Periconceptional Iron and Folate Status Is Inadequate among Married, Nulliparous Women in Rural Bangladesh1,2

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Recent evidence suggests that poor fetal growth is associated with preconception anemia and first trimester iron deficiency. Periconceptional iron and folate supplementation may improve the effectiveness of iron supplementation programs during pregnancy by treating preexisting anemia, building iron stores, and reducing risk of neural tube defects. Our objective in this study was to describe the iron and folate status of married, nulliparous women in rural Bangladesh from March to May 2007. Of 272 women, 37% were anemic (hemoglobin <120 g/L), 13% were folate deficient (plasma folate ≤10 nmol/L), 15% were iron deficient (plasma ferritin <12 μg/L or tranferrin receptor >4.4 mg/L), 11% were iron deficient and anemic, and 81% were estimated to have <500 mg of iron stores. Risk of anemia was 4 times greater among nonstudents than students (95% CI: 1.23, 14.69), twice as likely among women with a previous miscarriage compared with those who had never been pregnant (95% CI: 1.04, 5.47), and 6 times greater among iron-deficient compared to iron-replete women (95% CI: 2.76, 11.81). Adolescents (≤19 y) had lower mean plasma ferritin concentration (38.3 ± SD vs. 49.1 ± SD μg/L; P= 0.004) and body iron stores [3.4 ± 5.2 mg/kg vs. 4.3 ± 5.6 mg/kg (0.06 ± 0.09mmol/kg vs. 0.08 ± 0.10 mmol/kg); P= 0.006] compared with adults. An unacceptably high percentage of nulliparous women in rural Bangladesh have inadequate iron and folate status. As they enter pregnancy, more than one-third will be anemic, >80% will have inadequate iron stores, and more than one-tenth will be folate deficient. Further research is needed on risk factors of poor nutritional status before the start of a woman's childbearing years. J. Nutr. 139: 1179–1184, 2009.

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