Hemoglobin curves during pregnancy before and after fortification of
					flours with iron

Sato, Ana Paula Sayuri; Fujimori, Elizabeth; Szarfarc, Sophia Cornbluth

doi:10.1590/S0080-623420140000300004

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Original Article • Rev. esc. enferm. USP 48 (03) • June 2014 • https://doi.org/10.1590/S0080-623420140000300004 copy

Hemoglobin curves during pregnancy before and after fortification of flours with iron^* * Extracted from the thesis "Avaliação dos níveis de hemoglobina de gestantes brasileiras antes e após a fortificação de farinhas com ferro", Nursing School, Universidade de São Paulo, 2013.

Curvas de hemoglobina durante el embarazo antes y después de la fortificación de la harina con hierro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To assess the level of hemoglobin-Hb during pregnancy before and after fortification of flours with iron. Method: A cross-sectional study with data from 12,119 pregnant women attended at a public prenatal from five macro regions of Brazil. The sample was divided into two groups: Before-fortification (birth before June/2004) and After-fortification (last menstruation after June/2005). Hb curves were compared with national and international references. Polynomial regression models were built, with a significance level of 5%. Results: Although the higher levels of Hb in all gestational months after-fortification, the polynomial regression did not show the fortification effect (p=0.3). Curves in the two groups were above the references in the first trimester, with following decrease and stabilization at the end of pregnancy. Conclusion: Although the fortification effect was not confirmed, the study presents variation of Hb levels during pregnancy, which is important for assistencial practice and evaluation of public policies. 

Anemia, iron-deficiency; Pregnant women; Prenatal care ; Maternal-child nursing ; Food, fortified 

Month	Before-fortification	After-fortification	*p-value^ * The p-value is referred to Student t test.**
n	Mean (SD)	CI95%	n	Mean (SD)	CI95%
<3	803	12.53(1.18)	12.45-12.61	980	12.54(1.12)	12.47-12.61	0.197
3	1406	12.21(1.14)	12.15-12.27	1575	12.30(1.17)	12.24-12.36	0.029
4	1235	11.76(1.18)	11.69-11.83	1284	11.90(1.14)	11.83-11.96	0.003
5	935	11.43(1.17)	11.36-11.51	869	11.56(1.11)	11.48-11.63	0.025
6	540	11.21(1.16)	11.11-11.31	495	11.36(1.12)	11.26-11.46	0.035
7	508	11.16(1.16)	11.06-11.26	380	11.32(1.12)	11.21-11.44	0.034
≥8	447	11.22(1.16)	11.11-11.33	330	11.33(1.19)	11.20-11.46	0.200

Variables	Total
β	p-value
Gestational month	0.398	0.036
(Gestational month)²	-0.181	<0.001
(Gestational month)³	0.015	<0.001
Group
Before-fortification	Reference
After-fortification	0.03	0.316
Geographical region
Northeast	Reference
North	0.153	0.016
Midwest	0.062	0.401
Southeast	0.332	<0.001
South	0.813	<0.001
Age (years)	0.008	0.005
Relationship status
With partner	Reference
Without partner	-0.123	<0.001
BMI in the 1^st consultation (kg/m2)	0.024	<0.001
Previous pregnancies
<2	Reference
≥2	-0.239	<0.001
Adjusted R²	0.223
F (p-value)	121.280(<0.001)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Ana Paula Sayuri Sato . Av. Dr. Arnaldo, 715 – Consolação . CEP 01255-000 – São Paulo, SP, Brazil

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Hemoglobin curves during pregnancy before and after fortification of flours with iron* * Extracted from the thesis "Avaliação dos níveis de hemoglobina de gestantes brasileiras antes e após a fortificação de farinhas com ferro", Nursing School, Universidade de São Paulo, 2013.

Curvas de hemoglobina durante el embarazo antes y después de la fortificación de la harina con hierro

Hemoglobin curves during pregnancy before and after fortification of flours with iron^* * Extracted from the thesis "Avaliação dos níveis de hemoglobina de gestantes brasileiras antes e após a fortificação de farinhas com ferro", Nursing School, Universidade de São Paulo, 2013.