Nutr Res Pract.  2011 Feb;5(1):3-10.

Vitamins and minerals for women: recent programs and intervention trials

• Greiner T

Abstract

Women's nutrition has received little attention in nutrition programming, even though clinical trials and intervention trials have suggested that dietary improvement or supplementation with several nutrients may improve their health, especially in low-income settings, the main focus of this paper. Most attention so far has focused on how improvements in maternal nutrition can improve health outcomes for infants and young children. Adequate vitamin D and calcium nutrition throughout life may reduce the risk of osteoporosis, and calcium supplementation during pregnancy may reduce preeclampsia and low birth weight. To reduce neural tube defects, additional folic acid and possibly vitamin B12 need to be provided to non-deficient women before they know they are pregnant. This is best achieved by fortifying a staple food. It is unclear whether maternal vitamin A supplementation will lead to improved health outcomes for mother or child. Iron, iodine and zinc supplementation are widely needed for deficient women. Multimicronutrient supplementation (MMS) in place of the more common iron-folate supplements given in pregnancy in low-income countries may slightly increase birth weight, but its impact on neonatal mortality and other outcomes is unclear. More sustainable alternative approaches deserve greater research attention.

Keyword

Maternal nutrition; multimicronutrient supplementation; vitamins; minerals; low birth weight

MeSH Terms

Birth Weight
Calcium
Child
Female
Folic Acid
Humans
Hypogonadism
Infant
Infant Mortality
Infant, Low Birth Weight
Infant, Newborn
Iodine
Iron
Minerals
Mitochondrial Diseases
Mothers
Neural Tube Defects
Ophthalmoplegia
Osteoporosis
Pre-Eclampsia
Pregnancy
Vitamin A
Vitamin B 12
Vitamin D
Vitamins
Zinc
Calcium
Folic Acid
Hypogonadism
Iodine
Iron
Minerals
Mitochondrial Diseases
Ophthalmoplegia
Vitamin A
Vitamin B 12
Vitamin D
Vitamins
Zinc

Reference

1. Dewey KG, Huffman SL. Maternal, infant, and young child nutrition: combining efforts to maximize impacts on child growth and micronutrient status. Food Nutr Bull. 2009. 30:S187–S189.

2. Shrimpton R, Victora CG, de Onis M, Lima RC, Blossner M, Clugston G. Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics. 2001. 107:E75.

3. Greiner T. A New Theory: Breastmilk Displacement May be the Major Cause of Nutritional Stunting. UN Standing Committee on Nutrition News. 2004. 28:63–64.

4. Greiner T. The Breastfeeding Mother's Nutrition. Breastfeeding Today. 2010. 1:10–13.

5. Underwood BA, Deckelbaum RJ, Akabas SR. Women and Micronutrients: Addressing the Gap Throughout the Life Cycle. Am J Clin Nutr. 2005. 81:1187S.

6. Zehner ER. Integrating maternal, infant, and young child nutrition: Report on the Ten Year Strategy Infant and Young Child Nutrition (IYCN) Working Group October 2008 Workshop. Food Nutr Bull. 2009. 30:S190–S196.

7. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Premenstrual Syndrome Study Group. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998. 179:444–452.

8. Bendich A. Micronutrient's in womens health and immune function. Nutrition. 2001. 17:858–867.

9. Hofmeyr GJ, Lawrie T, Atallah A, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010. 4:CD001059.

10. Earl S, Cole ZA, Holroyd C, Cooper C, Harvey NC. Session 2: Other diseases: Dietary management of osteoporosis throughout the life course. Proc Nutr Soc. 2010. 69:25–33.

11. Nieves JW. Osteoporosis: the role of micronutrients. Am J Clin Nutr. 2005. 81:1232S–1239S.

12. Pynaert I, De Bacquer D, Matthys C, Delanghe J, Temmerman M, De Backer G, De Henauw S. Determinants of ferritin and soluble transferrin receptors as iron status parameters in young adult women. Public Health Nutr. 2009. 12:1775–1782.

13. Fraser IS. Non-contraceptive health benefits of intrauterine hormonal systems. Contraception. 2010. 82:396–403.

14. Greiner T. Are lactating women a risk group for iron deficiency anemia? Paper presented at: the First National Workshop on the Control of Nutritional Anaemia in Tanzania. 1992. Dar es Salaam.

15. Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr. 2008. 26:232–240.

16. Khambalia AZ, O'Connor DL, Macarthur C, Dupuis A, Zlotkin SH. Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh. Am J Clin Nutr. 2009. 90:1295–1302.

17. Allen LH, Peerson JM. Maternal Micronutrient Supplementation Study Group. Impact of multiple micronutrient versus iron-folic acid supplements on maternal anemia and micronutrient status in pregnancy. Food Nutr Bull. 2009. 30:S527–S532.

18. Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005. 81:1218S–1222S.

19. Latham M. The great vitamin A fiasco. [Commentary]. World Nutrition. 2010. 1:12–44.

20. Greiner T. The case for universal supplementation is not well made. [Short communication]. World Nutrition. 2010. 1:275–282.

21. Oliveira-Menegozzo JM, Bergamaschi DP, Middleton P, East CE. Vitamin A supplementation for postpartum women. Cochrane Database Syst Rev. 2010. 6:CD005944.

22. West KP Jr, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, Connor PB, Dali SM, Christian P, Pokhrel RP, Sommer A. The NNIPS-2 Study Group. Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. BMJ. 1999. 318:570–575.

23. Christian P, West KP, Labrique A. Effects of maternal vitamin A or beta-carotene supplementation on maternal and infant mortality in rural Bangladesh: the JiVitA-1 trial. 2007. In : Micronutrient Forum; Istanbul; Turkey.

24. Kirkwood BR, Hurt L, Amenga-Etego S, Tawiah C, Zandoh C, Danso S, Hurt C, Edmond K, Hill Z, Ten Asbroek G, Fenty J, Owusu-Agyei S, Campbell O, Arthur P. ObaapaVitA Trial Team. Effect of vitamin A supplementation in women of reproductive age on maternal survival in Ghana (ObaapaVitA): a cluster-randomised, placebo-controlled trial. Lancet. 2010. 375:1640–1649.

25. Kirkwood B. ObaapaViTa Trial Team. Effect of vitamin A supplementation on maternal survival [Letter to the editor: Reply]. Lancet. 2010. 376:874.

26. London RS, Murphy L, Kitlowski KE, Reynolds MA. Efficacy of alpha-tocopherol in the treatment of the premenstrual syndrome. J Reprod Med. 1987. 32:400–404.

27. DiGirolamo AM, Ramirez-Zea M. Role of zinc in maternal and child mental health. Am J Clin Nutr. 2009. 89:940S–945S.

28. Sanghvi T, Van Ameringen M, Baker J, Fiedler J. Vitamin and mineral deficiencies technical situation analysis: a report for the Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies, Summary. Food Nutr Bull. 2007. 28:S160–S164.

29. Busby A, Abramsky L, Dolk H, Armstrong B, Addor MC, Anneren G, Armstrong N, Baguette A, Barisic I, Berghold A, Bianca S, Braz P, Calzolari E, Christiansen M, Cocchi G, Daltveit AK, De Walle H, Edwards G, Gatt M, Gener B, Gillerot Y, Gjergja R, Goujard J, Haeusler M, Latos-Bielenska A, McDonnell R, Neville A, Olars B, Portillo I, Ritvanen A, Robert-Gnansia E, Rösch C, Scarano G, Steinbicker V. Preventing neural tube defects in Europe: a missed opportunity. Reprod Toxicol. 2005. 20:393–402.

30. Beinner MA, Soares ADN, Barros ALA, Monteiro MAM. Sensory evaluation of rice fortified with iron. Ciencia E Tecnologia De Alimentos. 2010. 30:516–519.

31. Thompson MD, Cole DE, Ray JG. Vitamin B-12 and neural tube defects: the Canadian experience. Am J Clin Nutr. 2009. 89:697S–701S.

32. Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ, Bhat DS, Naik SS, Coyaji KJ, Joglekar CV, Joshi N, Lubree HG, Deshpande VU, Rege SS, Fall CH. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia. 2008. 51:29–38.

33. Wieringa FT, Dijkhuizen MA, Muhilal , Van der Meer JW. Maternal micronutrient supplementation with zinc and β-carotene affects morbidity and immune function of infants during the first 6 months of life. Eur J Clin Nutr. 2010. 64:1072–1079.

34. Iannotti LL, Zavaleta N, León Z, Huasquiche C, Shankar AH, Caulfield LE. Maternal zinc supplementation reduces diarrheal morbidity in peruvian infants. J Pediatr. 2010. 156:960–964.

35. Bryce J, Coitinho D, Darnton-Hill I, Pelletier D, Pinstrup-Andersen P. Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: effective action at national level. Lancet. 2008. 371:510–526.

36. de Onis M, Villar J, Gülmezoglu M. Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998. 52:S83–S93.

37. Merialdi M, Carroli G, Villar J, Abalos E, Gülmezoglu AM, Kulier R, de Onis M. Nutritional interventions during pregnancy for the prevention or treatment of impaired fetal growth: an overview of randomized controlled trials. J Nutr. 2003. 133:1626S–1631S.

38. Mason JB, Deitchler M, Gilman A, Gillenwater K, Shuaib M, Hotchkiss D, Mason K, Mock N, Sethuraman K. Iodine fortification is related to increased weight-for-age and birthweight in children in Asia. Food Nutr Bull. 2002. 23:292–308.

39. Cogswell ME, Parvanta I, Ickes L, Yip R, Brittenham GM. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr. 2003. 78:773–781.

40. Semba RD, de Pee S, Hess SY, Sun K, Sari M, Bloem MW. Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia. Am J Clin Nutr. 2008. 87:438–444.

41. Saaka M, Oosthuizen J, Beatty S. Effect of prenatal zinc supplementation on birthweight. J Health Popul Nutr. 2009. 27:619–631.

42. Goldenberg RL, Tamura T, Neggers Y, Copper RL, Johnston KE, DuBard MB, Hauth JC. The effect of zinc supplementation on pregnancy outcome. JAMA. 1995. 274:463–468.

43. Christian P, Murray-Kolb LE, Khatry SK, Katz J, Schaefer BA, Cole PM, Leclerq SC, Tielsch JM. Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. JAMA. 2010. 304:2716–2723.

44. Katz J, Khatry SK, Leclerq SC, Mullany LC, Yanik EL, Stoltzfus RJ, Siegel EH, Tielsch JM. Daily supplementation with iron plus folic acid, zinc, and their combination is not associated with younger age at first walking unassisted in malnourished preschool children from a deficient population in rural Nepal. J Nutr. 2010. 140:1317–1321.

45. Caulfield LE, Putnick DL, Zavaleta N, Lazarte F, Albornoz C, Chen P, Dipietro JA, Bornstein MH. Maternal gestational zinc supplementation does not influence multiple aspects of child development at 54 mo of age in Peru. Am J Clin Nutr. 2010. 92:130–136.

46. Ekström EC, Hyder SM, Chowdhury AM, Chowdhury SA, Lönnerdal B, Habicht JP, Persson LA. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. Am J Clin Nutr. 2002. 76:1392–1400.

47. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2006. 18:CD004905.

48. Zeng L, Dibley MJ, Cheng Y, Dang S, Chang S, Kong L, Yan H. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ. 2008. 337:a2001.

49. Sunawang , Utomo B, Hidayat A, Kusharisupeni , Subarkah . Preventing low birthweight through maternal multiple micronutrient supplementation: a cluster-randomized, controlled trial in Indramayu, West Java. Food Nutr Bull. 2009. 30:S488–S495.

50. Roberfroid D, Huybregts L, Lanou H, Henry MC, Meda N, Menten J, Kolsteren P. MISAME Study Group. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2008. 88:1330–1340.

51. Bhutta ZA, Rizvi A, Raza F, Hotwani S, Zaidi S, Moazzam Hossain S, Soofi S, Bhutta S. A comparative evaluation of multiple micronutrient and iron-folic acid supplementation during pregnancy in Pakistan: impact on pregnancy outcomes. Food Nutr Bull. 2009. 30:S496–S505.

52. Zagré NM, Desplats G, Adou P, Mamadoultaibou A, Aguayo VM. Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster-randomized, double-blind, controlled programmatic study in rural Niger. Food Nutr Bull. 2007. 28:317–327.

53. Huy ND, Le Hop T, Shrimpton R, Hoa CV. An effectiveness trial of multiple micronutrient supplementation during pregnancy in Vietnam: impact on birthweight and on stunting in children at around 2 years of age. Food Nutr Bull. 2009. 30:S506–S516.

54. Fall CH, Fisher DJ, Osmond C, Margetts BM. Maternal Micronutrient Supplementation Study Group. T Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation. Food Nutr Bull. 2009. 30:S533–S546.

55. Kaestel P, Michaelsen KF, Aaby P, Friis H. Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau. Eur J Clin Nutr. 2005. 59:1081–1089.

56. Brough L, Rees GA, Crawford MA, Morton RH, Dorman EK. Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. Br J Nutr. 2010. 104:437–445.

57. Hininger I, Favier M, Arnaud J, Faure H, Thoulon JM, Hariveau E, Favier A, Roussel AM. Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometrics measurements: a randomized double-blind, placebo-controlled trial in apparently healthy pregnant women. Eur J Clin Nutr. 2004. 58:52–59.

58. Scholl TO, Hediger ML, Bendich A, Schall JI, Smith WK, Krueger PM. Use of multivitamin/mineral prenatal supplements: influence on the outcome of pregnancy. Am J Epidemiol. 1997. 146:134–141.

59. Shrimpton R. UNSCN. Maternal nutrition and the intergenerational cycle of growth failure. Progress in Nutrition, 6th Report on the World Nutrition Situation. 2010. Geneva: United Nations System Standing Committee on Nutrition.

60. Ramakrishnan U, Neufeld LM, Flores R, Rivera J, Martorell R. Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers. Am J Clin Nutr. 2009. 89:1125–1131.

61. Stewart CP, Christian P, Schulze KJ, Leclerq SC, West KP Jr, Khatry SK. Antenatal micronutrient supplementation reduces metabolic syndrome in 6- to 8-year-old children in rural Nepal. J Nutr. 2009. 139:1575–1581.

62. Shankar AH, Jahari AB, Sebayang SK, Aditiawarman , Apriatni M, Harefa B, Muadz H, Soesbandoro SD, Tjiong R, Fachry A, Shankar AV, Atmarita , Prihatini S, Sofia G. Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) Study Group. Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial. Lancet. 2008. 371:215–227.

63. Gupta P, Ray M, Dua T, Radhakrishnan G, Kumar R, Sachdev HP. Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial. Arch Pediatr Adolesc Med. 2007. 161:58–64.

64. Ronsmans C, Fisher DJ, Osmond C, Margetts BM, Fall CH. Maternal Micronutrient Supplementation Study Group. Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on stillbirths and on early and late neonatal mortality. Food Nutr Bull. 2009. 30:S547–S555.

65. Tofail F, Persson LA, El Arifeen S, Hamadani JD, Mehrin F, Ridout D, Ekström EC, Huda SN, Grantham-McGregor SM. Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. Am J Clin Nutr. 2008. 87:704–711.

66. Eneroth H, El Arifeen S, Persson LA, Lönnerdal B, Hossain MB, Stephensen CB, Ekström EC. Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation. J Nutr. 2010. 140:618–624.

67. Li Q, Yan H, Zeng L, Cheng Y, Liang W, Dang S, Wang Q, Tsuji I. Effects of maternal multimicronutrient supplementation on the mental development of infants in rural western China: follow-up evaluation of a double-blind, randomized, controlled trial. Pediatrics. 2009. 123:E685–E692.

68. Christian P, Khatry SK, LeClerq SC, Dali SM. Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Int J Gynaecol Obstet. 2009. 106:3–7.

69. Dalmiya N, Darnton-Hill I, Schultink W, Shrimpton R. Multiple micronutrient supplementation during pregnancy: a decade of collaboration in action. Food Nutr Bull. 2009. 30:S477–S479.

70. Shrimpton R, Huffman SL, Zehner ER, Darnton-Hill I, Dalmiya N. Multiple micronutrient supplementation during pregnancy in developing-country settings: policy and program implications of the results of a meta-analysis. Food Nutr Bull. 2009. 30:S556–S573.

71. McLaren DS. Multiple Micronutrients and "Hidden Hunger". Sight and Live Magazine. 2008. 9. Basel, Switzerland: Sight and Life, DSM;6–12.

72. Barber SL, Gertler PJ. The impact of Mexico's conditional cash transfer programme, Oportunidades, on birthweight. Trop Med Int Health. 2008. 13:1405–1414.

73. Uauy-Dagach R, Hertrampf E. Bowman B, Russell R, editors. Food-based dietary recommendations: possibilities and limitations. Present Knowledge in Nutrition. 2001. 9:8th ed. Washington DC: ILSI Press;636–649.

74. Olney DK, Talukder A, Iannotti LL, Ruel MT, Quinn V. Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food Nutr Bull. 2009. 30:355–369.

75. Aarts C, Kylberg E, Hörnell A, Hofvander Y, Gebre-Medhin M, Greiner T. How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data. Int J Epidemiol. 2000. 29:1041–1046.

76. Hien NN, Kam S. Nutritional status and the characteristics related to malnutrition in children under five years of age in Nghean, Vietnam. J Prev Med Public Health. 2008. 41:232–240.

77. Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK. Infant Feeding Study Group. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet. 2003. 361:1418–1423.

78. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M. Maternal and Child Undernutrition Study Group. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008. 371:417–440.

79. Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, Irlam J, Isaacs W, Sive A, Tomlinson M. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005. 135:267–272.

80. Perez EM, Hendricks MK, Beard JL, Murray-Kolb LE, Berg A, Tomlinson M, Irlam J, Isaacs W, Njengele T, Sive A, Vernon-Feagans L. Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. J Nutr. 2005. 135:850–855.

81. Frith AL, Naved RT, Ekström EC, Rasmussen KM, Frongillo EA. Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh. Am J Clin Nutr. 2009. 90:141–148.

82. Murray-Kolb LE, Beard JL. Iron deficiency and child and maternal health. Am J Clin Nutr. 2009. 89:946S–950S.

83. WHO/UNICEF. Focusing on anemia: towards an integrated approach for effective anemia control. 2004. Geneva: World Health Organization.

84. Palmer AP, Stewart CP. Micronutrients, Health and Development: Evidence-Based Programs. Sight and Live Magazine. 2009. Basel, Switzerland: Sight and Live, DSM;25–33.

85. Sanghvi TG, Harvey PW, Wainwright E. Maternal iron-folic acid supplementation programs: evidence of impact and implementation. Food Nutr Bull. 2010. 31:S100–S107.

86. Gillespie S, Kevany J, Mason J. Controlling Iron Deficiency. 1991. Geneva: ACC/SCN.

87. Souza AI, Batista Filho M, Bresani CC, Ferreira LO, Figueiroa JN. Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials. Cad Saude Publica. 2009. 25:1225–1233.

88. Shankar AV, Asrilla Z, Kadha JK, Sebayang S, Apriatni M, Sulastri A, Sunarsih E, Shankar AH. SUMMIT Study Group. Programmatic effects of a large-scale multiple-micronutrient supplementation trial in Indonesia: using community facilitators as intermediaries for behavior change. Food Nutr Bull. 2009. 30:S207–S214.

89. Ndiaye M, Siekmans K, Haddad S, Receveur O. Impact of a positive deviance approach to improve the effectiveness of an iron-supplementation program to control nutritional anemia among rural Senegalese pregnant women. Food Nutr Bull. 2009. 30:128–136.

90. Vir SC, Singh N, Nigam AK, Jain R. Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh, India. Food Nutr Bull. 2008. 29:186–194.

91. Soekarjo DD, Pee Sd S, Kusin JA, Schreurs WH, Schultink W, Muhilal , Bloem MW. Effectiveness of weekly vitamin A (10,000 IU) and iron (60 mg) supplementation for adolescent boys and girls through schools in rural and urban East Java, Indonesia. Eur J Clin Nutr. 2004. 58:927–937.

92. Ahmed F, Khan MR, Akhtaruzzaman M, Karim R, Marks GC, Banu CP, Nahar B, Williams G. Efficacy of twice-weekly multiple micronutrient supplementation for improving the hemoglobin and micronutrient status of anemic adolescent schoolgirls in Bangladesh. Am J Clin Nutr. 2005. 82:829–835.

93. Paesano R, Berlutti F, Pietropaoli M, Pantanella F, Pacifici E, Goolsbee W, Valenti P. Lactoferrin efficacy versus ferrous sulfate in curing iron deficiency and iron deficiency anemia in pregnant women. Biometals. 2010. 23:411–417.

94. Ma AG, Schouten EG, Zhang FZ, Kok FJ, Yang F, Jiang DC, Sun YY, Han XX. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic Acid supplements. J Nutr. 2008. 138:1946–1950.

95. Gill SK, Nguyen P, Koren G. Adherence and tolerability of iron-containing prenatal multivitamins in pregnant women with pre-existing gastrointestinal conditions. J Obstet Gynaecol. 2009. 29:594–598.

96. Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, Cousens S. Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy Plan. 2008. 23:101–117.