We examined hemoglobin (Hb, g/L), iron status (zinc protoporphyrin, ZPP, ȝmol/mol heme, and
transferrin receptor, TfR, mg/L), and inflammation (C-reactive protein, CRP and alpha-1
glycoprotein, AGP) in pregnant Ghanaian women who participated in a randomized controlled
5 trial. Women (n=1320) received either 60 mg Fe + 400 µg folic acid (IFA); 18 micronutrients
6 including 20 mg Fe (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNS, 118
7 kcal/d) with the same micronutrient levels as in MMN, plus 4 additional minerals (LNS) daily
during pregnancy. Intention-to-treat analysis included 349, 354, and 354 women in the IFA,
MMN and LNS groups, respectively, with overall baseline mean Hb and anemia (Hb <100)
prevalence of 112 and 13.3%, respectively. At 36 gestational weeks, overall Hb was 117 and
anemia prevalence was 5.3%. Compared with the IFA group, the LNS and MMN groups had
lower mean Hb (120±11 vs 115±12 and 117±12, respectively; p<0.001), higher mean ZPP
(42±30 vs 50±29 and 49 ±30; p=0.010) and TfR (4.0±1.3 vs 4.9±1.8 and 4.6±1.7; p<0.001), and
greater prevalence of anemia (2.2% vs 7.9% and 5.8%; p=0.019), elevated ZPP (>60) [9.4% vs
18.6% and 19.2%; p=0.003] and elevated TfR (>6.0) [9.0% vs 19.2% and 15.1%; p=0.004]. CRP
and AGP concentrations did not differ among groups. We conclude that among pregnant women
in a semi-urban setting in Ghana, supplementation with SQ-LNS or MMN containing 20 mg
18 iron resulted in lower Hb and iron status but had no impact on inflammation, when compared
with iron (60 mg) plus folic acid (400 µg). The amount of iron in such supplements that is most
effective for improving both maternal Hb/iron status and birth outcomes requires further
evaluation. This trial was registered at ClinicalTrials.gov as: NCT00970866.