Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy, Sri Lanka: A Hospital-Based Cross-Sectional Study

Nutrients
Q1
Oct 2020
Citations:28
Influential Citations:4
Observational Studies (Human)
83
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Methods
Descriptive, hospital-based cross-sectional study of 703 postpartum women (0–4 days after delivery) with singleton pregnancies at Kurungegala Provincial General Hospital, Sri Lanka; mean age 30.2 ± 5.1 years; data collected via interviewer-administered questionnaire and review of pregnancy charts/bedside notes; Exclusions: psychiatric disorders, chronic disorders, obstetric complications.
Intervention
Daily iron and folic acid supplementation (60 mg elemental iron + 400 mcg folic acid) with vitamin C and calcium lactate; started from the beginning of the 13th gestational week and continued daily until hospital admission for impending delivery.
Results
80.1% compliance with iron–folic-acid supplementation from the second trimester to delivery; 84.2% complied with all supplements (iron, folic acid, vitamin C, calcium lactate); 26.6% adhered to dietary recommendations; forgetfulness (66.9%) was the main reason for non-compliance, followed by side effects (15.7%). Multivariate analysis: employed vs non-employed—compliance OR 1.70 (95% CI 1.00–2.89; p=0.048); history of low birth weight infant—OR 0.41 (95% CI 0.19–0.90; p=0.021); history of anaemia—OR 0.35 (95% CI 0.12–0.98; p=0.046). Third-trimester anaemia prevalence was 44.9%, suggesting poor dietary adherence despite high supplement compliance. Authors recommend revising antenatal education to emphasize anemia prevention, adherence to supplementation, and dietary guidelines; consider reminders to reduce forgetfulness.
Limitations
Self-reported compliance data; anemia status based on pregnancy charts with potential reporting errors; Hb testing performed across multiple laboratories introducing inter-laboratory variation; cross-sectional design limits causal inference; single-hospital sample limiting generalizability.

Abstract

Iron deficiency anaemia during pregnancy is a common public health problem that negatively affects maternal and newborn health. This study aims to identify the rate of maternal compliance with the recommended iron and folic acid (IFA) supplementation...