PREVALENCE OF MULTIPLE MICRONUTRIENT DEFICIENCY AMONG FILIPINO PREGNANT WOMEN

Background: Pregnant women are particularly vulnerable to micronutrient deficiencies because of the increased metabolic demands for high quality nutrients imposed by pregnancy involving a growing placenta, fetus, and maternal tissues, coupled with associated dietary risk. Data from several national nutrition surveys revealed high prevalence of iron deficiency anemia, vitamin A deficiency, folate, riboflavin and other B vitamin deficiencies. However, the existence of concurrent multiple micronutrient deficiencies among pregnant women has received little attention. Objectives: (1) To assess the prevalence of multiple micronutrient deficiencies (MMD) among Filipino pregnant women; and (2) To identify the significant variables associated with MMD, either occurring singly or in combination with others. Methods: A total of 535 pregnant women from the 2003 6 th National Nutrition Survey (6NNS), who had complete data on five (5) biochemical parameters that described micronutrient status, were included in the study. The 6NNS used a stratified multi-stage sampling design that covered all regions of the country and 5,522 households. Blood samples were collected in a non-fasted state. Serum ferritin and red blood cell (RBC) folate were determined by radioimmunoassay (RIA) and serum zinc, by atomic absorption spectrometry (AAS). Serum retinol was determined by high pressure liquid chromatography (HPLC). Erythrocyte glutathione reductase activity coefficient (EGR-AC) was determined as a measure of riboflavin status. Descriptive statistics such as frequency and percentage distributions, means, and proportions/ratios were computed to describe the profile of pregnant mothers. Logistic regression was used to describe the relationships between micronutrient status and some sets of independent variables. Results: Multi-micronutrient deficiencies (MMD) were common among pregnant women, with only 18.8 % of women being considered as normal in all five biochemical parameters, while the rest suffered from a single (34.2%) to a combination of 2 (31.0%), 3 (12.9%), 4 to 5 (2.8%) micronutrient deficiencies. For single micronutrient deficiency (being normal in 4 other biochemical parameters), 11.9%, 11.2%, 5.6%, 3.4% and 1.8% had riboflavin, folate, iron, vitamin A, and zinc deficiencies, respectively. The most common concurrent double MD prevalence was iron and riboflavin (10.2%). Other double MD prevalence rates were in the range of 0.8%- 7.8%. The most prevalent of triple MDs was the combination of iron, folate and riboflavin (6.0%), followed by vitamin A, folate and riboflavin combination (1.9%). Other triple MD prevalence rates were in the range of 0.3%-1.5 %. Concurrent prevalence of quadruple MDs was highest for vitamin A, folate, riboflavin and zinc combination (1%). Only a small group of pregnant women (0.3%) had concurrent deficiencies of all the five micronutrients. Three nutrient intakes (iron, riboflavin and folate), use of supplements, age of gestation, and education were significantly positively associated with micronutrient status. Recommendation: It is recommended that the present iron and folate supplementation program for pregnant women be reviewed to include other nutrients based on MD prevalence.