Iron Supplementation In Pregnancy Research Articles

Effects of Oral Iron Supplements in Pregnancy with IDA in Association with Oxidative Stress

Background: Iron deficiency anemia (IDA) is associated with adverse outcomes related to hemoglobin (Hb) and red cell indices and is now recognized as a major contributor to oxidative stress (OS). Maternal IDA during pregnancy is one of the most common nutritional deficiencies worldwide, exposing both the mother and developing fetus to the risk of OS. This study aims to identify the effects of IDA and oral iron supplements on oxidative stress during pregnancy. Methodology: The IDA group comprised 90 pregnant women between 16 to 20 weeks of gestation. The study lasted 12 weeks with follow-up visits every 4 weeks. Two antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), were studied as OS parameters. Hemoglobin (Hb), serum ferritin concentration (SFC), and total iron binding capacity (TIBC) were also measured. Results: The study found decreased levels of SOD, Hb, and SFC in the anemic group, which showed significant improvement after iron supplementation. GSH-Px and TIBC values were significantly lower compared to the control group. There was a direct relationship between SOD and Hb levels, with the highest SOD levels observed in conjunction with the highest Hb values. Conclusion: Oral iron administration to treat IDA during pregnancy not only improves hematological parameters but also decreases oxidative stress by improving SOD levels. However, other micronutrient deficiencies might be responsible for the alterations in GSH-Px levels.

Intravenous Iron Supplementation in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683469

INTRODUCTION: Intravenous (IV) iron supplementation for patients with iron deficiency anemia in pregnancy has been shown to improve hemoglobin (Hb) levels in the peripartum period and ultimately lead to a decrease in severe maternal morbidity (SMM), specifically blood transfusion. The objective of this study was to analyze the effects of IV iron supplementation on maternal pre-delivery Hb levels after the implementation of an institution-based protocol focused on maternal red blood cell transfusion reduction. METHODS: We performed a retrospective review of patients who received IVFe supplementation after the implementation of a maternal transfusion reduction bundle at our Level IV maternal care center in 2020. We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023), along with rates of postpartum blood transfusion. Patients were excluded if they received an antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software. RESULTS: Two hundred ninety-five patients met inclusion criteria; most patients were Hispanic (71.9%), had Medicaid (51.9%), and underwent a vaginal delivery (76.9%). Mean gestational age at time of infusion was 34.2 weeks (95% CI, 33.7–34.7) The average Hb pre-infusion and pre-delivery were 8.9 (95% CI, 8.8–9.0) and 10.6 (95% CI, 10.4–10.8), respectively. The change in maternal Hb at time of delivery increased by 2 points (P<.0001). Only two patients received a blood transfusion postpartum. CONCLUSION: Implementation of a standardized antenatal IV iron infusion protocol can improve maternal pre-delivery Hb levels and reduce morbidity associated with blood transfusion.

The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study

IntroductionThe objective of this study was to understand the experience of iron deficiency anaemia requiring oral iron in pregnancy and the factors affecting compliance with oral iron supplementation. Participants’ understanding regarding the possible consequences of anaemia in pregnancy was also explored. Feedback on a proposed randomised controlled trial of daily versus alternate day oral iron in pregnancy was sought. Materials & methodsFollowing ethical approval, fourteen semi-structured one-to-one interviews were carried out using an interview tool with open-ended questions. Recruitment was carried out through social media and from an antenatal out-patient setting. Interviews were audio-recorded, transcribed and analysed thematically. ResultsFatigue emerged as a predominant and troubling symptom. Awareness was often highlighted through friends/family and from healthcare professionals, particularly in first pregnancies. Knowledge surrounding the potential short-term and long-term adverse consequences of untreated anaemia however was limited.Gastro-intestinal side-effects, a previous experience of poor tolerance and forgetfulness all negatively impacted compliance with oral iron supplementation in pregnancy. Routine, a perceived improvement in fatigue with supplementation and reduced dose frequency recurred as themes which positively affected compliance.Pregnancy as a motivating factor recurred as a theme in analysis. The role of diet was felt to be important. Knowledge of iron-rich foods and absorption aids and inhibitors was good, but practice on optimal ingestion of oral iron supplementation varied.Feedback on trial acceptability was positive with the benefit of extra supportive care noted. Incorporating study visits with routine care was advised in view of time constraints. This area of research was perceived as important. ConclusionIn order to successfully reduce the rates of iron deficiency anaemia in pregnancy, it is crucial that all factors affecting compliance with oral iron are considered. Providing women with the important information on the possible consequences of sub optimally treated anaemia may help to improve this public health issue.

Combination effects of environmental tobacco smoke exposure and nutrients supplement during pregnancy on obesity in Chinese preschool children.

This study aimed to explore the combination effects of prenatal exposure to environment tobacco smoke (ETS) and nutrients supplement during pregnancy on childhood obesity in preschoolers. A cross-sectional study was conducted with 58,814 child-mother dyads from 235 kindergartens in Longhua District of Shenzhen, China in 2021. A self-administered structured questionnaire was completed by mothers to collect socio-demographic characteristics, prenatal ETS exposure, and nutrients supplement in pregnancy, and preschoolers' heights and weights were measured at the same time. After controlling for potential confounding variables, logistic regression models and cross-analyses were used to examine the independent and combination effects of maternal prenatal ETS exposure and nutrients supplementation during pregnancy on obesity in preschool children. The results of our study showed that prenatal ETS exposure increased the risk of childhood obesity (AOR = 1.22, 95% CI = 1.11-1.34) in preschoolers. In addition, risk of childhood obesity was significantly higher when mothers didn't take supplements of multivitamins (AOR = 1.12, 95% CI = 1.05-1.20), folic acid (AOR = 1.23, 95% CI = 1.10-1.37) and iron (AOR = 1.11, 95% CI = 1.04-1.19) during pregnancy. The cross-over analysis showed that the combination of prenatal ETS exposure with mothers taking no multivitamins (AOR = 1.40, 95% CI = 1.21-1.62), no folic acid (AOR = 1.55, 95% CI = 1.12-2.14) and no iron (AOR = 1.38, 95% CI = 1.19-1.59) during pregnancy also increased the risk of obesity among Chinese preschoolers. We also discovered additive interactive effects between prenatal ETS exposure and no maternal multivitamin, folic acid and iron supplementation in pregnancy on the risk of obesity in preschoolers. The combination of prenatal exposure to ETS with no supplementation of these nutrients might jointly increase the risk of childhood obesity. Public health interventions are needed to reduce prenatal exposure to ETS and to encourage mothers to take appropriate multivitamin, folic acid and iron supplements during pregnancy.

Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines.

Iron deficiency anemia (IDA) in pregnancy is a common diagnosis that is associated with adverse obstetric and neonatal outcomes. There remains uncertainty regarding how best to screen for, prevent, and treat established IDA in pregnancy. There is no consensus on the benefits of routine iron supplementation in pregnancy, with concerns regarding potential harmful effects of routine iron supplementation in women who are iron replete. Fourteen international guidelines were selected and appraised and compared by a multidisciplinary team. The AGREE II GRS tool was used. Each reviewer independently made their own assessment, and the scores from 1 to 7 were also collated and averaged for an overall score incorporating seven domains: process of development, clarity of presentation, completeness of reporting, clinical validity, and overall quality. The reviewers' scores were also individually compared according to discipline. The mean score across all the guidelines was 4.4 (range 3.5-6.5). Only half of the guidelines recommend routine iron in pregnancy. In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy, two recommend selective screening with ferritin for at risk groups only, and one guideline suggests using ferritin where feasible. Although many of the guidelines recommend similar doses of oral elemental iron of 100-200 mg daily for the treatment of established IDA in pregnancy, two recommend twice or three times daily dosing. Only five guidelines give hemoglobin rises to expect within specific timeframes. There remains a need to clarify the optimal screening method, dosing regimen, timing, and route of iron supplementation in pregnancy. Robust randomized controlled data are needed to guide appropriate prevention and management.

Iron supplements in pregnant women with normal iron status: A systematic review and meta-analysis.

Effects of daily iron supplementation in iron replete pregnancy are unclear. This systematic review aimed to assess benefits and harms of oral iron supplements in pregnant women without anemia and iron deficiency. We predefined and registered a protocol in PROSPERO (CRD42020186210) and performed the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched for randomized clinical trials (RCTs) and observational studies comparing daily oral iron supplementation with no iron supplements in non-anemic iron replete pregnant women. Searches were conducted in MEDLINE (by PubMed), EMBASE (by OVID), Cochrane Library, and ClinicalTrials.gov from inception to September 2022 without language restrictions. Two authors independently screened records, extracted data, and assessed risk of bias using the revised Cochrane risk of bias tool (RoB2). One author read full-texts, assessed certainty of evidence by GRADE and conducted meta-analyses using a random-effects model. Primary outcomes included iron deficiency anemia, iron deficiency, hemoglobin >130 g/L, elevated iron status, small for gestational age newborns, low birthweight newborns, preterm birth, and congenital anomalies. Eight RCTs (2822 women) but no observational studies were eligible for inclusion. Daily oral iron supplementation in pregnancy probably reduces iron deficiency anemia at term (risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.38-0.70; 4 RCTs, 1670 women; I2 = 13%; moderate-certainty evidence) and the incidence of low birthweight babies (RR: 0.30, 95% CI: 0.13-0.68; 2 RCTs, 361 infants; I2 = 0%; moderate-certainty evidence). In addition, it may reduce iron deficiency at term (RR: 0.74, 95% CI: 0.60-0.92; 4 RCTs, 1663 women; I2 = 58%; low-certainty evidence) and the incidence of small for gestational age babies (RR: 0.39, 95% CI: 0.17-0.86; 1 RCT, 213 infants; I2 not estimable; low-certainty evidence). Daily iron supplementation in iron replete non-anemic pregnant women probably reduces the risk of maternal iron deficiency anemia at term and low birthweight.

Iron Supplementation in Pregnancy and Risk of Gestational Diabetes: A Narrative Review.

Pregnant women frequently supplement their diets with iron to treat any cryptic anemia, on the assumption that if anemia is not present, there will be no negative consequences. However, in women who are already iron-replete, it has been suggested that this can lead to iron overload and an increased risk of certain pregnancy complications. One such complication is gestational diabetes. Fourteen clinical trials, case-control or cohort studies (found using Pubmed/Scopus/Web of Science) have investigated links between iron supplementation in pregnancy and risk of gestational diabetes, several of them finding significant associations with increased risk. Potential mechanisms include increased oxidative stress leading to insulin resistance and inadequate compensatory insulin secretion. Current evidence suggests that dietary supplementation with iron in pregnancy may increase a pregnant woman's chance of developing gestational diabetes, although available evidence is somewhat contradictory, and the magnitude of any increased risk appears relatively small. Meta-analyses have suggested the presence of significant heterogeneity in results between studies, urging a degree of caution in interpreting these results. It is currently suggested that advice to pregnant women about whether to supplement their diets with iron or not should consider both their current iron status and their other established risk factors for gestational diabetes.

Associations between maternal iron supplementation in pregnancy and offspring growth and cardiometabolic risk outcomes in infancy and childhood.

It was previously observed that maternal iron supplementation in pregnancy was associated with increased offspring size and adiposity at birth, possibly mediated through increased risk of gestational diabetes. In this study we investigated potential long-term associations of maternal iron supplementation in pregnancy with offspring growth in infancy, and growth and cardiometabolic risk factors in mid-childhood to seek evidence of nutritional programming. Using a nested case-control format, markers of growth and adiposity were measured at 3, 12 and 24 months of age in 341 infants from the Cambridge Baby Growth Study whose mothers supplemented with iron in pregnancy and 222 infants whose mothers did not. Measures of growth, glucose tolerance (using a 30 minute 1.75 g glucose/kg body weight oral glucose tolerance test), insulin sensitivity (HOMA IR) and blood pressure were collected in 122 and 79 of these children, respectively, at around 9.5 years of age. In infancy adiposity-promoting associations with maternal iron supplementation in pregnancy were evident at 3 months of age (e.g. mean difference in skinfold thickness: β = +0.15 mm, p = 0.02, in n = 341 whose mothers supplemented versus 222 that did not; waist circumference: β = +0.7 cm, p = 0.04, in n = 159 and 78, respectively) but differences lessened after this time (e.g. 3–12 month change in mean difference in skinfold thickness: β = -0.2 mm, p = 0.03, in n = 272 and 178, respectively). At ~9.5 years of age children whose mothers supplemented with iron in pregnancy had lower mean arterial blood pressures (β = -1.0 mmHg, p = 0.03, in n = 119 and 78, respectively). There were no apparent differences in markers of growth or other cardiometabolic factors. These results suggest that most of the associations of maternal iron supplementation in pregnancy on growth and adiposity evident at birth disappear during infancy, but there may be some evidence of long-term nutritional programming of blood pressure in mid-childhood.

Maternal iron supplementation during pregnancy affects placental function and iron status in offspring

BackgroundIron deficiency and overload during pregnancy damage to maternal and fetal health. Placenta as an organ for the transport of nutrients between mother and fetus protects fetus from the harmful effects of iron deficiency and iron overload through regulation of placental iron homeostasis. MethodsTo determine the effect of dietary iron supplementation during pregnancy on reproduction and the mechanism of placental iron regulation, we designed dietary high iron (HI: 344 mg/kg), medium iron (MI: 40 mg/kg), low iron (LI: 2 mg/kg) groups of pregnant female mice fed ferrous citrate 2 weeks before mating to 18.5 days of gestation. ResultsWe find dietary iron supplementation during pregnancy effect maternal liver iron, placental iron, hemoglobin and fetal iron. Dietary iron significantly improves reproductive performance as litter weight and fetal weight. Correlation analysis suggest placental iron increased with liver iron, higher and lower liver iron is not conducive to the accumulation of fetal iron, placental iron deficiency and excess reduce litter weight. Placental transcriptome analysis revealed DEGs with the same trend in HI and LI groups compared with MI group, dietary iron may change biology process of ion transport and gland development in placenta. Granzyme may affect the placental trophoblast structure prior to delivery with iron overload uniquely. ConclusionThis research highlights the importance of moderate iron supplements in pregnancy due to damage of reproduction by affecting placental function under different dose of maternal iron supplementation.

U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh.

ABSTRACT.Low birth weight (LBW) is associated with a higher risk of neonatal mortality and the development of adult-onset chronic disease. Understanding the ongoing contribution of maternal hemoglobin (Hgb) levels to the incidence of LBW in South Asia is crucial to achieve the World Health Assembly global nutrition target of a 30% reduction in LBW by 2025. We enrolled pregnant women from the rural Tangail District of Bangladesh in a Maternal Newborn Health Registry established under The Global Network for Women’s and Children’s Health Research. We measured the Hgb of pregnant women at enrollment and birth weights of all infants born after 20 weeks gestation. Using logistic regression to adjust for multiple potential confounders, we estimated the association between maternal Hgb and the risk of LBW. We obtained Hgb measurements and birth weights from 1,665 mother–child dyads between July 2019 and April 2020. Using trimester-specific cutoffs for anemia, 48.3% of the women were anemic and the mean (±SD) Hgb level was 10.6 (±1.24) g/dL. We identified a U-shaped relationship where the highest risk of LBW was seen at very low (< 7.0 g/dL, OR = 2.00, 95% CI = 0.43–7.01, P = 0.31) and high (> 13.0 g/dL, OR = 2.17, 95% CI = 1.01–4.38, P = 0.036) Hgb levels. The mechanisms underlying this U-shaped association may include decreased plasma expansion during pregnancy and/or iron dysregulation resulting in placental disease. Further research is needed to explain the observed U-shaped relationship, to guide iron supplementation in pregnancy and to minimize the risk of LBW outcomes.

Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine.

To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia. Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control. We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial. Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters. Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.

Associations between Maternal Iron Supplementation in Pregnancy and Changes in Offspring Size at Birth Reflect Those of Multiple Micronutrient Supplementation.

It was previously observed that in a population of a high-income country, dietary multiple micronutrient supplementation in pregnancy was associated with an increased risk of gestational diabetes (GDM) and increased offspring size at birth. In this follow-up study, we investigated whether similar changes are observed with dietary iron supplementation. For this we used the prospective Cambridge Baby Growth Study with records of maternal GDM status, nutrient supplementation, and extensive offspring birth size measurements. Maternal iron supplementation in pregnancy was associated with GDM development (risk ratio 1.67 (1.01–2.77), p = 0.048, n = 677) as well as offspring size and adiposity (n = 844–868) at birth in terms of weight (β’ = 0.078 (0.024–0.133); p = 0.005), head circumference (β’ = 0.060 (0.012–0.107); p = 0.02), body mass index (β’ = 0.067 (0.014–0.119); p = 0.01), and various skinfold thicknesses (β’ = 0.067–0.094; p = 0.03–0.003). In a subset of participants for whom GDM statuses were available, all these associations were attenuated by adjusting for GDM. Iron supplementation also attenuated the associations between multiple micronutrient supplementation and these same measures. These results suggest that iron supplementation may mediate the effects associated with multiple micronutrient supplementation in pregnancy in a high-income country, possibly through the increased risk of developing GDM.

A Prospective Study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India

Aim: A prospective study on Impact of Anemia and Iron Supplementation in Pregnancy, Baptist Hospital, Bangalore, India Methodology: the prospective observational study was conducted for 6 months from September 2016_Febrry to 2017. All inpatients women who are pregnant and anemic. The patient data collection was used to collect all the details like inpatient number, age, sex, social history, history, laboratory data, diagnosis, therapeutic management. All inpatients diagnosed anemia in pregnancy and pregnant women without anemia. Fulfilling the inclusion criteria will be enrolled into the study and their prescriptions will be analyzed on daily basis. The prescription guidelines, Micromedex, interaction checker, drug interaction database, and Stockley's drug interaction book 8 edition. The drug interaction in prescription was collected and then compare with guidelines. When the analysis of prescription was completed then all data entered into the appropriate software and the results were gained. Results: The present study was focused to find out the presence of anemia in 110 pregnant women who were admitted to gynecology and OBG wards of BBH (Bangalore Baptist Hospital). Presence study showed that anemia was Confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20 (18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. The result of this study showed that LBW is higher in anemic women 19(25%) compared to non-anemic 17(21%). Conclusion: The present study showed from a total of 110 patients were included in this study, anemia was confirmed in 50 patients. Of these 28(25.4%) of them diagnosed as mild anemic, 20(18.1%) Of them with Moderate and 2(1.8%) of them as severe anemic patients. More low-birth-weight (LBW) babies were born to anemic mothers. Anemia in pregnancy may be reduced by proper Iron and folic acid supplementation which can be improved through providing proper ANC services. Has also a recognizable association with fetal outcome. Keywords: Anemia, Iron, anemia, iron supplementation, pregnancy, low birth weight.

Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal.

Background Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant (P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.

Association between Maternal Plasma Ferritin Level and Infants’ Size at Birth: A Prospective Cohort Study in Rural Bangladesh

ABSTRACT Background: Iron supplementation in pregnancy is recommended by the WHO to prevent a major public health problem, namely, maternal iron deficiency and its consequences. There are gaps in the existing evidence regarding maternal and neonatal benefits and harms of universal iron supplementation. Objective: To evaluate the association between maternal iron status during pregnancy and infant size at birth (birth weight and length). Method: This present prospective cohort study was nested in a food and micronutrient supplementation trial conducted in Matlab (MINIMat study), rural Bangladesh. We randomly selected 573 women recruited into the MINIMat study from January – December 2002 who delivered singletons with available birth anthropometric information. The plasma ferritin of each mother was measured at gestational week 14 (GW14; before the start of micronutrient supplementation) and at week 30 (GW30). Results: Multivariable linear regression revealed no association between plasma ferritin at GW14 and birth weight. However, newborns of women in the highest tertile of plasma ferritin at GW30 (median = 29 µg/L) had on average a 93-gm lower birth weight (95% CI: −172, – 14; p = 0.021) than the newborns of women in the lowest tertile (median = 8 µg/L). Logistic regression showed that odds of low birth weight were approximately two times higher [odds ratio (OR) = 2.27; 95% CI: 1.40, 3.67] among those with mothers in the highest ferritin tertile than in the lowest tertile at GW30. No association was found between maternal plasma ferritin and birth length. Conclusion: We observed an inverse association between high plasma ferritin in the last trimester (GW30) and birth weight but not birth length. The results suggested that elevated plasma ferritin in pregnancy could have an untoward effect on birth weight.

Prophylactic Iron Supplementation in Pregnancy and its Implications in Development of Pre-eclampsia: A Case-control Study

Introduction: Pre-eclampsia is a serious complication of pregnancy and is associated with increased maternal and perinatal morbidity and mortality. Increased iron and ferritin concentration is associated to a higher risk of pre-eclampsia and prophylactic iron supplementation can sometimes be harmful to pregnant women who are otherwise not iron deficient. Aim: To analyse serum iron, serum ferritin, serum Transferrin Receptor (sTFR) levels, Total Iron Binding Capacity (TIBC) among iron supplemented pre-eclamptic cases and normotensive pregnant controls. Materials and Methods: This prospective, observational, case- control study was conducted in Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India for a period of one year from (February 2019-January 2020). A total of 200 pregnant females, all on iron supplementation during the course of their pregnancy, 100 in pre-eclampsia group (case group); 100 in normotensive group (control group), in third trimester and between 18- 45 years of age were enrolled in the study. Serum iron, serum ferritin, sTFR and TIBC were estimated using fully automated analysers. Results: Median Interquartile Range (IQR) of serum ferritin levels in cases were higher than the controls [41 (30-70) vs 24 (17-44); p&lt;0.001]. Serum ferritin in cases were also found to correlate positively with systolic (r=0.37, p=0.001) Blood Pressure (BP) whereas TIBC correlated negatively with diastolic BP (r=-0.238, p-value=0.017). The median IQR differences of TIBC values among cases and controls were insignificant {485 (404-523) vs 493 (448- 544)} and differences of median IQR of sTFR values among cases and controls were significant {8.5 (7-9) vs 8.9 (8-10)}. Subjects with serum feritin levels &gt;40 ng/mL had three times increased risk of PE (Odds ratio=3, 95% Cl=1.571-5.157). Conclusion: Elevated serum ferritin, decreased sTFR levels and correlation of Ferritin and TIBC to BP in pre-eclampsia compels us to put cautionary remarks over testing these parameters before continuing with iron supplements. This may prevent a possible iron related added complications in pre-eclampsia and help clinicians decide about restricting/lowering iron supplement doses in case a situation of iron overload arise.

Women's adherence to iron supplementation during pregnancy in Kumasi, Ghana

IntroductionAnaemia in pregnancy is caused by factors such as malaria, poor diet and hook worm infestation. Adherence to iron supplementation in pregnancy has been found to correct anaemia and improve fetal outcomes. In Ghana, though iron is given to pregnant women at no cost under the free maternal healthcare policy, anaemia prevalence is high. This calls for investigation into adherence to iron supplementation. This study investigated adherence of pregnant women to prescribed iron supplements in Kumasi, Ghana.MethodsA cross-sectional survey was conducted among postnatal women in Kumasi in November and December 2017. Women were selected through systematic random sampling and given a structured questionnaire to elicit information regarding their sociodemographic characteristics and iron supplementation intake during pregnancy. Results were analysed using descriptive statistics and the chi-square test, with P≤0.05 considered to be significant.ResultsOverall, most of the women were between 22 and 35 years old (69.5%) and had some form of formal education (86.7%). The majority (96.6%) took iron supplements during pregnancy. Most (82.2%) had their supplements prescribed by a midwife or nurse. The majority of women (61.9%) adhered to their prescription. There was a significant relationship between education level and adherence to iron prescription.ConclusionsStrategies to improve education regarding adherence to the use of iron supplements by midwives are required.

The Role of Iron in Brain Development: A Systematic Review.

One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0–6 months, 6–24 months, or 2–4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.

Emblica Officinalis (Amloki) – Could Be the Remedy for Side Effects of Iron Supplementation in Pregnancy

Emblica Officinalis (Amloki) – Could Be the Remedy for Side Effects of Iron Supplementation in Pregnancy

Effect Heterogeneity in Responding to Performance-Based Incentives: A Quasi-Experimental Comparison of Impacts on Health Service Indicators Between Hospitals and Health Centers in Malawi

ABSTRACT Heterogeneity of effects produced by performance-based incentives (PBIs) at different levels of care provision is not well understood. This study analyzes effect heterogeneities between different facility types resulting from a PBI program in Malawi. Identical PBIs were applied to both district hospitals and health centers to improve the performance of essential health services provision. We conducted two complementary quasi-experiments comparing all 17 interventions with 17 matched independent control facilities (each 12 health centers, five hospitals). A pre- and post-test design with difference-in-differences analysis was used to estimate effects on 14 binary quality indicators; interrupted time series analysis of monthly routine data was used to estimate effects on 11 continuous quantity indicators. Effects were estimated separately for health centers and hospitals. Most quality indicators performed high at baseline, producing ceiling effects on further measurable improvements. Significant positive effects were observed for stocks of iron supplements (hospitals) and partographs (health centers). Four quantity indicators showed similar positive trend improvements across facility types (first-trimester antenatal visits, voluntary HIV-testing of couples, iron supplementation in pregnancy, vitamin A supplementation of children); two showed no change for either type of facility (skilled birth attendance, fully immunized one-year-olds); five indicators revealed different effect patterns for health centers and hospitals. In both health centers and hospitals, the largely positive PBI effects on antenatal care included resilience against interrupted supply chains and improvements in attendance rates. Observed heterogeneity might have been influenced by the availability of specific resources or the redistribution of service use.