Abstract
BackgroundDeficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, thus supplements are recommended. Adherence to current tablet-based supplements is documented to be poor. Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence. However, before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy, the bioavailability of the iron needs to be determined. Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women.MethodsEighteen healthy pregnant women (24 – 32 weeks gestation) were randomized to receive the supplements in a crossover design. Following ingestion of each supplement, the changes (over baseline) in serum iron and folate over 8 hours were determined. The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid.ResultsOverall absorption of iron from the powdered supplement was significantly lower than the tablet (p = 0.003). There was no difference in the overall absorption of folic acid between supplements. Based on the differences in the area under the curve and doses, the relative bioavailability of iron from powdered supplement was lower than from the tablet (0.22).ConclusionThe unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports. However, since pills and capsules are known to be poorly accepted by some women during pregnancy, it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose.Trial RegistrationClinicalTrials.gov NCT00789490
Highlights
Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, supplements are recommended
Folate deficiency has significantly decreased in North America primarily due to folic acid fortification of the food supply but the need for adequate folate intake prior to conception and during the early weeks of pregnancy remains a significant concern to reduce the risk for the development of neural tube defects (NTD) [3]
The area under the curve (AUC) -iron was significantly smaller for the powdered supplement than for the tablet (p = 0.0003)
Summary
Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, supplements are recommended. Supplements containing iron and folic acid are recommended during pregnancy by various health organizations to meet requirements and to reduce the risk for deficiency [2]. Folate deficiency has significantly decreased in North America primarily due to folic acid fortification of the food supply but the need for adequate folate intake prior to conception and during the early weeks of pregnancy remains a significant concern to reduce the risk for the development of neural tube defects (NTD) [3]. Up to half of the women taking multivitamin and iron supplements during pregnancy will experience some gastrointestinal side effects, constipation and nausea [5,6,7], it is not surprising that adherence to supplementation during pregnancy is only about 50% [7]. This limited adherence to supplementation during pregnancy due to gastrointestinal side effects associated with supplemental iron can be further exacerbated by morning sickness and may be related to tablet size [7,8,9]
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