Periconceptional Iron Supplementation and Iron and Folate Status among Pregnant and Non-pregnant Women in Rural Bangladesh

In 2007, Bangladesh’s national strategy to reduce anemia included adolescents and newly married women as target groups for iron and folic acid (IFA) supplementation. This thesis is comprised of a pilot study and a double-blinded randomized controlled trial (RCT) aimed at providing evidence-based research to inform decision-making on periconceptional IFA programs in rural Bangladesh. Results from the pilot study indicate that women who marry during adolescence had significantly longer intervals to first pregnancy compared to adult brides; however, the time interval was not long enough to delay family formation beyond adolescence. Education, age at marriage and contraceptive use were significant factors for delaying time to first pregnancy. The RCT examined the effect of daily periconceptional iron (60 mg) and folic acid (400 μg) vs. folic acid (FA) on iron and folate indictors. Of 272 women, 37% were anemic (Hb 4.4 mg/L), 11% were iron deficient and anemic and 81% were estimated to have <500 mg of iron stores. Adolescents had significantly lower plasma ferritin and body iron stores vs. adults. Among 88 pregnant women (PW), an interaction between treatment and adherence was significantly associated with change in Hb (p=0.04) and anemia (p=0.05). During pregnancy, group differences for iron status were not significant. Among NPW (n=146), IFA reduced anemia by 80.0% (95% CI: 0.04, 1.00, p=0.05) and significantly improved change in plasma ferritin concentrations by level of adherence in a dose-response relationship (p=0.01). In both groups, mean plasma folate concentrations increased from 16.9 to31.8 nmol/L and the prevalence of low plasma folate concentrations (