The Effects of Vitamin C for Iron Supplementation during Pregnancy with Risk of Anemia: A Randomized Controlled Clinical Trial
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Abstract
Objectives: To evaluate the effects of combining vitamin C with iron supplementation on hemoglobin (Hb) and hematocrit (Hct) levels among pregnant women at high risk of anemia.
Materials and Methods: A randomized controlled trial was conducted among singleton pregnant women at 14-28 weeks of gestation, with Hb ≥ 10.5 g/dL, Hct ≥ 32% and ferritin ≥ 30 ng/mL, who were at risk of anemia (> prior 2 pregnancies, age < 18 or > 35 year-old or body mass index < 18 kg/m2 ). Women attending Rajavithi Hospital from July 2023 - June 2024 were randomly assigned to receive vitamin C (500 mg) plus iron supplement or iron only. Hb and Hct were measured 2 months after intervention.
Results: Total of 100 enrolled participants, 22 (22%) were excluded for having ferritin levels < 30 ng/mL. The remaining 78 women were randomized, with 38 in the experimental group (vitamin C plus iron) and 40 in the control group (iron only). There were no significant differences in Hb and Hct levels between the two groups, both initially and 2 months after the intervention (Hb: mean difference (MD) -0.11; 95% CI -0.53, 0.31; p = 0.609 and MD -0.24; 95% CI -0.67, 0.32; p = 0.253; respectively) (Hct: MD -0.77; 95% CI -1.96, 0.55; p = 0.266; MD -0.70; 95% CI -1.97, 0.58; p = 0.282). The repeated measure analysis of variance (ANOVA) showed non-significant overall mean differences. No adverse events were reported.
Conclusion: Vitamin C was not essential with iron supplements to improve Hb and Hct levels in pregnant women at risk of anemia.
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References
Soma-Pillay P, Catherine NP, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27:89-94.
Aguree S. Gernand AD. Plasma volume expansion across healthy pregnancy: a systematic review and meta-analysis of longitudinal studies. BMC Pregnancy Childbirth 2019;19:508.
World Health Organization. Haemoglobin concentrations of the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf [Accessed 30th August 2024].
Anemia in pregnancy. ACOG Practice Bulletin No. 223. Obstet Gynecol 2021;138: e55-e64.
World Health Organization. Anaemia in women and children. WHO Global Anaemia Estimates, 2021 Edition. https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children [Accessed 30th August 2024].
Palinlat W, Chonlada L, Sakchai P. Prevalence and associated factors of iron-deficient erythropoiesis in Thai pregnant women. Thai J Obstet Gynaecol 2024; 32:391-9.
Suphawet L, Budsaba V. Prevalence and associated factors of anemia in different periods of pregnancy. Thai J Obstet Gynaecol 2023;31:56-63.
Lin L, Wei Y, Zhu W, Su CWR, Feng H, Yang H. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth 2018;18:1-18.
Abd Rahman R, Idris IB, Isa ZM, Rahman RA, Mahdy ZA. The prevalence and risk factors of iron deficiency anemia among pregnant women in Malaysia: a systematic review. Front Nutr 2022;9.
Lestari S, Fujiati II, Keumalasari D, Daulay M, Martina SJ, Syarifah S. The prevalence of anemia in pregnant women and its associated risk factors in North Sumatera, Indonesia. IOP Conference Series: Earth Env Sci 2018;125:012195.
World Health Organization. Daily iron and folic acid supplementation during pregnancy. https://www.who.int/tools/elena/interventions/daily-iron-pregnancy [Accessed 30th August 2024].
Aznar B, Grandia J, Tejedor MT, Falceto MV. Effect of vitamin C and iron supplementation in pregnant hyper-prolific sows. Livestock Sci 2024;280.
Panel on dietary antioxidants and related compounds, Institute of Medicine. Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington DC: National Academies Press; 2000.
Palupi PD, Khan MS, Karseno KK. Antianemia supplementation combination with vitamin C on hemoglobin levels among pregnant women in primary health care center, Jepara, Indonesia. J Pharma Sci Comm 2021;18: 95-101.
Stoffel NU, von Siebenthal HK, Moretti D, Zimmermann MB. Oral iron supplementation in iron-deficient women: How much and how often? Mol Aspects Med 2020;75:100865.
Fernandez-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev 2019;31:1.
Nemeth E, Ganz T. The role of hepcidin in iron metabolism. Acta Haematol 2009;122:78-86.
Puspita AJ. The effect of iron supplement and vitamin C towards increasing hemoglobin levels in pregnant women with anemia. J Medika Hutama 2021;2:1060-6.
Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev 2015;CD004072.
Li N, Zhao G, Wu W, Zhang M, Liu W, Chen Q, Wang X. The efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: a randomized clinical trial. JAMA Netw Open 2020;3:e2023644.
Murtiningsih M, Lestari L, Fitriani H. The effect of iron and vitamin C supplements on hemoglobin levels of pregnant women with anemia: systematic literature review. J Matern Care Reprod Health 2021;4:31-41.
Hans U, Byamukama E. Regular vitamin C supplementation during pregnancy reduces hospitalization: outcomes of a Ugandan rural cohort study. Pan Afr Med J 2010;5:15.
Brown B, Wright C. Safety and efficacy of supplements in pregnancy. Nutr Rev 2020;78:813-26.
Moustarah F, Daley SF. Dietary iron. https://www.ncbi.nlm.nih.gov/books/NBK540969/ [Accessed 30th August 2024].
Harvard Health Publishing. Foods high in iron: incorporating high-iron foods into a healthy diet. https://www.health.harvard.edu/nutrition/foods-high-in-iron-incorporating-high-iron-foods-into-a-healthy-diet [Accessed 30th August 2024].