The Multiple Vitamin Status of Chinese Pregnant Women with Anemia and Nonanemia in the Last Trimester

Iron-deficiency or anemia in pregnancy is a major public health problem in China. This cross-sectional study was carried out to observe the association between iron status and multiple vitamin levels of Chinese pregnant women in the third trimester. We measured iron, ascorbic acid, retinol, folate and vitamin B_<12> in serum, and riboflavin in urine specimens of 1,163 pregnant women in four sites throughout rural and city areas in China. Based on hemoglobin concentrations (Hb), the subjects were divided into an anemia group with Hb<110 g/L or Hb≤100 g/L as severe anemia group, and nonanemia group with Hb≥110g/L. Results showed that 41.58% of the population with serum iron <700μg/L and 51.04% of the population with ferritin <12μg/L in the anemia group, percentages that were much higher than those in the nonanemia group. Relationships between five vitamins and hemoglobin concentrations of all subjects were observed. There was a lower level of serum ascorbic acid (291.05 μg/dL) in the Hb≤100 g/L group than in the Hb≥120g/L group (487.79μg/dL) (p<0.001). Serum levels of vitamin B_<12> and folate were 445.67 pg/mL and 5.94 ng/mL in the Hb≤100 g/L group, whose levels were much lower than the levels of 502.01 pg/mL (p<0.012) and 8.07 ng/mL (p<0.010) respectively in the Hb≥120 g/L group. Further, cross-sectional analysis showed positive correlations between abnormal hematological results and prevalences of vitamin deficiencies. The subjects with iron-deficiency anemia had much higher rates of vitamin C, folate and vitamin B_12 deficiencies than those in the nonanemic subjects, and especially in the deficient rates of ascorbic acid and folate in the anemia (Hb <110 g/L) group, which reached 64.04% and 22.70% respectively. Moreover, we observed that the decreasing trends of hemoglobin concentrations were accompanied by the decreases of serum levels of vitamin A, ascorbic acid, folate and vitamin B_<12>. In conclusion, multiple vitamin deficiencies, especially ascorbic acid, retinol and folic acid, may be associated with anemia or iron deficiency in pregnant women in the last trimester. The study suggested that anemic pregnant women in China should be supplemented with iron and multiple vitamins simultaneously.