Interventions
The trial had three intervention arms at the cluster (commune)
level: (1) one tablet of IFA taken daily (60 mg elemental iron plus
0.4 mg folic acid per tablet, administered as 7 tablets/week)—this
regime is the recommended approach for antenatal iron in Viet
Nam, and was used as the control arm; (2) one capsule of IFA
taken twice a week (60 mg elemental iron plus 1.5 mg folic acid
per capsule; administered as 2 capsules/week); or (3) one capsule
of MMNs taken twice a week (60 mg elemental iron plus 1.5 mg
folic acid plus a variation of the dose of micronutrients in the
UNIMMAP [24] daily supplement; administered as 2 capsules/
week) (Table 1). Participants took supplements from enrolment
until 3 mo postpartum. The IFA and MMN capsules in the twice
weekly groups were identical in appearance. A placebo control was
not contemplated, as it was considered unethical to withhold iron
supplementation during pregnancy. Both IFA and MMN supplements
were manufactured by the local Nam Ha Pharmaceutical
Company (Nam Dinh, Viet Nam), which has WHO Good
Manufacturing Practice certification. Tablets/capsules were independently
analysed by the ALC Laboratory Group (Melbourne,
Australia) to verify micronutrient dose.
Each woman was visited every 6 wk at home, to distribute the
intervention with written instructions for the next 6 wk, and collect
information on adherence, side effects, and pregnancy complications.
Intake was not supervised.
The research team did not provide medical treatment for
women in the trial. However, the field teams worked closely with
commune health workers, and women with hemoglobin levels less
than 80 g/l, clinical depression, or other significant illness were
referred to the commune health station for further management.
Following completion of the trial, feedback was given to women
about ferritin, iodine, and hemoglobin results, along with nutrition