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Iron deficiency anemia during pregnancy is a public health problem that may increase the risk of preterm birth with low birth weight infants and the high cost of neonatal intensive care. This quasi - experimental study in Thailand examined the effects of a balanced diet-iron supplement program on maternal and birth outcomes. The participants were pregnant women with anemia aged between 20-35 years and had a gestational age of 20-24 weeks. The experimental group (n = 40) received a balanced diet-iron supplement program in addition to usual care, whereas the control group (n = 40) received only usual care. The data collection instruments included: the personal information form, laboratory report of hematocrit, the INMUCAL-Nutrients V.3 software, iron supplement record sheet, a 3-day dietary record, a weight and height scale, and a baby weighing scale.Data were analyzed by descriptive statistics, Chi-square test, and McMemar test.
The results revealed that the proportion of participants in the experimental group had normal hematocrit, adequate dietary intake, adherence to iron supplement, and appropriate total weight gain significantly higher than those in the control group. In addition, the proportion of preterm birth and low birth weight baby in the experimental group were lower than those in the control group. The Balanced Diet-Iron Supplement Program of this study should be tested with other groups of women in different settings, but it has the good potential for nurses, midwives, and women to utilize in practice. Pregnant women with iron deficiency need assistance, knowledge, and practicing with meal plans to eat a balanced diet
and adhere to iron supplements to improve maternal health and prevent adverse birth outcomes.
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2. Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis. Ann NY Acad Sci. 2019; 1450(1): 47–68. doi: 10.1111/nyas.14093.
3. Cappellini MD, Musallam KM, Taher AT. Iron deficiency anemia revisited. J Intern Med. 2020; 287 (2):153–70. doi: 10.1111/joim.13004.
4. Finkelstein JL, Kurpad AV, Bose B, Thomas T, Srinivasan K, Duggan C. Anaemia and iron deficiency in pregnancy and adverse perinatal outcomes in Southern India. Eur J Clin Nutr. 2020;74(1):112–25. doi: 10.1038/s41430-019-0464-3.
5. Rahmati S, Delpishe A, Azami M, Hafezi-Ahmadi MR, Sayehmiri K. Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis. Int J Reprod Biomed. 2017;15(3):125–32.
6. Yuan X, Hu H, Zhang M, Long W, Liu J, Jiang J, et al. Iron deficiency in late pregnancy and its associations with birth outcomes in Chinese pregnant women: a retrospective cohort study. Nutr Metab (Lond). 2019;16(1): 30. doi: 10.1186/s12986-019-0360-9.
7. Finkelstein JL, Kurpad AV, Bose B, Thomas T, Srinivasan K, Duggan C. Anaemia and iron deficiency in pregnancy and adverse perinatal outcomes in Southern India. Eur J Clin Nutr. 2020;74(1):112–25. doi: 10.1038/s414 30-019-0464-3.
8. Zhang Q, Lu X-M, Zhang M, Yang C-Y, Lv S-Y, Li S-F, et al. Adverse effects of iron deficiency anemia on pregnancy outcome and offspring development and intervention of three iron supplements. Sci Rep. 2021;10(1):1–11. doi:10.1038/s41598-020-79971-y.
9. Athe R, Dwivedi R, Pati S, Mazumder A, Banset U. Metaanalysis approach on iron fortification and its effect on pregnancy and its outcome through randomized, controlled trials. J Family Med Prim Care. 2020;9(2):513–9. doi:10.4103/jfmpc.jfmpc_817_19.
10. Ministry of Public Health. The control and prevention of iron deficiency anemia project in 2021.[Internet]. 2021 [cited 2021 Jul 1]. Available from: http://doc.anamai. moph.go.th/index.php?r=str-project/view&id=4428
11. Jamnok J, Sanchaisuriya K, Sanchaisuriya P, Fucharoen, G, Fucharoen S, Ahmed F. Factors associated with anemia and iron deficiency among women of reproductive age in Northeast Thailand: a cross-sectional study. BMC Public Health. 2020;20(1):102. doi: 10.1186/s12889-020-8248-1.
12. Thongperm W, Chaisen M, Chunchom Y, Aueduldecha S, Sarakul O. Preliminary study for the prevalence and causes of anemia in pregnant women attending an Antenatal Care Unit in different periods of gestation. JAMS [Internet]. 2018
Aug4 [cited 2021Jul.6];51(3):122-7. Available from: https://he01.tci-thaijo.org/index.php/bulletin AMS/article/view/111918
13. Iqbal S, Ekmekcioglu C. Maternal and neonatal outcomes related to iron supplementation or iron status: a summary of meta-analyses. J Matern Fetal Neonatal Med. 2019; 32(9): 1528–40. doi: 10.1080/14767058.2017. 1406915.
14. Dhaher EA. Descriptive study for pregnant women’s knowledge attitude and practices regarding iron deficiency anemia and iron supplements in the Southern region of KSA. Asian Journal of Clinical Nutrition. 2020;12(1):21–23. doi: 10.3923/ajcn.2020.21.33.
15. Committee on Thai DRI, Health Department, Ministry of Public Health, Nonthaburi. [Internet]. 2003 [cited 2021 Jul 1]. Available from: http://food.fda.moph.go.th/law/data/announ_moph/P182.pdf
16. Araban M, Baharzadeh K, Karimi M. Nutrition modification aimed at enhancing dietary iron and folic acid intake: an application of health belief model in practice. Eur J Public Health. 2017;27(2):287–92. doi: 10.1093/eurpub/ckw238.
17. Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, Leshargie CT, Merkel Y. Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Reprod Health. 2020; 16(1): 172-82. doi: 10.1186/s12978-019-0848-9.
18. Pipatkul W, Sinsuksai N, Phahuwatanakorn W. Effects of a nutrition and iron supplement promoting program on iron deficiency anemia in pregnant women. Nurs Sci J Thail [Internet]. 2015 Mar 31 [cited 2021Jul6];33(1):69-6. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/41215
19. Jaranai P, Nirattharadorn M, Buaboon N. The effect of nutrition promotion program on the nutritional health behavior and hematocrit levels of adolescent pregnant women. JNSCU. 2018;30(1):59–69.
20. Ancira MM, O’Neill MS, Rivera DJA, Batis C, Rodriguez Ramirez S, Sanchez BN, et al. Dietary patterns and diet quality during pregnancy and low birthweight: the PRINCESA cohort. Matern Child Nutr.2020;16(3): 1–11. doi: 10.1111/mcn.12972.
21. Summawan P, Sinsuksai N, Pahuwatanakorn W. Effects of a nutrition promotion program on pregnancy outcomes in adolescents. KJN. 2013;20(2):100-15.
22. Petcharapun R, Wacharasin C. Effects of nutritional promotion program on fetal growth and pregnancy weight gain among pregnant women with low body mass index in private clinic, Chon Buri Province. PHJBUU. 2015;10(1): 130–44.
23. Chia AR, Chen LW, Lai JS, Wong CH, Neelakantan N, Van Dam RM, Chong MF. Maternal dietary patterns and birth outcomes: a systematic review and meta-analysis. Adv Nutr. 2019; 10(4):685–95. doi: 10.1093/advances/nmy123.
24. Odiwuor F. Nutrition education and counselling: an essential consideration to optimize maternal nutrition and pregnancy outcomes in Kenya. AJMRD.2020;2(5):16–24.
25. Ancira‐Moreno M, O Neill MS, Rivera‐Dommarco JA,Batis C, Rodriguez Ramirez S, Sanchez BN, Castillo‐Castrejon M, Vadillo‐Ortega F. Dietary patterns and diet quality during pregnancy and low birthweight: the PRINCESA cohort. Matern
Child Nutr. 2020;16 (3):1–11. doi: 10.1111/mcn.12972.
26. El Bilbeisi AH, El Afifi A, Baloushah S, Alblbeisi A, Albelbeisi AH, Taleb M. Maternal dietary patterns during early pregnancy and their association with pregnancy outcome among obese women in Gaza Strip, Palestine: a prospective cohort study. Austin J Nutri Food Sci. 2020;8(1):1138.
27. McAlpine JM, McKeating DR, Vincze L, Vanderlelie JJ, Perkins AV. Essential mineral intake during pregnancy and its association with maternal health and birth outcomes min South East Queensland, Australia. Nutr Metab Insights. 2019;12:1-12. doi: 10.1177/1178638819879444.
28. Pigatti Silva F, Souza RT, Cecatti JG, Passini R, Tedesco RP, Lajos GJ, et al. Role of body mass index and gestational weight gain on preterm birth and adverse perinatal outcomes. Sci Rep. 2019; 9 (1): 174-86. doi: 10. 1038/s41598-019-49704-x.
29. Tran NT, Nguyen LT, Berde Y, Low YL, Tey SL, Huynh DTT. Maternal nutritional adequacy and gestational weight gain and their associations with birth outcomes among Vietnamese women. BMC Pregnancy Childbirth. 2019;19 (1): 272-93. doi: 10.1186/s12884-019-2643-6.
30. Diemert A, Lezius S, Pagenkemper M, Hansen G, Drozdowska A, Hecher K Zyriax BC. Maternal nutrition, inadequate gestational weight gain and birth weight: results from a prospective birth cohort. BMC Pregnancy Childbirth. 2016;16(1):1–9. doi: 10.1186/s12884-016-1012-y.
31. Sehgal R, Kriplani A, Perumal V, Kumar A, Maiti L, Kandpal S, Kumar N, Chandhok N, Jindal V, Mittal S. Impact of pre-pregnancy body mass index, anemia and gestation weight gain on neonatal outcomes. IJOG.2017; 7(4):11-20.
32. Eick, SM, Welton M, Cordero JF. Relationship between pre-pregnancy overweight, obesity, and preterm birth in Puerto Rico. Matern Child Health J.2019;23(7): 925–33. doi: 10.1007/s10995-018-02719-8.
33. Ju AC, Heyman MB, Garber AK, Wojcicki JM. Maternal obesity and risk of preterm birth and low birth weight in Hawaii PRAMS, 2000–2011. Matern Child Health J.2018;22(6): 893–902. doi: 10.1007/s10995-018-2464-7.
34. Goodarzi–Khoigani M, Baghiani Moghadam MH, Nadjarzadeh A, Mardanian F, Fallahzadeh H, Mazloomy–Mahmoodabad S. Impact of nutrition education in improving dietary pattern during pregnancy based on Pender’s Health Promotion Model: a randomized clinical trial. Iran J Nurs Midwifery Res. 2018;23(1):18-25. doi: 10.4103/ijnmr.IJNMR_198_16.
35. Pender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. 6thed. Upper Saddle River, NJ: Pearson Prentice Hall; 2011.
36. Vajira Hospital, Faculty of Medicine, Navamindradhiraj University. The annual report of performance statistics in 2018. [Internet]. 2018 [cited 2021 Jul 1]. Available from: https://drive.google.com/drive/ folders/0B0J/Content/41149
37. Jung SH, Chow SC, & Chi EM. A note on sample size calculation based on propensity analysis in nonrandomized trials. J Biopharm Stat. 2007;17(1):35–41. doi: 10.1080/10543400601044790.
38. Grove SK, Burns N, Gray J. The practice of nursing research: appraisal, synthesis, and generation of evidence. 7th ed. Elsevier Health Sciences; 2013.
39. Institute of Nutrition, Mahidol University, Thailand. INMUCAL–Nutrients Program. Bangkok: Institute of Nutrition, Mahidol University; 2009.
40. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Rasmussen KM, Yaktine AL, editors. Washington (DC): National Academies Press (US); 2009. PMID: 20669500.