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Title: Anemia in Brazilian pregnant women before and after flour fortification with iron
Authors: Fujimori, Elizabeth
Sato, Ana Paula Sayuri
Szarfarc, Sophia Cornbluth
Veiga, Glória Valéria da
Oliveira, Valterlinda Alves de
Colli, Célia
Moreira-Araújo, Regilda Saraiva dos Reis
Arruda, Ilma Kruze Grande de
Uchimura, Taqueco Teruya
Brunken, Gisela Soares
Yuyama, Lucia Kiyoko Ozaki
Muniz, Pascoal Torres
Priore, Sílvia Eloíza
Tsunechiro, Maria Alice
Frazão, Andréa das Graças Ferreira
Passoni, Cynthia R Matos Silva
Araújo, Claudia Regina Marchiori Antunes
Keywords: Hemoglobin A
Diet Supplementation
Diet Therapy
Gestational Age
Health Care Delivery
Iron Deficiency Anemia
Iron Intake
Pregnancy Complication
Prenatal Care
Anemia, Iron-deficiency
Delivery Of Health Care
Epidemiologic Methods
Food, Fortified
Gestational Age
Hemoglobin A
Iron, Dietary
Pregnancy Complications, Hematologic
Prenatal Care
Issue Date: 2011
metadata.dc.publisher.journal: Revista de Saúde Pública
metadata.dc.relation.ispartof: Volume 45, Número 6, Pags. 1027-1035
Abstract: OBJECTIVE: To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS: A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Student's t tests, and logistic regression, with a significance level of 5%. RESULTS: In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS: Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.
metadata.dc.identifier.doi: 10.1590/S0034-89102011005000078
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