Nutrition of Indonesian women during pregnancy and lactation: a focus on vitamin A and iron

Nutrition during pregnancy is important for women's health, outcome of pregnancy and child survival. A community-based study was conducted in a rural area of West Java, Indonesia to investigate 1) the effect of weekly vitamin A and iron supplementation during pregnancy on iron and vitamin A status of women near term and on postpartum and pregnancy outcomes, 2) whether weekly iron supplementation was as effective as the ongoing national iron supplementation program in improving iron status. Women from 5 villages, 16 - 20 weeks pregnant, aged 17 - 35 years, parity &lt;6, and with hemoglobin concentrations 80 - 140 g/L, were randomly allocated on an individual basis to receive a weekly supplement either with 120 mg iron as Fe 2 SO 4 and 500μg folic acid (n = 121) or the same amount of iron and folic acid plus 4,800 RE vitamin A (n = 122). A third group participating in the ongoing national iron supplementation program in which women are advised to take iron tablets daily during pregnancy ("daily" group) was recruited at the same time from 4 neighboring villages (n = 123). At near term, the iron status of pregnant women in the group supplemented weekly with iron (n = 66) was not different from the "daily" group (n = 53). However, iron status decreased with daily iron supplementation if &lt;50 iron tablets were ingested. Hemoglobin concentrations in the group supplemented weekly with iron and vitamin A (n = 71) increased but serum ferritin concentrations decreased significantly, suggesting that vitamin A improved utilization of iron for hematopoiesis. Concentrations of serum transferrin receptor increased significantly in all groups. Serum retinol concentrations remained constant in the weekly iron and vitamin A group but decreased significantly in the other two groups. At4 months postpartum, compared with the weekly iron group (n = 88), the weekly iron and vitamin A group (n = 82) had significantly fewer subjects with serum retinol concentrations≤0.70μmol/L. The iron status of women in the weekly iron and vitamin A group did not differ from that of women in the weekly iron group. The concentrations of iron and retinol in transitional milk (4 - 7 days postpartum) was almost double than that in mature milk (3 months postpartum). Compared with the weekly iron group, the weekly iron and vitamin A group had significantly higher concentrations of retinol in transitional milk (asμmol/L) and in mature milk (asμmol/g fat). Neonatal weight (3094 ± 440 g) and length (49.1 ± 2.0 cm) did not differ among the three groups (n = 296). Iron and vitamin A status during pregnancy did not influence neonatal weight and length. Gestational age, maternal weight at the beginning of the second trimester and infant gender were the main predictors of neonatal weight and length. The proportion of women with a body mass index≤21.0 kg/m² was 37% at the beginning of the second trimester of pregnancy and 52% at4 months postpartum. Low nutritional status of the women was associated with household characteristics reflecting a lower socioeconomic status. In conclusion, compared with weekly supplementation with iron alone, supplementation with vitamin A and iron given at the time when women entered their second trimester of pregnancy prevented the deterioration of vitamin A status near term and4 month postpartum, and increased retinol concentration in breast milk. The performance of weekly iron supplementation did not differ from the ongoing daily iron supplementation program in improving the iron status during pregnancy and lactation. Intervention did not influence weight and length of the neonates. It is recommended to include vitamin A in the iron supplementation program.</p

Vitamin A and iron supplementation of Indonesian pregnant women benefits vitamin A status of their infants

Many Indonesian infants have an inadequate nutritional status, which may be due in part to inadequate maternal nutrition during pregnancy. This study was designed to investigate whether infant nutritional status could be improved by maternal vitamin A and Fe supplementation during gestation. Mothers of these infants from five villages had been randomly assigned on an individual basis, supervised and double-blind, to receive supplementation once weekly from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg Fe and 500 μg folic acid with or without 4800 retinol equivalent vitamin A. Mothers of infants from four other villages who participated in the national Fe and folic acid supplementation programme were also recruited; intake of tablets was not supervised. Anthropometric and biochemical parameters of infants and their mothers were assessed approximately 4 months after delivery. Infants of mothers supplemented with vitamin A plus Fe had higher serum retinol concentrations than infants of mothers supplemented with Fe alone. However, the proportion of infants with serum retinol concentrations 70 n all groups. Maternal and infant serum retinol concentrations were correlated. Fe status, weight and length of infants were similar in all groups. Fe status of girls was better than that of boys, but boys were heavier and longer. We conclude that supplementation with vitamin A in conjunction with Fe supplementation of women during pregnancy benefits vitamin A status of their infants. However, considering the large proportion of infants with marginal serum retinol concentrations, it may still be necessary to increase their vitamin A intake

Efektivitas Program Fortifikasi Minyak Goreng dengan Vitamin A terhadap Status Gizi Anak Sekolah di Kota Makasar

Vitamin A deficiency (VAD) remains as one of significant public health problems in Indonesia. Around 50% of under five children are suffering from subclinical VAD. Deficiency of vitamin A will affect several important role in the body, such as immune system, vision, reproductive system and cell differentiation. Therefore, guarding Indonesian children to be free from VAD is crucial for their quality as Human Resources. We assessed the impact of the consumption of vitamin A fortified cooking oil on the improvement of vitamin A and hemoglobin status among school children in urban slum area in Makassar City. The study was an intervention design Before-After. Healthy school children 7-10 years were selected from schools and de-wormed before the intervention. Serum retinol and hemoglobin was measured at baseline and at 3 months after. Fortified oil was made available through distribution at shops and accompanied with social marketing. Eventhough overall there was no change in VAD prevalence, the VAD prevalence is lower among children who consumedfortified oil ³12 weeks (26.6%) compared to those who consumed <12 weeks (42%). Prevalence of anemia decreased from 21.8% to 11.6%. We recommended that fortified oil is made mandatory

Mental and psychomotor development in Indonesian infants of mothers supplemented with vitamin A in addition to iron during pregnancy

Maternal nutrition is important for fetal development, but its impact on the functional outcome of infants is still unclear. The present study investigated the effects of vitamin A and Fe supplementation during gestation on infant mental and psychomotor development. Mothers of infants from five villages in Indonesia were randomly assigned to supervised, double-blind supplementation once per week from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg Fe + 500 µg folic acid with (n 94) or without (n 94) 4800 µg retinol in the form of retinyl acetate. Mothers of infants who participated in the national Fe+folic acid supplementation programme, but whose intake of supplements was not supervised, were recruited from four other villages (n 88). The mental and psychomotor development of infants was assessed, either at 6 or 12 months of age, using the Bayley Scales of Infant Development (BSID). We found no impact of vitamin A supplementation on mental or psychomotor development of infants. In addition, infants whose mothers had received weekly Fe supplementation had similar mental and psychomotor indices as those whose mothers had participated in the governmental Fe supplementation programme. The study population was moderately Fe and vitamin A deficient. The size of the treatment groups was large enough to detect a mean difference of 10 points on the BSID, which is less than 1 sd (15 points) of the average performance of an infant on the BSID. In conclusion, the present study did not find an impact of weekly supplementation of 4800 RE vitamin A in addition to Fe during gestation on functional development of Indonesian infants. However, smaller improvements in development may be seen if studied in a larger and/or more deficient population

PENINGKATAN KEMAMPUAN MENGENAL KONSEP BILANGAN MELALUI PERMAINAN KARTU BILANGAN BERGAMBAR PADA TAMAN KANAK KANAK SATU ATAP SDN 147 LEMBANG KABUPATEN PINRANG

Muslimatun, S. 2014. Peningkatan kemampuan mengenal konsep bilangan melalui permainan kartu bilangan bergambar pada Taman Kanak-Kanak Satu Atap SDN 147 Lembang Kabupaten Pinrang. Skripsi. Dibimbing oleh Dr. Parwoto, M.Pd dan Syamsuardi, S.Pd, M.Pd pada Program Studi Pendidikan Guru Pendidikan Anak Usia Dini (PGPAUD) Fakultas Ilmu Pendidikan Universitas Negeri Makassar. Rumusan masalah dalam penelitian ini adalah bagaimanakah meningkatkan kemampuan mengenal konsep bilangan melalui permainan kartu bilangan bergambar pada Taman Kanak-Kanak Satu Atap SDN 147 Lembang Kabupaten Pinrang?. Tujuan penelitian ini adalah untuk mengetahui peningkatan kemampuan mengenal konsep bilangan melalui permainan kartu bilangan bergambar pada Taman Kanak-Kanak Satu Atap SDN 147 Lembang Kabupaten Pinrang. Pendekatan yang digunakan dalam penelitian adalah pendekatan kualitatif dengan jenis penelitian tindakan kelas (PTK) yang berdaur ulang/siklus yaitu meliputi perencanaan, pelaksanaan, observasi, dan refleksi. Fokus penelitian adalah kemampuan mengenal konsep bilangan dan permainan kartu bilangan bergambar. Teknik pengumpulan data yang digunakan adalah observasi dan dokumentasi. Analisis data menggunakan analisis kualitatif. Hasil penelitian menunjukkan bahwa ada peningaktan kemampuan mengenal konsep bilangan melalui permainan kartu bilangan bergambar pada Taman Kanak-Kanak Satu Atap SDN 147 Lembang Kabupaten Pinrang. Peningkatan itu dapat dilihat dari setiap siklus pembelajaran, siklus I aktivitas mengajar guru kategori cukup dan aktivitas belajar anak kategori cukup dan pada siklus II kemampuan mengajar guru dan belajar anak meningkatkan menjadi kategori baik. Sehingga dapat disimpulkan kemampuan mengenal konsep bilangan melalui permainan kartu bilangan bergambar pada Taman Kanak-kanak Satu Atap SDN 147 Lembang Kabupaten Pinrang meningkat

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

Objective: To investigate whether supplementation with vitamin A together with iron of Indonesian pregnant women decreases morbidity and improves growth of their infants during the first year of life. Design: Women from a rural area in West Java, Indonesia, were randomly assigned on an individual basis to double-blind supplementation once weekly from ~18 weeks of pregnancy until delivery. Supplementation comprised 120 mg iron and 500 ?g folic acid with or without 4800 RE vitamin A. Their newborn infants were followed up during the first year of life: weight, length, morbidity and food intake were assessed monthly. Results: Infants whose mothers had taken vitamin A supplements during pregnancy had similar weight, length, weight gain and growth as their counterparts during the follow-up period. The proportions of infants with reported symptoms of morbidity were similar in the vitamin A plus iron group and the iron group. In addition immunisation coverage and feeding mode did not differ between the groups. All infants were breast-fed, but exclusive breast-feeding rapidly declined at 4 months of age. Infants with serum retinol concentrations >0.70 ?mol/l increased their weight and length more during the first 6 months of life and had higher weight-for-age Z-scores during the first year of life than infants with serum retinol concentrations £0.70 ?mol/l. Serum retinol concentrations were not associated with morbidity. Conclusion: In this study, vitamin A supplementation in conjunction with iron supplementation of pregnant women did not improve growth or reduce morbidity of their infants during the first year of life

Determinants of weight and length of Indonesian neonates

Design: From 16-20 week of pregnancy, 366 mothers of the neonates had participated in the community-based study to investigate the effect of weekly supplementation during pregnancy with iron and vitamin A on infant growth. Women from five villages were allocated randomly to receive two tablets each containing 60 mg iron as ferrous sulphate and 250 ?g folic acid (n=121) or two tablets each containing 2400 RE vitamin A in addition to the same amount of ferrous sulphate and folic acid (n=122). A third ('daily') group (n=123) participating in the national iron supplementation programme was recruited from four neighbouring villages. Results: Neonatal weight and length did not differ between the two weekly groups and between the weekly iron group and the 'daily' group. Iron and vitamin A status during pregnancy did not influence neonatal weight and length significantly. Boys were 100 g heavier and 0.53 cm longer than girls (P<0.05). First born neonates were lighter (P<0.01) and tended to be shorter (P=0.070) than neonates of higher birth order. Maternal age and education as well as other socioeconomic determinants were not associated with neonatal weight and length. Neonatal weight was 32␎xplained by gestational age, maternal weight, postnatal measurement, gender and parity, while neonatal length was 28␎xplained by gestational age, maternal weight, postnatal measurement, gender and maternal height. Conclusions: Gestational age, maternal weight at second trimester and infant gender were the main predictors of neonatal weight and length