Patterns of compliance with prenatal iron supplementation among Peruvian women.

Prenatal iron supplementation is recommended to control anaemia during pregnancy. Low compliance and side effects have been claimed as the main obstacles for adequate impact of the supplementation. As part of a double-blind supplementation study carried out in a hospital located in a shantytown in Lima, Peru, we monitored compliance throughout pregnancy and evaluated factors associated with variation in compliance over time. Overall, 985 pregnant women were enrolled in a supplementation study that was administered through their prenatal care from 10 to 24 weeks of gestation until 4 weeks postpartum. They received 60 mg iron and 250 µg folate with or without 15 mg zinc. Women had monthly care visits and were also visited weekly to query regarding compliance, overall health status, and potential positive and negative effects of supplement consumption. Median compliance was 79% (inter-quartile range: 65-89%) over pregnancy, and the median number of tablets consumed was 106 (81-133). Primpara had lower average compliance; positive health reports were associated with greater compliance, and negative reports were associated with lower compliance. There was no difference by type of supplement. Women with low initial compliance did achieve high compliance by the end of pregnancy, and women who reported forgetting to take the supplements did have lower compliance. Compliance was positively associated with haemoglobin concentration at the end of pregnancy. In conclusion, women comply highly with prenatal supplementation within a prenatal care model in which supplies are maintained and reinforcing messages are provided.

Randomized controlled trial of prenatal zinc supplementation and the development of fetal heart rate.

OBJECTIVES: This study was undertaken to evaluate whether prenatal zinc supplementation affects maturation of fetal cardiac patterns. STUDY DESIGN: A randomized double-blind controlled trial among 242 low-income Peruvian women was performed. Beginning at 10 to 16 weeks' gestation, women received supplements containing 60 mg iron, 250 microg folic acid with or without 25 mg zinc. Fetal heart rate (mean FHR, variability [HRV], number of accelerations) and movements (number and amplitude of movement bouts, time spent moving) were electronically monitored monthly from 20 weeks' gestation. Developmental trends were evaluated by supplement type among 195 women who completed the trial and had no serious complications of pregnancy. RESULTS: Zinc supplementation was associated with lower FHR, greater number of accelerations, and greater HRV. Supplementation effects on HRV and accelerations were more pronounced after 28 weeks' gestation. No differences in motor activity were observed. CONCLUSION: Prenatal supplementation of zinc-deficient mothers may be beneficial to fetal neurobehavioral development.

Randomized controlled trial of prenatal zinc supplementation and fetal bone growth.

BACKGROUND: Maternal zinc deficiency is relatively common in developing countries, but its consequences for fetal growth are not established. OBJECTIVE: The goal was to examine whether improvement in maternal gestational zinc status is positively associated with fetal growth as assessed by ultrasonography. DESIGN: We conducted a double-masked, randomized trial among 242 pregnant Peruvian women in an impoverished shantytown in Lima, Peru. At 10-16 wk of gestation, the women were randomly assigned to receive daily supplements containing 60 mg Fe and 250 microg folic acid, with or without 25 mg Zn. We measured fetal head circumference, biparietal diameter, abdominal circumference, and femur diaphysis length at 20, 24, 28, 32, 36, and 38 wk of gestation. Fetal measures were analyzed longitudinally to evaluate differences in trends of fetal growth by supplement type, and within-subject correlations were taken into account. RESULTS: Femur diaphysis length was greater in fetuses whose mothers received zinc supplements (P < 0.05), and the difference tended to increase with gestational age. No significant differences by supplement type were observed for the other anatomical sites measured. CONCLUSIONS: The observed positive effect of prenatal zinc on fetal femur diaphysis length is consistent with the results of experimental studies in animals and in vitro. The supplementation effect represents an upward shift in mean femur diaphysis length at term of about one-quarter of the reference SD. These findings suggest the potential importance of maternal zinc status for fetal bone growth in humans and illustrate the value of ultrasonography for evaluating the effect of prenatal nutritional interventions on components of fetal growth.