The role of maternal nutrition in growth and health of Indonesian infants: a focus on vitamin A and iron

Nutrition during pregnancy is important for women's health, pregnancy outcome, and infant growth and health. The aim of the present study was to investigate whether weekly supplementation with iron and vitamin A of pregnant women improves growth and health, as indicated by reduced morbidity and improved mental and psychomotor development, of their infants. At18 weeks of pregnancy, women from 5 villages were randomly assigned on an individual basis to supervised, double-masked supplementation once weekly from enrolment until delivery. Supplementation comprised 120 mg iron as Fe 2 SO 4 and 500μg folic acid with (n =121) or without (n=122) 4800 RE vitamin A. Pregnant women participating in the ongoing national iron supplementation programme and receiving iron/folic acid tablets through medical services were recruited at the same time from 4 neighbouring villages ('daily' group, n= 123). Compliance with iron tablet intake in this group was expected to be very low. Newborn infants were followed up at least until 1 year of age.At4 months of age, infants in the weekly vitamin A plus iron group had significantly higher serum retinol concentrations than infants in the weekly iron group. However, in all groups >70% of the infants had serum retinol concentrations <0.70μmol/L. Higher serum retinol levels were associated with better growth and nutritional status during the first 6 months of life. Iron status did not differ among groups, while 29% of the infants had a haemoglobin concentration <100 g/L and only 3 infants had a serum ferritin concentration <12μg/L. During the first year of life, anthropometric parameters, morbidity and mental and psychomotor development of infants, whose mothers were supplemented with vitamin A plus iron during pregnancy, did not differ from those whose mothers had received iron alone. In addition, none of the investigated parameters differed between the infants in the weekly iron supplementation group and infants in the 'daily' group. Growth faltering of infants started at 6 months of age and led to high prevalence of stunting (24%) and underweight (32%) at 12 months of age. Almost all infants were breast-fed during the whole follow up period. Neonatal weight and length, reflecting prenatal factors, were the strongest predictors of growth and nutritional status of infants at 12 months of age. In addition, maternal weight and height at18 weeks of pregnancy, housing, and postnatal variables such as intake of certain food groups and morbidity were predictors of growth and nutritional status of infants at 12 months of age. In conclusion, vitamin A supplementation in concurrence of iron supplementation of pregnant women does not improve growth or health of their infants. However, it improved vitamin A status of their infants at4 months of age. Considering the association between growth and vitamin A status, and the high prevalence of serum retinol levels <0.70μmol/L, vitamin A intake during infancy may need to be increased. However, in order to optimise nutritional status and growth of infants the whole life cycle should be considered.