Anemia and Iron Deficiency in Rural Nepali Pregnant Women: Risk Factors, Effect of Vitamin A Supplementation and Their Association with Birth Outcomes

Persistent Link:
http://hdl.handle.net/10150/193930
Title:
Anemia and Iron Deficiency in Rural Nepali Pregnant Women: Risk Factors, Effect of Vitamin A Supplementation and Their Association with Birth Outcomes
Author:
Makhoul, Zeina
Issue Date:
2007
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
The objectives of the present study in rural Nepali pregnant women living in the terai were: 1) to identify the risk factors of severe anemia and investigate whether risk factors for anemia without iron deficiency, iron deficiency without anemia and iron deficiency anemia (IDA) were different; 2) to examine the effect of vitamin A supplementation, alone or combined with iron, on hemoglobin (Hb) and soluble transferrin receptor (sTfR); and 3) to identify the risk factors of low birth weight (LBW) and preterm delivery, focusing on maternal Hb concentrations. The prevalence of severe anemia (Hb < 8.0 g/dl) in this population (n = 3531) was 4.2% and that of iron deficiency was 31%. Logistic regression analyses indicated that risk factors of severe anemia included hookworm infestation, impaired dark adaptation, lack of iron supplement intake, a diet low in heme iron and malnutrition manifested by thinness and short stature. These same factors differed among non-iron-deficient anemic, iron deficient non-anemic, and iron-deficient anemic pregnant women. We found a significant positive correlation between Hb and retinol concentrations (Pearson r = 0.212, P < 0.0001) and one fourth of our anemic subjects were also vitamin A deficient. There was no evidence that vitamin A alone significantly increased Hb and decreased the prevalence of anemia (n = 498). However, vitamin A, when given together with iron, had an added beneficial effect on Hb but not sTfR. In addition, women with initially compromised iron status benefited more from iron and vitamin A supplementation. The prevalence of LBW and preterm delivery was 22% and 20%, respectively (n = 915). There was an increased risk of LBW associated with short stature, thinness and impaired dark adaptation. The association between Hb measured during the second trimester and risk of LBW had a U-shaped distribution, with risk increasing significantly with Hb < 8.0 g/dl. Based on our findings, we recommend that Hb is evaluated during the second trimester as an indicator of increased LBW risk. While vitamin A supplementation to all pregnant women is recommended, routine supplementation of iron and deworming during pregnancy are essential.
Type:
text; Electronic Dissertation
Keywords:
Vitamin A deficiency; anemia; birth outcomes; iron deficiency; Nepal; pregnant women
Degree Name:
PhD
Degree Level:
doctoral
Degree Program:
Nutritional Sciences; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Taren, Douglas
Committee Chair:
Taren, Douglas; Thomson, Cynthia

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.titleAnemia and Iron Deficiency in Rural Nepali Pregnant Women: Risk Factors, Effect of Vitamin A Supplementation and Their Association with Birth Outcomesen_US
dc.creatorMakhoul, Zeinaen_US
dc.contributor.authorMakhoul, Zeinaen_US
dc.date.issued2007en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThe objectives of the present study in rural Nepali pregnant women living in the terai were: 1) to identify the risk factors of severe anemia and investigate whether risk factors for anemia without iron deficiency, iron deficiency without anemia and iron deficiency anemia (IDA) were different; 2) to examine the effect of vitamin A supplementation, alone or combined with iron, on hemoglobin (Hb) and soluble transferrin receptor (sTfR); and 3) to identify the risk factors of low birth weight (LBW) and preterm delivery, focusing on maternal Hb concentrations. The prevalence of severe anemia (Hb < 8.0 g/dl) in this population (n = 3531) was 4.2% and that of iron deficiency was 31%. Logistic regression analyses indicated that risk factors of severe anemia included hookworm infestation, impaired dark adaptation, lack of iron supplement intake, a diet low in heme iron and malnutrition manifested by thinness and short stature. These same factors differed among non-iron-deficient anemic, iron deficient non-anemic, and iron-deficient anemic pregnant women. We found a significant positive correlation between Hb and retinol concentrations (Pearson r = 0.212, P < 0.0001) and one fourth of our anemic subjects were also vitamin A deficient. There was no evidence that vitamin A alone significantly increased Hb and decreased the prevalence of anemia (n = 498). However, vitamin A, when given together with iron, had an added beneficial effect on Hb but not sTfR. In addition, women with initially compromised iron status benefited more from iron and vitamin A supplementation. The prevalence of LBW and preterm delivery was 22% and 20%, respectively (n = 915). There was an increased risk of LBW associated with short stature, thinness and impaired dark adaptation. The association between Hb measured during the second trimester and risk of LBW had a U-shaped distribution, with risk increasing significantly with Hb < 8.0 g/dl. Based on our findings, we recommend that Hb is evaluated during the second trimester as an indicator of increased LBW risk. While vitamin A supplementation to all pregnant women is recommended, routine supplementation of iron and deworming during pregnancy are essential.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectVitamin A deficiencyen_US
dc.subjectanemiaen_US
dc.subjectbirth outcomesen_US
dc.subjectiron deficiencyen_US
dc.subjectNepalen_US
dc.subjectpregnant womenen_US
thesis.degree.namePhDen_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineNutritional Sciencesen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorTaren, Douglasen_US
dc.contributor.chairTaren, Douglasen_US
dc.contributor.chairThomson, Cynthiaen_US
dc.contributor.committeememberDuncan, Burrisen_US
dc.contributor.committeememberHakim, Imanen_US
dc.contributor.committeememberMuramoto, Myraen_US
dc.contributor.committeememberWinzerling, Joyen_US
dc.identifier.proquest2324en_US
dc.identifier.oclc659748191en_US
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