The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Adherence to Iron- Folic- Acid Supplementation and its Related Factors among Pregnant Women in Mazandaraz, Iran in 2022

Document Type : Original Article

Authors
Pegah Salehi 1
Mojgan Firouzbakht 2
1 Pharmacy Graduate, Amol Branch, Islamic Azad University, Amol, Iran.
2 Assistant Professor of Reproductive Health, Department of Midwifery, Comprehensive Health Resaerch, Babol Branch, Islamic Azad University, Babol, Iran.
10.22038/ijogi.2023.22356
Abstract
Introduction: Adhering to the daily intake of folic acid-iron during pregnancy reduces maternal complications such as premature birth, low birth weight and fetal defects. It seems necessary to identify factors related to iron/ folic acid adherence. This study was conducted with aim to determine the adherence to iron- folic acid supplementation and its related factors among pregnant women.
Methods: This descriptive-analytical study was conducted in 2022 on 178 pregnant women in Mazandaran province/ Iran. Data were collected via questionnaires (Demographic, self-report adherence, Morisky questionnaire and Iron/ folic acid knowledge). Analysis was done using SPSS software (version 21) and chi-square test and logistic regression analysis. P<0.05 was considered statistically significant.
Results: Nearly 70% of pregnant women adhered to iron-folic acid intake. The most observed side effects were gastrointestinal complications, and the most common reason for non-adherence to use was forgetfulness. Age over 30 years old (OR=2.49; p=0.027), prenatal care more than 4 times (OR=2.33; p=0.042), and the absence of drug side effects (OR=2.42; p=0.033) increased the chances of adhering to iron-folic acid. The chance of adhering decreased in working mothers (OR=0.33; p=0.025).
Conclusion: In this study, adherence to iron and folic acid intake in pregnant women was high. Regular prenatal care and appropriate consultation will improve adherence to iron/folic acid intake in pregnant women.
Keywords
Adherence
Folic acid
Iran
Iron
Pregnancy
  1. Stoltzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Washington, DC: Ilsi Press; 1998.
  2. Tang G, Lausman A, Abdulrehman J, Petrucci J, Nisenbaum R, Hicks LK, et al. Prevalence of iron deficiency and iron deficiency anemia during pregnancy: a single centre Canadian study. Blood 2019; 134:3389.
  3. World Health Organization. Guideline: Daily Iron and Folic Acid Supplementation in Pregnant Women. Geneva: World Health Organization; 2012. Available from: https://www.ncbi.nlm.nih.gov/books/NBK132263/
  4. Zhao G, Xu G, Zhou M, Jiang Y, Richards B, Clark KM, et al. Prenatal iron supplementation reduces maternal anemia, iron deficiency, and iron deficiency anemia in a randomized clinical trial in rural China, but iron deficiency remains widespread in mothers and neonates. The Journal of nutrition 2015; 145(8):1916-23.
  5. Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data. The Lancet Global Health 2022; 10(5):e627-39.
  6. Azami M, Darvishi Z, Borji M, Sayehmiri K. The prevalence of anemia among pregnant women in Iran (2005-2016); a systematic review and meta-analysis study. Journal of School of Public Health & Institute of Public Health Research 2016; 14(1):15-30.
  7. Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to iron with folic acid supplementation and its associated factors among pregnant women attending antenatal care follow up at Debre Tabor General Hospital, Ethiopia, 2017. PloS one 2019; 14(1):e0210086.
  8. Shewasinad S, Negash S. Adherence and associated factors of prenatal iron folic acid supplementation among pregnant women who attend ante natal care in health facility at Mizan-Aman Town, Bench Maji Zone, Ethiopia, 2015. J Pregnancy Child Health 2017; 4(3):1-15.
  9. Ogundipe O, Hoyo C, Østbye T, Oneko O, Manongi R, Lie RT, et al. Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: a cross-sectional hospital-based study. BMC public health 2012; 12:1-10.
  10. Museka-Saidi TM, Mlambo TT, Aburto N, Keith RS. Strengthen iron folate supplementation of pregnant women in Ntchisi District, Malawi. World Nutrition 2018; 9(3):254-60.
  11. Mithra P, Unnikrishnan B, Rekha T, Nithin K, Mohan K, Kulkarni V, et al. Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India. African health sciences 2014; 14(1):255-60.
  12. Mamo TT, Ashenafi E, Gube AA, Bekele T. Adherence to prenatal iron–folic acid supplementation and associated factors among pregnant women attending antenatal care services in Dilla town, South Ethiopia. Medicine Access@ Point of Care 2021; 5:23992026211008805.
  13. Lacerte P, Pradipasen M, Temcharoen P, Imamee N, Vorapongsathorn T. Determinants of adherence to iron/folate supplementation during pregnancy in two provinces in Cambodia. Asia Pacific Journal of Public Health 2011; 23(3):315-23.
  14. Fmoh A. Rapid, initial assessment of the distribution and consumption of Iron-folic acid tab-lets through antenatal Care in Ethiopia in selected four regions. SPRING 2013.
  15. Ugwu EO, Olibe AO, Obi SN, Ugwu AO. Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria. Nigerian journal of clinical practice 2014; 17(5):608-12.
  16. Steiner JF, Earnest MA. The language of medication-taking. Annals of internal medicine 2000; 132(11):926-30.
  17. Abbas Q, Latif S, Ayaz Habib H, Shahzad S, Sarwar U, Shahzadi M, et al. Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC psychiatry 2023; 23(1):86.
  18. Dehvan F, Baghi V, Lotfi A, Ghanei Gheshlagh R. Medication adherence inhibitors and facilitators in type 2 diabetic patients: An integrative review. Scientific Journal of Nursing, Midwifery and Paramedical Faculty 2017; 3(1):1-17.
  19. Nasir BB, Fentie AM, Adisu MK. Adherence to iron and folic acid supplementation and prevalence of anemia among pregnant women attending antenatal care clinic at Tikur Anbessa Specialized Hospital, Ethiopia. Plos one 2020; 15(5):e0232625.
  20. Sendeku FW, Azeze GG, Fenta SL. Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC pregnancy and childbirth 2020; 20:1-9.
  21. Low MS, Speedy J, Styles CE, De‐Regil LM, Pasricha SR. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database of Systematic Reviews 2016(4).
  22. WHO W. Guideline: daily iron and folic acid supplementation in pregnant women; 2012.
  23. Berti C, Faber M, Smuts CM. Prevention and control of micronutrient deficiencies in developing countries: current perspectives. Nutrition and Dietary Supplements 2014; 6:41-57.
  24. Rahmati S, Delpisheh A, Parizad N, Sayehmiri K. Maternal anemia and pregnancy outcomes: A systematic review and meta-analysis. International journal of pediatrics 2016; 4(8):3323-42.
  25. Iuga AO, McGuire MJ. Adherence and health care costs. Risk management and healthcare policy 2014: 35-44.
  26. Siabani S, Arya MM, Babakhani M, Rezaei F, Siabani S. Determinants of adherence to Iron and folate supplementation among pregnant women in West Iran: a population based cross-sectional study. Qual Prim Care 2017; 25(3):157-63.
  27. Rezaei M, Mohammadinia N, Heidari N, Pejmankhah SH. Awareness on taking folic acid among pregnant women who referred to heath centers in Iranshahr city (2010). Community Health Journal 2017; 5(1):53-61.
  28. Riazi H, Bashirian S. The pattern of folic acid intake in pregnant women referring to Fatemieh hospital in Hamadan (2005). Koomesh 2009; 10(3).
  29. Urgessa BT, Abdo ZA. Adherence to iron/folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka Sub City, Addis Ababa, Ethiopia. BLDE University Journal of Health Sciences 2020; 5(2):145-53.
  30. Popa AD, Niţă O, Popescu RM, Botnariu GE, Mihalache L, Graur M. Nutritional knowledge as a determinant of vitamin and mineral supplementation during pregnancy. BMC public health 2013; 13(1):1-10.
  31. Timmermans S, Jaddoe VW, Mackenbach JP, Hofman A, Steegers-Theunissen RP, Steegers EA. Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in The Netherlands: the Generation R study. Preventive Medicine 2008; 47(4):427-32.
  32. Gebre A, Debie A, Berhane A, Redddy PS. Determinants of compliance to iron-folic acid supplementation among pregnant women in pastoral communities of Afar region: the cases of mille and assaita districts, Afar, Etiopia-2015. Medico research chronicles 2017 ;4(04):352-62.
  33. Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, et al. Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Reproductive health 2019; 16(1):1-4.
  34. Ratanawongsa N, Karter AJ, Parker MM, Lyles CR, Heisler M, Moffet HH, et al. Communication and medication refill adherence: the Diabetes Study of Northern California. JAMA internal medicine 2013; 173(3):210-8.
  35. Banning M. Older people and adherence with medication: a review of the literature. International journal of nursing studies 2008; 45(10):1550-61.
  36. Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG, Bentley ME. Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women. The Journal of nutrition 2005; 135(5):1093-101.
  37. Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. The journal of clinical hypertension 2008; 10(5):348-54.
  38. Mofisky DE, Dimatteo MR. Improving the measurement of self-reported medication nonadherence: Final response. Journal of clinical epidemiology 2011; 64(3):262-3.
  39. Moharamzad Y, Saadat H, Shahraki BN, Rai A, Saadat Z, Aerab-Sheibani H, et al. Validation of the Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Iranian hypertensive patients. Global journal of health science 2015; 7(4):173.
  40. Solomon Y, Sema A, Menberu T. Adherence and associated factors to iron and folic acid supplementation among pregnant women attending antenatal care in public hospitals of Dire Dawa, Eastern Ethiopia. European Journal of Midwifery 2021; 5.
  41. Lavanya P, Jayalakshmy R, Rajaa S, Mahalakshmy T. Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, Puducherry: A mixed-methods study. Journal of Family Medicine and Primary Care 2020; 9(10):5205.
  42. Abdullahi H, Gasim GI, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan. BMC research notes 2014; 7:1-4.
  43. Ibrahim ZM, El-Hamid S, Mikhail H, Khattab M. Assessment of adherence to iron and folic acid supplementation and prevalence of anemia in pregnant women. Med J Cairo Univ 2011; 79(2):115-21.
  44. Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study. Pan African Medical Journal 2015; 20(1).
  45. Assefa H, Abebe SM, Sisay M. Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia. BMC pregnancy and childbirth 2019; 19(1):1-8.
  46. Fouelifack FY, Sama JD, Sone CE. Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital. The Pan African Medical Journal 2019; 34.
  47. Debbarma B, Konjengbam S, Elangbam V, Christina S, Akoijam BS. Prevalence of nonadherence to iron and folic acid supplementation among pregnant women in Bishnupur district of Manipur. Journal of Medical Society 2022; 36(2):43.
  48. Kalaivani K, Ramachandran P. Time trends in prevalence of anaemia in pregnancy. The Indian journal of medical research 2018; 147(3):268.
  49. Boti N, Bekele T, Godana W, Getahun E, Gebremeskel F, Tsegaye B, et al. Adherence to Iron-Folate supplementation and associated factors among Pastoralist’s pregnant women in Burji districts, Segen area People’s zone, southern Ethiopia: community-based cross-sectional study. International journal of reproductive medicine 2018; 2018.
  50. Bilimale A, Anjum J, Sangolli HN, Mallapur M. Improving adherence to oral iron supplementation during pregnancy. Australasian Medical Journal (Online) 2010; 15(5):281.
  51. Manasa K, Chandrakumar SG, Prashantha B. Assessment of compliance with iron-folic acid therapy during pregnancy among postnatal mothers in a tertiary care centre, Mysuru. Int J Community Med Public Health 2019; 6:1665-9.
  52. Kamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya. BMC public health 2018; 18:1-10.
  53. Sangwan K, Kumar N, Jindal HA, Jintendra BB, Sahoo SS. Socio demographic determinants of IFA intake during pregnancy among mothers in rural area of Rohtak, Haryana, India. Int J Basic Appl Med Sci 2014; 4:49-56.
  54. Ba DM, Ssentongo P, Kjerulff KH, Na M, Liu G, Gao X, et al. Adherence to iron supplementation in 22 sub-Saharan African countries and associated factors among pregnant women: a large population-based study. Current developments in nutrition 2019; 3(12):nzz120.
  55. Wendt A, Stephenson R, Young M, Webb-Girard A, Hogue C, Ramakrishnan U, et al. Individual and facility-level determinants of iron and folic acid receipt and adequate consumption among pregnant women in rural Bihar, India. PloS one 2015; 10(3):e0120404.
  56. Chourasia A, Pandey CM, Awasthi A. Factors influencing the consumption of iron and folic acid supplementations in high focus states of India. Clinical Epidemiology and Global Health 2017; 5(4):180-4.
  57. Arega Sadore A, Abebe Gebretsadik L, Aman Hussen M. Compliance with iron-folate supplement and associated factors among antenatal care attendant mothers in Misha District, South Ethiopia: community based cross-sectional study. Journal of environmental and public health 2015; 2015.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 26, Issue 2
April 2023
Pages 34-45