The objective of the current analysis was to explore the association of multiple micronutrients with Hb concentration among pregnant women in a South Asian setting, a topic that has not been adequately explored.

Sociodemographic, anthropometric and micronutrient status (plasma ferritin, transferrin receptor, retinol, α- and γ-tocopherol, folate, vitamin B12, Zn) and Hb concentration were assessed at early pregnancy.

The biochemical sub-study was nested within a double-blind, placebo-controlled, community-based vitamin A and β-carotene supplementation trial in rural north-western Bangladesh (JiVitA). All assessments were conducted before trial supplementation was initiated.

A systematic sample of 285 women was selected from those enrolled in the biochemical sub-study.

Seventeen per cent of women were mildly anaemic; moderate and severe anaemia was uncommon (2·1 %). α-Tocopherol, vitamin B12 and Zn deficiencies were common (43·5 %, 19·7 % and 14·7 %, respectively); however, vitamin A, folate and Fe deficiencies were comparatively rare (7·4 %, 2·8 % and <1 %, respectively). Plasma Zn, vitamin B12 and α-tocopherol were positively associated and plasma γ-tocopherol was negatively associated with Hb (P < 0·05) after adjustment for gestational age, inflammation status, season and nutritional status measured by mid-upper arm circumference.

Among pregnant women in rural Bangladesh with minimal Fe deficiency, plasma Zn, vitamin B12, and α- and γ-tocopherol concentrations were associated with Hb concentration. Appreciating the influence on Hb of micronutrients in addition to those with known associations with anaemia, such as Fe, folate, and vitamin A, is important when addressing anaemia in similar settings.