THE ROLE OF IRON FOLIC ACID AND MULTIPLE MICRONUTRIENTS IN TYPE OF CHILDBIRTH DELIVERY: ECONOMIC AND HEALTH IMPLICATION
DOI:
https://doi.org/10.22159/ajpcr.2025v18i2.53549Keywords:
dietary, pregnancy, labor, cesarean, costAbstract
Objective: Pregnancy is a critical period that can pose nutritional challenges, such as chronic energy deficiency and anemia, increasing maternal mortality risk. The World Health Organization recommends iron and folic acid supplements to mitigate these risks. This study compared labor types and associated costs between iron-folic acid (IFA) and multiple micronutrient (MMN) supplementations during pregnancy.
Methods: An economic evaluation was conducted retrospectively at Semen Padang Hospital, analyzing data from January to December 2021. A total of 201 pregnant women were included, with 128 undergoing cesarean delivery. Cost data were collected from the hospital’s perspective and analyzed to identify differences between supplementation groups.
Results: Total direct costs did not differ significantly between the IFA and MMN groups (p=0.82). However, medical costs varied substantially, with cesarean delivery costs being approximately 5 times higher than normal delivery costs.
Conclusion: This study emphasizes the economic burden of cesarean deliveries compared to normal births and highlights the need for further evaluation of micronutrient supplementation’s cost-effectiveness. Findings advocate for policies that optimize maternal health outcomes and reduce delivery-related costs, addressing the high incidence of elective cesarean sections.
Downloads
References
Fitria N, Ikramah N, Sukma A, Nasif H. The effect of iron-folic acid (IFA) on the size of the mid-upper arm circumference of pregnant women during pregnancy. J Obstet Gynecol Cancer Res. 2024;9(3):276- 82. doi: 10.30699/jogcr.9.3.276
Roozbeh N, Hajian S, Darvish S, Kiani Z. The risk factors affecting low birth weight in Iran: An update systematic review. J Obstet Gynecol Cancer Res. 2022;7(3):131-43. doi: 10.30699/jogcr.7.3.131
Ekowati D, Ani LS, Windiani IG. High parity and chronic energy deficiency increase risk for low birth weight in situ Bondo District. Public Health Prev Med Arch. 2017;5(1):28-32.
Saini J, Lora SS, Gupta MC. Maternal obesity as a predictive marker for adverse pregnancy outcome: A case-control study. Asian J Pharm Clin Res. 2023;16:33-7. doi: 10.22159/ajpcr.2023v16i9.48679
Brown B, Wright C. Safety and efficacy of supplements in pregnancy. Nutr Rev. 2020;78(10):813-26. doi: 10.1093/nutrit/nuz101, PMID: 31925443
Diana FM, Fitria N. Association of omega 3 and omega 6 and child development: A systematic review. Nutr Clin Diet Hosp. 2022;42(2):98-104.
Keats EC, Haider BA, Tam E, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;3(3):CD004905. doi: 10.1002/14651858.CD004905.pub6, PMID: 30873598
Roche ML, Samson KL, Green TJ, Karakochuk CD, Martinez H. Perspective: Weekly iron and folic acid supplementation (WIFAS): A critical review and rationale for inclusion in the essential medicines list to accelerate anemia and neural tube defects reduction. Adv Nutr. 2021;12(2):334-42. doi: 10.1093/advances/nmaa169, PMID: 33439978
Valentin M, Coste Mazeau P, Zerah M, Ceccaldi PF, Benachi A, Luton D. Acid folic and pregnancy: A mandatory supplementation. Ann Endocrinol (Paris). 2018;79(2):91-4. doi: 10.1016/j.ando.2017.10.001, PMID: 29433770
Sukma A, Suharto EL, Melia S, Juliyarsi I, Vebriyanty E, Fitria N, et al. Probiotic-rich fermented milk from Lactiplantibacillus plantarum IIA-1A5: Effects on pregnancy health in the animal model. Narra J. 2024;4(3):1-8.
Fitria N, Lailaturrahmi L, Sukma A. The effect of consuming fermented milk containing probiotics during pregnancy IOP Conf Ser Earth Environ Sci. 2024;1341(1):012032.
Fatdillah H, Desriani MS, Melia S, Fitria N, Morita H, Sukma A. Variant alpha and beta biodiversity of the genus in dadiah through deep sequencing 16S Ribosomonal RNA genes. IOP Conf Ser Earth Environ Sci. 2021;888(1):012040. doi: 10.1088/1755-1315/888/1/012040
Fitria N, van Asselt AD, Postma MJ. Cost-effectiveness of controlling gestational diabetes mellitus: A systematic review. Eur J Health Econ. 2019;20(3):407-17. doi: 10.1007/s10198-018-1006-y, PMID: 30229375
Salenius M, Pyykkö J, Ashorn U, Dewey KG, Gondwe A, Harjunmaa U, et al. Association between prenatal provision of lipid-based nutrient supplements and caesarean delivery: Findings from a randomised controlled trial in Malawi. Matern Child Nutr. 2022;18(4):e13414. doi: 10.1111/mcn.13414, PMID: 35909334
Geze Tenaw S, Girma Fage S, Assefa N, Kenay Tura A. Determinants of maternal near-miss in private hospitals in Eastern Ethiopia: A nested case-control study. Womens Health (Lond Engl). 2021;17:17455065211061949. 1-8 doi: 10.1177/17455065211061949, PMID: 34844476.
Chisin R. Cost-effectiveness analysis. J Nucl Med. 2009;50(3):338-9. doi: 10.2967/jnumed.108.057489, PMID: 19223418.
Yosmar R, Shepany E, Fitria N. A comprehensive analysis of antidiabetic drug interactions in geriatric non-insulin dependent diabetes mellitus patients. Int J Appl Pharm. 2024;16(1):62-5.
Melia S, Juliyarsi I, Kurnia YF, Aritonang SN, Purwati E, Sukma A, et al. Effect of fermented milk Pediococcus acidilactici BK01 on cholesterol and microbiota in Wistar mice intestine. J Adv Vet Anim Res. 2023;10(1):64-71. doi: 10.5455/javar.2023.j653, PMID: 37155540
Fitria N, Idrus L, Putri AR, Sari YO. The usability testing of the integrated electronic healthcare services for diabetes mellitus patients during the pandemic in Indonesia. Digit Health. 2023;9:20552076231173227. 1-6. doi: 10.1177/20552076231173227, PMID: 37152237.
Renee JA. Pharmacoeconomics: From Theory to Practice. 2nd ed. Oxon: CRC Press; 2021.
Mei Z, Jefferds ME, Namaste S, Suchdev PS, Flores-Ayala RC. Monitoring and surveillance for multiple micronutrient supplements in pregnancy. Matern Child Nutr. 2018;14(Suppl 5):e12501. doi: 10.1111/ mcn.12501, PMID: 29271064
Dabiran S, Khosravi S, Pourali L, Ayati S, Mohaddes Ardebili ZM, Delavari S. Childbearing in advanced maternal age and pregnancy outcomes: A cross-sectional study. J Obstet Gynecol Cancer Res. 2022;8(1):35-40. doi: 10.30699/jogcr.8.1.35
Ogunyemi DA, Fong A, Rad S, Fong S, Kjos SL. Attitudes and practices of healthcare providers regarding gestational diabetes: Results of a survey conducted at the 2010 meeting of the International Association of Diabetes in Pregnancy Study Group (IADPSG). Diabet Med. 2011;28(8):976-86. doi: 10.1111/j.1464-5491.2011.03326.x, PMID: 21535123
Sharma S, Dhakal I. Cesarean vs vaginal delivery: An institutional experience. JNMA J Nepal Med Assoc. 2018;56(209):535-9. doi: 10.31729/jnma.3467, PMID: 30058639
Fitria N, Febiana D, Akram M, Yosmar R. Aspirin-clopidogrel combination therapy for ischemic stroke patients: Clinical efficacy and cost-effectiveness analyses in low-resource setting. Narra J. 2024;4(2):e758. doi: 10.52225/narra.v4i2.758, PMID: 39280302
Da Silva Lopes K, Yamaji N, Rahman MO, Suto M, Takemoto Y, Garcia-Casal MN, et al. Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: An overview of systematic reviews. Cochrane Database Syst Rev. 2021;9(9):CD013092. doi: 10.1002/14651858.CD013092.pub2, PMID: 34564844
Khaksary Mahabady M, Najafzadeh Varzi H, Zareyan Jahromi S. L-carnitine protect against cyclophosphamide induced skeletal and neural tube malformations in rat fetuses. Acta Med Iran. 2015;53(11):703-10. PMID: 26786992
Meldrum S, Simmer K. Docosahexaenoic acid and neurodevelopmental outcomes of term infants. Ann Nutr Metab. 2016;69(Suppl 1):22-8. doi: 10.1159/000448271, PMID: 27842311
Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev. 2006;3(3):CD004736. doi: 10.1002/14651858. CD004736.pub2, PMID: 16856058
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. Reprod Health. 2019;16(1):182. doi: 10.1186/s12978-019- 0848-9, PMID: 31864397
Fitria N, Andela M, Rerita R, Nasif H. Cost-effectiveness of metformin-glimepiride combination compared to single metformin use in decreasing 2 h post prandial blood glucose. Int J Appl Pharm. 2024;16(1):53-7. doi: 10.22159/ijap.2024.v16s1.10
Published
How to Cite
Issue
Section
Copyright (c) 2025 Najmiatul Fitria, Afifah Machlaurin, Sarah Puti Amelia, Hansen Nasif
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
