Maternal Iron-and-Folic-Acid Supplementation and its Association with Low-birthweight and Neonatal Mortality in India.

OBJECTIVE This study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, <100 days of IFA consumption or <100 IFA, and ≥100 days of IFA consumption or ≥100 IFA) among prospective mothers and its association with various stages of low-birthweight (ELBW: extremely low-birthweight, VLBW: very low-birthweight, and LBW: low-birthweight) and neonatal mortality (death during day 0-1, 2-6, 7-27, and 0-27) in India. DESIGN The cross-sectional, nationally representative, 2015-2016 National Family Health Survey (NFHS-4) data were used. Weighted descriptive analysis, and multiple binary logistic regression modelling were used. SETTING NFHS-4 covered 640 districts from 37 states/ union territories of India. PARTICIPANTS A total of 120,374 and 143,675 index children aged 0-59 months were included to analyse LBW and neonatal mortality, respectively. RESULTS Overall, 30.7% mothers consumed ≥100 IFA in 2015-2016, and this estimate ranged from 0.0% in Zunheboto district of Nagaland state to 89.5% in Mahe district of Puducherry of India. Multiple regression analysis revealed that children of mothers who consumed ≥100 IFA had lower odds of ELBW, VLBW, LBW, and neonatal mortality during day 0-1, as compared to mothers who did not buy/receive any IFA. Consumption of IFA (<100 IFA and ≥100 IFA) had protective association with neonatal death during day 7-27, and 0-27. Consumption of IFA was not associated with neonatal death during day 2-6. CONCLUSIONS While ≥100 IFA consumption during pregnancy was found to be associated with preventing select types of LBW and neonatal mortality, a large variation in coverage of ≥100 IFA consumption across 640 districts is concerning.