生体重是否会改变这些关联?

Is Iron Supplementation Associated with Infant Mortality in Sub-Saharan Africa and Does Birth Weight Modify These Associations?

作者信息

Bekele Yibeltal, Erbas Bircan, Batra Mehak

机构信息

School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia.

School of Public Health, Bahir Dar University, Bahir Dar 79, Ethiopia.

出版信息

Nutrients. 2025 May 16;17(10):1696. doi: 10.3390/nu17101696.

Abstract

Iron supplementation during pregnancy is associated with several health benefits, including a reduced risk of maternal anaemia and improved neonatal outcomes such as lower rates of low birth weight, infection, and anaemia in infancy. However, its impact on neonatal and post-neonatal mortality remains unclear in resource-limited settings, where adherence to maternal iron supplementation is low. This study examined the association between maternal iron supplementation and neonatal and post-neonatal mortality and explored whether low birth weight (LBW) modifies those associations. This cross-sectional study utilised Demographic and Health Survey data collected between 2015 and 2023 from 26 sub-Saharan countries, including 287,642 neonates and 279,819 post-neonates. The primary outcomes were neonatal deaths (within 28 days) and post-neonatal deaths (between 29 days and 12 months). These outcomes and the exposure variables of iron supplementation and its duration were based on maternal recall. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using generalised linear mixed models, with stratification by LBW. There was no significant association between maternal iron supplementation and neonatal mortality (aOR = 1.07; 95% CI: 0.86, 1.34). However, the interaction between LBW and iron supplementation was statistically significant ( = 0.04). Among the LBW infants, the absence of iron supplementation increased the odds of neonatal mortality by 68% (aOR = 1.68; 95% CI: 1.14, 2.47), while supplementation for ≥90 days reduced the odds by 45% (aOR = 0.55; 95% CI: 0.35, 0.84). For post-neonatal mortality, lack of iron supplementation increased the odds by 25% (aOR = 1.25; 95% CI: 1.01, 1.56), whereas supplementation for ≥90 days reduced the odds by 27% (aOR = 0.73; 95% CI: 0.57, 0.93). Maternal iron supplementation was associated with lower post-neonatal mortality and improved neonatal survival among LBW infants. These findings suggest that iron intake may support infant survival, particularly in vulnerable populations.

摘要

孕期补充铁剂有多项健康益处,包括降低孕产妇贫血风险,改善新生儿结局,如降低低出生体重、感染和婴儿期贫血的发生率。然而,在资源有限的环境中,孕产妇补充铁剂的依从性较低,其对新生儿和新生儿后期死亡率的影响仍不明确。本研究调查了孕产妇补充铁剂与新生儿及新生儿后期死亡率之间的关联,并探讨了低出生体重是否会改变这些关联。这项横断面研究利用了2015年至2023年期间从撒哈拉以南26个国家收集的人口与健康调查数据,包括287,642名新生儿和279,819名新生儿后期婴儿。主要结局是新生儿死亡(28天内)和新生儿后期死亡(29天至12个月之间)。这些结局以及铁剂补充及其持续时间的暴露变量均基于母亲的回忆。使用广义线性混合模型估计调整后的比值比(aOR)及其95%置信区间(CI),并按低出生体重进行分层。孕产妇补充铁剂与新生儿死亡率之间无显著关联(aOR = 1.07;95% CI:0.86,1.34)。然而,低出生体重与铁剂补充之间的交互作用具有统计学意义(P = 0.04)。在低出生体重婴儿中,未补充铁剂使新生儿死亡几率增加68%(aOR = 1.68;95% CI:1.14,2.47),而补充铁剂≥90天使几率降低45%(aOR = 0.55;95% CI:0.35,0.84)。对于新生儿后期死亡率,未补充铁剂使几率增加25%(aOR = 1.25;95% CI:1.01,1.56),而补充铁剂≥90天使几率降低27%(aOR = 0.73;95% CI:0.57,0.93)。孕产妇补充铁剂与较低的新生儿后期死亡率以及低出生体重婴儿的新生儿存活率提高相关。这些发现表明,铁摄入可能有助于婴儿存活,尤其是在弱势群体中。

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