Efficacy of micronutrient supplement intake in increasing hemoglobin in pregnancy: dose‐effect comparisons with multiple micronutrient in the MINIMat trial in rural Bangladesh

It is unclear how large amount of supplemental iron is required to reach maximum hemoglobin concentration in pregnancy and whether addition of multiple micronutrients modify supplement efficacy In the MINIMat prenatal nutrition trial in Bangladesh ( ISRCTN16581394 ) 4436 pregnant women were randomised into 3 types of supplement; either 30 mg Fe and 400 μg folic acid (FE30), or 60 mg Fe and 400 μg folic acid (FE60), or a multiple micronutrient supplement (MMS) containing a daily allowance of 15 micronutrients including 30 mg Fe and folic acid starting at around 14 wk. Adherence was monitored by use of a drug container equipped with an electronic device (eDEM; Aprex). Number of capsules taken between wk14 and wk30 were converted to amount of iron before dose‐response on hemoglobin concentrations at wk30 of gestation were evaluated using adjusted multivariate regression analyses. All 3 types of supplement produced a significant dose effect up to a similar intake of iron (about 2400 mg) after which no further significant effect was observed. In the intake range below 2400mg and evaluated per mg iron ingested ; efficacy of Fe60 was higher then Fe30 and higher than MMS. There was no such difference between Fe30 and MMS. The results showed that a lower total amount of iron than commonly recommended is required for maximum hemoglobin response and addition of multiple micronutrients did not modify efficacy. Main source of funds came from icddr,b Bangladesh, UNICEF, and Sida Sweden