THE IMPACT OF PARENTERAL MICRONUTRIENTS AND IRON ADMINISTRATION ON THE HAEMOGLOBIN CONCENTRATION OF PREGNANT WOMEN

Abstract

Context: Micronutrient deficiency in pregnancy is a major risk factor for the development of anaemia in pregnancy. Though most micronutrients are present in fruits and vegetables, gastrointestinal tract pathology or alterations affecting appetite and absorption of nutrients, poor food preparation techniques and poverty make the gain from fruits and vegetables inadequate. Oral administration is the standard approach for micronutrient supplementation in pregnant women, but nausea and vomiting in pregnancy may prevent the absorption of the nutrients from the gastrointestinal tract, necessitating a parenteral route of administration. Anaemia in pregnancy is a common problem in Nigeria and the West African sub region in spite of several efforts, programs and interventions aimed at reducing the prevalence. Studies available on the role of parenteral micronutrient are few; the impact of this route of administration of micronutrients is yet to be studied extensively.

Objective: This study was conducted to determine the impact of parenteral micronutrient supplementation in pregnancy on the blood haemoglobin concentration of recipients.

Materials and Methods: A prospective randomized controlled design was used to study 200 pregnant women between the gestational ages of 16 – 32 weeks and with haemoglobin concentration of between 8 to 10 grams per decilitre. Consenting pregnant women were randomised into two groups, using a balanced block randomisation scheme. One group received oral supplementation of iron (200mg ferrous sulphate) and folic acid (5mg) as is
usually given to pregnant women in the antenatal clinic. Another group received parenteral micronutrient injections of a combination of Vitamin C, Folic Acid, Vitamin B12 and Vitamin B3 weekly in addition to oral iron. Both groups were monitored until term. The data collected included basic biodata, nutritional recall to estimate nutrient intake, anthropometric measurements and serial estimation of haemoglobin and haematocrit levels until the end of the pregnancy.

Results: Eighty (80) out of the 100 patients receiving parenteral micronutrient who were followed up till labour and delivery attained a haemoglobin concentration of 11g/dl or more while 18 of the control group attended Haemoglobin of greater than or equal to 11g/dl.(p<o.05). No significant difference existed between the control and the study groups with respect to fetal outcome, mode of delivery except with caesarean section. Maternal complications were more in the control group and included malaria, pre-term delivery, pre-eclampsia and post-partum haemorrhage.

Conclusions: Anaemia is a common obstetric problem associated with poor fetal and maternal outcome. Parenteral micronutrient administration has a statistically significant impact on the haemoglobin concentration of pregnant women. Further studies are needed to determine if this is a viable way of combating anaemia in pregnancy.

THE IMPACT OF PARENTERAL MICRONUTRIENTS AND IRON ADMINISTRATION ON THE HAEMOGLOBIN CONCENTRATION OF PREGNANT WOMEN