Iron Supplementation In Pregnant Women Research Articles

The Effects of Prenatal Iron Supplementation on Offspring Neurodevelopment in Upper Middle- or High-Income Countries: A Systematic Review

Iron supplementation is commonly recommended for the prevention and treatment of maternal iron deficiency (ID) or iron deficiency anemia (IDA). However, the impacts of prophylactic of therapeutic prenatal iron supplementation on child neurodevelopment in upper middle-income (UMI) and high-income countries (HICs), where broad nutritional deficiencies are less common, are unclear. To investigate this, we conducted a systematic review, searching four databases (Medline, CINAHL, EMBASE, Cochrane Library) through 1 May 2023. Randomized controlled trials (RCTs) assessing oral or intravenous iron supplementation in pregnant women reporting on child neurodevelopment (primary outcome: age-standardized cognitive scores) were eligible. We included three RCTs (five publications) from two HICs (Spain and Australia) (N = 935 children; N = 1397 mothers). Due to clinical heterogeneity of the RCTs, meta-analyses were not appropriate; findings were narratively synthesized. In non-anemic pregnant women, prenatal iron for prevention of IDA resulted in little to no difference in cognition at 40 days post-partum (1 RCT, 503 infants; very low certainty evidence). Similarly, the effect on the intelligence quotient at four years was very uncertain (2 RCTs, 509 children, very low certainty evidence). No RCTs for treatment of ID assessed offspring cognition. The effects on secondary outcomes related to language and motor development, or other measures of cognitive function, were unclear, except for one prevention-focused RCT (302 children), which reported possible harm for children’s behavioral and emotional functioning at four years. There is no evidence from UMI countries and insufficient evidence from HICs to support or refute benefits or harms of prophylactic or therapeutic prenatal iron supplementation on child neurodevelopment.

Efficacy of daily versus intermittent oral iron supplementation for prevention of anaemia among pregnant women: a systematic review and meta-analysis

The World Health Organization recommends daily oral supplementation of iron for prevention of maternal anaemia. However, the adverse effects due to daily supplementation leads to poor compliance among pregnant women. Also, the mucosal block theory suggests that intermittent oral iron may be more efficient than daily iron with respect to optimum absorption. Our meta-analysis reviewed the existing clinical studies for the efficacy of daily versus intermittent oral iron supplementation. In this systematic review and meta-analysis [PROSPERO ID:CRD42024498180], we searched PubMed, Google Scholar, Scopus, Science Direct and Cochrane database for studies published from 1st January 1970 to 31st December, 2023. Studies comparing daily and intermittent iron supplementation in pregnant women were included. The median intermittent iron dose was 120mg/day and daily iron dose was 60mg/day. The primary outcome was endpoint haemoglobin levels after iron supplementation. The data was analysed using the 'meta' and 'metafor' packages in RStudio using random effects model. The heterogeneity, publication bias, risk of bias and certainty of evidence were assessed using I2 statistics, funnel plots, Cochrane Risk of Bias 2 (ROB2) tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach respectively. Of 4615 search results, 26 studies (n=4365 participants) were included in this meta-analysis. There was no significant difference (p=0.18) between the endpoint mean haemoglobin levels of the daily versus intermittent oral iron groups (standardized mean difference (SMD): 0.51, 95% CI:-0.23 to 1.24, I2=97%, low certainty evidence) irrespective of baseline anaemic status. However, the endpoint ferritin levels were significantly higher in the daily supplementation group (SMD: 0.85, 95% CI: 0.15-1.54, p=0.02, I2=97%, low certainty evidence). The adjusted odds ratio for nausea, (adjusted odds ratio (OR) 3.56, 95% CI: 2.23-5.69, p<0.001, I2=9%, moderate certainty evidence), diarrhoea (adjusted OR 5.40, 95% CI: 1.90-15.33, p=0.002, I2=0%, low certainty evidence) and constipation (adjusted OR 1.95, 95% CI: 1.21-3.14, p=0.006, I2=0%, moderate certainty evidence) was significantly higher in daily oral iron supplementation group. Intermittent oral iron supplementation with a median dose of 120mg/day demonstrates comparable efficacy to daily oral iron supplementation median dose of 60mg/day in increasing haemoglobin levels among pregnant women with a significant reduction in adverse events. There was no funding for this study.

Intravenous Iron Supplementation in Pregnant Women with Sickle Cell Disease: Case Series

Intravenous Iron Supplementation in Pregnant Women with Sickle Cell Disease: Case Series

Digital versus non-digital health interventions to improve iron supplementation in pregnant women: a systematic review and meta-analysis.

To investigate the effects of digital health interventions for improving adherence to oral iron supplementation in pregnant women. Five databases were searched from their inception to October 2023 with no date restrictions. Randomized controlled trials (RCTs) that assessed the effects of digital health interventions on adherence to oral iron supplementation (e.g., tablets and capsules) compared to non-digital health interventions for pregnant women were eligible. We calculated standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) for continuous variables using the inverse variance method. We calculated odds ratios (OR) with 95%CI for categorical variables using the Mantel-Haenszel model. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The risk of bias of the included RCTs was assessed using the Cochrane risk of bias tool 2.0. Ten trials with 1,633 participants were included. Based on 7 trials, digital health interventions can improve objective adherence rate comparing with non-digital health interventions (1,289 participants, OR = 4.07 [2.19, 7.57], p < 0.001, I2 = 69%) in pregnant women. Digital health interventions can improve subjective adherence behavior comparing with non-digital health interventions (3 trials, 434 participants, SMD = 0.82 [0.62, 1.01], p < 0.001, I2 = 0%) in pregnant women. Based on 3 trials, digital health interventions can improve tablets consumption comparing with non-digital health interventions (333 participants, SMD = 1.00 [0.57, 1.42], p < 0.001, I2 = 66%) in pregnant women. Digital health interventions can improve hemoglobin level comparing with non-digital health interventions (7 trials, 1,216 participants, MD = 0.59 [0.31, 0.88], p < 0.001, I2 = 93%) in pregnant women. Digital health interventions were effective at improving adherence to oral iron supplementation and hemoglobin levels in pregnant women.

Anemia in Pregnancy: Study Phenomenology

Introduction: The prevalence of anemia in pregnant women in Indonesia remains high. This condition is concerning because the government has run a program of giving iron tablets to pregnant women since 1970. This study aimed to determine socioenvironmental factors that cause anemia in pregnant women. Methods: This qualitative research used phenomenological methods. In-depth interviews were conducted with 20 mothers with anemia and 12 focus group discussion (FGD) informants. Qualitative data analysis was applied to analyze the data. Results: The study found three factors: anemia in the preconception period, diets that cause a lack of iron consumption, and knowledge and consumption of iron tablets in pregnant women. Anemia in pregnant women is a continuous cycle of anemia which begins in the preconception period. Adolescent eating behavior and supplementation programs for pregnant women integrated with antenatal care are still problematic. Discussion and Conclusion: The findings of this study provide important information for preventing anemia in pregnant women, increasing counseling, and evaluating the implementation of iron supplementation in pregnant women. The policy of administering iron tablets to pregnant women to prevent anemia is not effective in reducing the prevalence of anemia. This government policy must be accompanied by a community movement program because the findings of this study show the problems that exist in the individual factors of the mother.

The Influence of Calcium and Iron Supplementation in Pregnant Women to Affect Newborn Body Length in Bengkulu

The Influence of Calcium and Iron Supplementation in Pregnant Women to Affect Newborn Body Length in Bengkulu

The Importance of Iron Supplementation in Pregnant Women

Iron supplementation is an important treatment for pregnant people with iron deficiency anemia. For this reason, we designed and created an evidence-based infographic with accessible fonts, pictograms, and language. This tool serves as a framework for the potential of visual communication tools in the context of improving medication and treatment adherence. Various sources were utilized to derive information on a suggested iron intake regimen; however, we encourage individuals to consult with their primary care providers in order to establish the ideal regimen for them, adjusted to unique individual factors.

Development and testing of a nutrition education tool on iron supplementation for pregnant women

Background: Although iron supplementation may prevent iron deficiency anaemia (IDA) during pregnancy, a nutrition education tool highlighting the importance of iron supplementation during pregnancy is also important. Objectives: The aim was to develop and test a nutrition education tool on iron supplementation for pregnant women. Design: A cross-sectional study was conducted. Setting: Mutare City Clinic, Manicaland province, Zimbabwe. Subjects: Sixty-seven pregnant women in their second or third trimesters of pregnancy and attending Mutare City Clinic for antenatal care (ANC) participated in the study. Outcome measures: The preferences of pregnant women regarding form, structure and content of the nutrition education tool were established using eight focus-group discussions (FGDs) in which 67 pregnant women participated. Three additional FGDs were conducted with another 28 pregnant women to assess the user-friendliness and acceptability of the developed tool. Results: A pamphlet was the most preferred tool, with English being the most preferred language, along with some Shona phrases. Women wanted information on IDA, dosage, duration and side-effects of iron supplementation and iron food sources to be included in the pamphlet. The participants identified clinics, pharmacies and churches as ideal sites for dissemination of the tool. Conclusions: A pamphlet on iron supplementation in simple English with some Shona phrases was the nutrition education tool most preferred by the pregnant women. Offering the pamphlet together with iron supplements to pregnant women could improve compliance with iron supplements. However, follow-up ANC consultations are important for effective implementation of all key messages in the pamphlet.

Effect of knowledge and counseling on adherence to iron supplementation in pregnant women: A systematic literature review

Effect of knowledge and counseling on adherence to iron supplementation in pregnant women: A systematic literature review

Effect of knowledge and counseling on adherence to iron supplementation in pregnant women: A systematic literature review

Adherence is a determining factor for the success of iron supplementation programs in pregnant women. There are several factors that influence adherence, the most significant of which are knowledge of pregnant women and counseling by health workers. This systematic review of the literature aims to identify the effect of knowledge and counseling on pregnant women's adherence to taking iron supplementation. Literature searches were conducted through four main electronic databases, namely PubMed, Scopus, ScienceDirect, and Web of Science. Fourteen studies met the inclusion criteria and were eligible for review. The PRISMA approach is used in critically evaluating articles. Literature quality assessment was carried out using the quality assessment tool for quantitative studies from the EPHPP (Effective Public Health Practice Project). Findings are collected and summarized systematically. The results are categorized into two major themes. Consistent with previous research, this review explains that knowledge and counseling have a significant effect on adherence. Good knowledge increases adherence by two to five times, and counseling by health professionals increases adherence by two to four times.

Prevalence of iron-deficiency anemia in pregnant women with various thalassemia genotypes: Thoughts on iron supplementation in pregnant women with thalassemia genes.

There are limited studies on iron-deficiency anemia (IDA) in carriers of various thalassemia genotypes. However, for pregnant women (PW) with high iron demand, ignoring the phenomenon of carrying the thalassemia genes combined with IDA may lead to adverse pregnancy outcomes. The hematological phenotype indexes of 15,051 PW who received a prenatal diagnosis of thalassemia in our hospital were analyzed, and the plasma ferritin (PF) of 714 anemic pregnant women (APW) was determined. The results showed that 87.43% of APW without thalassemia suffered from IDA. Among APW with various thalassemia genotypes, we found that 40.00∼77.78% of subjects with α-thalassemia silent genotypes [αCS (or QS)α/αα (40.00%), -α3.7(or 4.2)/αα (57.65%), and αWSα/αα (77.78%)] and 18.18∼84.21% of subjects with α-thalassemia minor genotypes [αCS (or QS)α/-α3.7(or 4.2) (18.18%), -α3.7(or 4.2)/-α3.7(or 4.2) (40.00%), αα/-SEA (44.55%), and αWSα/-α3.7(or 4.2) (84.21%)] developed IDA, while in subjects with α-thalassemia intermedia genotypes, only αWSα/-SEA was associated with IDA, with an incidence of 16.67%. However, the incidence of IDA in APW with common β-thalassemia minor genotypes (βCD17(A>T)/β, βCD41/42 (-TTCT)/β, βCD71/72(+A)/β, βIVS-II-654(C>T)/β, and β-28(A>G)/β) was less than 10.85%. In addition, the APW with β-thalassemia minor had a higher PF level than the APW without thalassemia. Our study is the first to reveal differences in the prevalence of IDA among PW with various thalassemia genotypes, indicating that the possibility of IDA should be fully considered when managing PW with α-thalassemia silent or minor genotypes in high-risk areas, and that iron supplementation should be monitored dynamically for PW with β-thalassemia minor genotypes.

PRENATAL FACTORS FOR NEONATAL JAUNDICE

Objective: To establish the role of prenatal factors for neonatal jaundice (NJ) in newborns (NB). Material and methods: Retrospective study covering 566 mothers and their newborns, patients of University Hospital Medica Ruse, Bulgaria, from 01.01.2017 to 31.10.2020. The data were obtained from the documentation of the mother. Bilirubin (BR) levels were monitored by transcutaneous measurement with a KJ-8000 bilirubinometer . Results: Significantly higher levels of BR are registered in NBs, whose mothers aged ≤20 years. History of NJ in siblings and hyperbilirubinemia in subsequent NB are moderately strongly correlated (p=0.025). First-born infants have significantly lower BR levels (p=0.037). The BR levels of NBs whose mothers were at risk of premature birth were significantly higher. In infants of mothers with Preeclampsia, lower levels of BR are registered. We found a negative linear relationship between thyroid gland pathology and BR levels. We found a positive relationship between maternal urinary tract pathology and the manifestation of hyperbilirubinemia in NBs. A negative correlation was observed between maternal anemic conditions and NB hyperbilirubinemia. NBs of mothers with inflammatory diseases of the female reproductive system have significantly higher levels of BR. Conclusion: Prenatal factors influencing NJ are maternal parity and age, as well as a history of jaundice in siblings. Inflammatory diseases of the reproductive system affect the degree of bilirubinemia, pathology of the urinary system increases its frequency. Well-controlled thyroid function and balanced iron supplementation in pregnant women help to better balance the metabolism of BR in full-term NBs. Preeclampsia diminishes the incidence of hyperbilirubinemia in full-term infants.

Effects of Iron Supplements on Heme Scavengers in Pregnancy.

ABSTRACT.In malaria endemic countries, anemia in pregnant women occurs as a result of erythrocyte destruction by Plasmodium infections and other causes including malnutrition. Iron supplementation is recommended as treatment of iron-deficiency anemia. Erythrocyte destruction results in increased release of cytotoxic free heme that is scavenged by haptoglobin (Hp), hemopexin (Hx) and heme oxygenase-1 (HO-1). Paradoxically, iron supplementation in pregnant women has been reported to enhance parasitemia and increase levels of free heme. The relationship between free heme, heme scavengers, and birth outcomes has not been investigated, especially in women who are on iron supplementation. We hypothesized that parasite-infected pregnant women on routine iron supplementation have elevated heme and altered expression of heme scavengers. A cross-sectional study was conducted to determine the association between plasma levels of free heme, HO-1, Hp, Hx, and malaria status in pregnant women who received routine iron supplementation and their birth outcomes. Heme was quantified by colorimetric assay and scavenger protein concentration by ELISA. We demonstrated that iron-supplemented women with asymptomatic parasitemia had increased free heme (mean 75.6 µM; interquartile range [IQR] 38.8–96.5) compared with nonmalaria iron-supplemented women (mean 34.9 µM; IQR 17.4–43.8, P < 0.0001). Women with preterm delivery had lower levels of Hx (mean 656.0 µg/mL; IQR 410.9–861.3) compared with women with full-term delivery (mean: 860.9 µg/mL; IQR 715.2–1055.8, P = 0.0388). Our results indicate that iron supplementation without assessment of circulating levels of free heme and heme scavengers may increase the risk for adverse pregnancy outcomes.

Co-morbid anaemia and stunting among children 2–5 years old in southern Ethiopia: a community-based cross-sectional study

BackgroundIn Ethiopia, 38% of children less than 5 years of age are stunted and 57% are anaemic. Both have a negative impact later in life on physical growth and cognitive...

Comparison of Polish and international guidelines on diet supplements in pregnancy - review.

Proper nutrition is an important element that determines the course of pregnancy. Unfortunately, the everyday diet is not always able to cover the increased in pregnancy essential vitamins and minerals requirements. Therefore, pregnant women often use dietary supplements. This study aimed to compare Polish and international recommendations regarding dietary supplementation during pregnancy. The Polish Society of Gynaecologists and Obstetricians (PSGO) recommends in every pregnant woman the dietary supplementation of folates, vitamin D and iodine. Additionally, the benefits of iron supplementation in pregnant women with anemia or at high risk of developing anemia are also highlighted. In the light of Polish guidelines, the magnesium supplementation is recommended in the condition of its reduced level in blood. In the case of limited consumption of DHA (docosahexaenoic acid), Polish guidelines recommend in pregnant women's diet, at least 600 mg of DHA every day. Still, in case of the high risk of premature birth - at least 1000 mg DHA a day during the entire pregnancy period should be taken.

Daily Versus Weekly Oral Iron Supplementation in Pregnant Women (A Randomized Controlled Clinical Trial)

Background: High doses of iron lead to gastrointestinal intolerance suggesting some toxic effect on the gut mucosa that is probably mediated by iron-related oxidative stress.Aim : This study aimed to compare the hemoglobin levels in non anemic pregnant women receiving weekly versus daily iron supplementation.Material and Methods: This randomized controlled clinical trial was conducted One hundred and forty patients during the period from October 20017 to December 2018 at Ain-Shams University Maternity Hospital in the outpatient antenatal clinics. They were divided into two groups; group A (weekly group) received 2 capsules of 100 mg elemental iron (from 305 mg ferrous fumarate) plus 2 mg of folic acid (Ferro-6-Pharco- Egypt) once weekly and group B (daily group) received one capsule of 100 mg elemental iron (from 305 mg ferrous fumarate) plus 2 mg of folic acid (Ferro-6-Pharco-Egypt) once daily.Results: There was no statistically significant difference could be detected between both groups as regards the demographic data, body mass index, interval since last pregnancy, hemoglobin level before starting iron supplementation and duration of supplementation and this can be attributed to proper randomization. In this study, there was no statistically significant difference between both groups as regards the hemoglobin level after one month of iron supplementation and after three months of iron supplementation. Although the mean hemoglobin concentration at 36 weeks gestation was lower in the weekly supplementation group it did not reach the level of statistical significance. There was significant increase in the incidence of iron side-effects mainly gastrointestinal side-effects in the form of nausea, vomiting, constipation, heart burn and metallic taste. High doses of iron lead to gastrointestinal intolerance. There was no statistically significant difference could be detected between both groups as regards the fetal weight.Conclusion: Weekly iron supplementation as a prophylaxis in non-anemic pregnant women is as good as daily supplementation as regards the hemoglobin level in addition; it was associated with significantly fewer side-effects and much better compliance.

Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

ABSTRACTBackgroundIron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries.ObjectivesTo assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA.MethodsThis was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth.ResultsThe overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y.ConclusionsAdherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

Hepcidin-guided screen-and-treat interventions against iron-deficiency anaemia in pregnancy: a randomised controlled trial in The Gambia

SummaryBackgroundWHO recommends daily iron supplementation for pregnant women, but adherence is poor because of side-effects, effectiveness is low, and there are concerns about possible harm. The iron-regulatory hormone hepcidin can signal when an individual is ready-and-safe to receive iron. We tested whether a hepcidin-guided screen-and-treat approach to combat iron-deficiency anaemia could achieve equivalent efficacy to universal administration, but with lower exposure to iron.MethodsWe did a three-arm, randomised, double-blind, non-inferiority trial in 19 rural communities in the Jarra West and Kiang East districts of The Gambia. Eligible participants were pregnant women aged 18–45 years at between 14 weeks and 22 weeks of gestation. We randomly allocated women to either WHO's recommended regimen (ie, a daily UN University, UNICEF, and WHO international multiple-micronutrient preparation [UNIMMAP] containing 60 mg iron), a 60 mg screen-and-treat approach (ie, daily UNIMMAP containing 60 mg iron for 7 days if weekly hepcidin was <2·5 μg/L or UNIMMAP without iron if hepcidin was ≥2·5 μg/L), or a 30 mg screen-and-treat approach (ie, daily UNIMMAP containing 30 mg iron for 7 days if weekly hepcidin was <2·5 μg/L or UNIMMAP without iron if hepcidin was ≥2·5 μg/L). We used a block design stratified by amount of haemoglobin at enrolment (above and below the median amount of haemoglobin on every enrolment day) and stage of gestation (14–18 weeks vs 19–22 weeks). Participants and investigators were unaware of the random allocation. The primary outcome was the amount of haemoglobin at day 84 and was measured as the difference in haemoglobin in each screen-and-treat group compared with WHO's recommended regimen; the non-inferiority margin was set at −5·0 g/L. The primary outcome was assessed in the per-protocol population, which comprised all women who completed the study. This trial is registered with the ISRCTN registry, number ISRCTN21955180.FindingsBetween June 16, 2014, and March 3, 2016, 498 participants were randomised, of whom 167 were allocated to WHO's recommended regimen, 166 were allocated to the 60 mg per day screen-and-treat approach, and 165 were allocated to the 30 mg per day screen-and-treat approach. 78 participants were withdrawn or lost to follow-up during the study; thus, the per-protocol population comprised 140 women assigned to WHO's recommended regimen, 133 allocated to the 60 mg screen-and-treat approach, and 147 allocated to the 30 mg screen-and-treat approach. The screen-and-treat approaches did not exceed the non-inferiority margin. Compared with WHO's recommended regimen, the difference in the amount of haemoglobin at day 84 was −2·2 g/L (95% CI −4·6 to 0·1) with the 60 mg screen-and-treat approach and −2·7 g/L (–5·0 to −0·5) with the 30 mg screen-and-treat approach. Adherence, reported side-effects, and adverse events were similar between the three groups. The most frequent side-effect was stomachache, which was similar in the 60 mg screen-and-treat group (82 cases per 1906 person-weeks) and with WHO's recommended regimen (81 cases per 1974 person-weeks; effect 1·0, 95% CI 0·7 to 1·6); in the 30 mg screen-and-treat group the frequency of stomachache was slightly lower than with WHO's recommended regimen (58 cases per 2009 person-weeks; effect 0·7, 95% CI 0·5 to 1·1). No participants died during the study.InterpretationThe hepcidin-guided screen-and-treat approaches had no advantages over WHO's recommended regimen in terms of adherence, side-effects, or safety outcomes. Our results suggest that the current WHO policy for iron administration to pregnant women should remain unchanged while more effective approaches continue to be sought.FundingBill & Melinda Gates Foundation and the UK Medical Research Council.

Interventions to prevent iron deficiency during the first 1000 days in low-income and middle-income countries: recent advances and challenges.

Iron deficiency remains highly prevalent in women and young children in low-income and middle-income countries. To prevent the potentially life-long consequences of iron deficiency when occurring during early life, the WHO recommends iron supplementation of pregnant women and young children. However, increasing evidence of limited efficacy and risk of current iron intervention strategies are cause of concern. This review aims to highlight recent advances and challenges of established and novel intervention strategies for the prevention of iron deficiency during the first 1000 days in low-income and middle-income countries. Recent meta-analyses and trials challenged the WHO's current recommendation to provide iron-folic acid rather than multiple micronutrient supplements during routine antenatal care. Furthermore, several studies explored optimal windows for iron supplementation, such as prior to conception. Studies are demonstrating that infectious and noninfectious inflammation is compromising the efficacy of iron interventions in vulnerable groups. Therefore, strategies addressing iron deficiency should focus on targeting infection and inflammation while simultaneously providing additional iron. Furthermore, both iron deficiency and iron supplementation may promote an unfavourable gut microbiota. Recent trials in infants indicate that the provision of a prebiotic together with iron may alleviate the adverse effects of iron on the gut microbiome and gut inflammation, and may even enhance iron absorption. Recent studies highlight the need for and potential of novel intervention strategies that increase the efficacy and limit the potential harm of universal iron supplementation.

Pengaruh Konseling terhadap Kepatuhan Suplementasi Tablet Besi (Fe) pada Ibu Hamil di Kabupaten Lumajang

The prevalence of iron deficiency anemia in Indonesia is relatively high. However, adherence to iron supplementation among pregnant women is relatively low, even though the supplementation is provided free of charge by the government. Counseling is expected to increase patient adherence. Therefore, the present research was to study the effect of counseling on adherence to iron supplementation among pregnant women. A number of 62 respondents from a primary health center in Lumajang Regency were recruited after they gave informed consent and equally allocated to control and treatment groups based on their area residence. The control group received routine antenatal service, while the treatment group received the additional counseling using a brochure. The average of adherence score, based on Morisky Medication Adherence Scale-8 (MMAS-8), in the treatment group (5.9±1.9) was significantly different (p=0.027) from the control group (5.0±1.2). Counseling with brochure appeared to be effective to improve adherence to iron supplementation for pregnant women.&#x0D; Keywords: adherence, iron suplementation, pregnancy, pharmacy counseling