Increased Birth Weight Associated with Regular Pre-Pregnancy Deworming and Weekly Iron-Folic Acid Supplementation for Vietnamese Women

Abstract

Background Hookworm infections are significant public health issues in South-East Asia. In women of reproductive age, chronic hookworm infections cause iron deficiency anaemia, which, upon pregnancy, can lead to intrauterine growth restriction and low birth weight. Low birth weight is an important risk factor for neonatal and infant mortality and morbidity. Methodology We investigated the association between neonatal birth weight and a 4-monthly deworming and weekly iron-folic acid supplementation program given to women of reproductive age in north-west Vietnam. The program was made available to all women of reproductive age (estimated 51,623) in two districts in Yen Bai Province for 20 months prior to commencement of birth weight data collection. Data were obtained for births at the district hospitals of the two intervention districts as well as from two control districts where women did not have access to the intervention, but had similar maternal and child health indicators and socio-economic backgrounds. The primary outcome was low birth weight. Principal Findings The birth weights of 463 infants born in district hospitals in the intervention (168) and control districts (295) were recorded. Twenty-six months after the program was started, the prevalence of low birth weight was 3% in intervention districts compared to 7.4% in control districts (adjusted odds ratio 0.29, 95% confidence interval 0.10 to 0.81, p = 0.017). The mean birth weight was 124 g (CI 68 - 255 g, p<0.001) greater in the intervention districts compared to control districts. Conclusions/Significance The findings of this study suggest that providing women with regular deworming and weekly iron-folic acid supplements before pregnancy is associated with a reduced prevalence of low birth weight in rural Vietnam. The impact of this health system-integrated intervention on birth outcomes should be further evaluated through a more extensive randomised-controlled trial.

Elimination of Iron Deficiency Anemia and Soil Transmitted Helminth Infection: Evidence from a Fifty-four Month Iron-Folic Acid and De-worming Program

“…To redress this, a sub-study comparing birth weights recorded in the initial trial districts and those recorded in two other districts of the province prior to the expansion of the intervention was carried out. The results showed statistically significant differences in low birth weight prevalence and mean birth weight between the two study arms [29].…”

The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trial

“…Weekly IFA supplementation is also recommended for non-pregnant women of reproductive age in areas with higher rates of anemia, to improve general health as well as improve iron and folate stores pre-pregnancy and in the critical first trimester [33],[39]–[43]. Adoption of an intermittent IFA regimen during pregnancy would allow for integration of long-term IFA supplementation into community-based programs that enable women to take weekly IFA supplements throughout their reproductive years, starting in adolescence and doubling the dose when pregnant [44],[45].…”

The Case for Maternal Postpartum Deworming

“…While WRA may indirectly benefit from PC targeting children living in the same household, direct benefits of treatment are lost, as well as additional indirect benefits accruing to the household. Despite evidence of health benefits associated with pre-pregnancy deworming and iron supplementation [9], a major barrier to including WRA in deworming programs is likely the fear of inadvertently administering deworming drugs to women who may not be aware that they are in their first trimester of pregnancy (at which time deworming in contraindicated) [10]. A comprehensive approach to PC programs targeting WRA is currently lacking.…”