Iron Supplementation In Pregnancy Research Articles

Using Program Impact Pathways to Improve Anemia Reduction Programs

Recent evidence of the benefits of iron supplementation during pregnancy to reduce low birth weight and maternal mortality highlights the need for iron supplementation in pregnancy, an intervention known to be efficacious. Despite implementation of anemia reduction programs in many developing countries, the worldwide prevalence of maternal anemia in pregnancy remains over 40%. This suggests limitations in program delivery.To improve the delivery of a large‐scale anemia reduction program delivered through a mobile clinic program in rural Haiti, we designed a “Program Impact Pathway” (PIP) to delineate the mechanisms by which program activities resulted in desired outcomes. Survey data (n=663) from program beneficiaries were used to asses each essential component of the PIP, including consistent distribution of iron folic acid (IFA) at monthly clinics, women's understanding of how and why to IFA and barriers to adherence. Although knowledge about IFA benefits was high, irregular clinic attendance and inconsistent delivery of IFA resulted in a low median number of times women received IFA during pregnancy.Iron supplementation programs will be successful only if all essential elements linking program efforts to desired outcomes are identified and understood. The PIP provides such a method, and the lessons from its use in Haiti can be applied to other such programs.Research support: USAID, NIH/NIDDK

Routine iron supplementation in pregnancy: Why is the UK different?

Dr Nisreen Alwan and Professor Janet Cade from the University of Leeds look at why the UK does not recommend routine iron supplementation during pregnancy and if an alternative antenatal policy should be considered Iron deficiency (ID) remains the leading single nutrient deficiency in the world.1 The prevalence of ID in Western societies ranges between 25 to 40% of pregnant women,2 with this problem being more pronounced in lower socioeconomic groups.3 In the foetus, iron is used to synthesize haemoglobin and is essential in brain development. Iron deficiency anaemia (IDA) in pregnancy has been shown to increase the risk of low birth weight (LBW), preterm delivery and perinatal IDA.4-8 Perinatal ID can permanently impair intelligence, motor and behavioural development as well as increase the risk of future IDA.9 It has been suggested that the physiological iron requirement during the second half of pregnancy cannot be met through diet alone.10,11 In the USA, routine low-dose iron supplementation (30 mg/day) is recommended for all pregnant women.12 World Health Organization guidelines for pregnant women recommend a standard daily dose of 60 mg of iron for 6 months or 120 mg iron daily if taken for less than 6 months.13 European Union guidelines recommend iron supplements in the second half of pregnancy.14 However, high-dose supplements (>100 mg/day) are associated with sideeffects such as nausea, vomiting and constipation.15 The United States' Institute of Medicine has established an upper tolerable dose of 45 mg/day to minimize the risk of side-effects.16 There are potential drawbacks of taking routine iron supplements during pregnancy that need to be weighed against the benefits of correcting maternal IDA. In addition to gastrointestinal side effects, iron can inhibit the absorption of other minerals such as manganese and zinc.17-19 The potential for negative interactions is likely to increase if iron is taken as part of a multivitamin-mineral supplement. Iron supplements can also reduce the absorption of dietary non-haem iron20 and can increase oxidative stress and the production of free radicals.21, 22 About 10-15% of Northern European population is heterozygous for the common mutations in the HFE gene that predisposes to iron overload.23 Blanket routine supplementation may be harmful in women with this genetic predisposition.24 Individually-tailored use of iron supplements according to blood indices for iron status may be recommended to avoid the potential harms.25 Most randomized trials of iron supplementation in pregnancy have concentrated on maternal indices of ID and/or anaemia as outcomes and many have shown positive effects on maternal iron status. One randomised controlled trial showed that a supplement of 40 mg /day from 18 weeks gestation onwards prevented ID in 90% of women during pregnancy and post-partum.26 However, the evidence is inconsistent around the effects of iron supplements in pregnancy on infant outcomes. Many studies examining the relationship between routine iron supplements and birth weight have not differentiated between iron-deficient and non-iron-deficient mothers. A Cochrane review concluded that a mother is less likely to have IDA if taking iron supplements. However, further trials to assess the effect of routine iron supplementation during pregnancy on clinically important infant outcomes were recommended.27 In the UK, the National Institute for Clinical Excellence (NICE) takes account of the inconsistent evidence on the benefit of supplements as well as their potential side effects and therefore does not recommend routine iron supplementation during pregnancy. Rather it recommends that haemoglobin levels less than 11 g/100 ml in the first trimester and 10.5 g/100 ml at 28 weeks are investigated and iron supplementation considered if indicated.28 However, the problem arises that women are not necessarily anaemic if they have depleted iron stores. One solution for this would be routine serum ferritin testing for all pregnant women to assess their iron stores. …

Increased level of serum iron and gastrointestinal toxicity in patients with solid tumor treated with cytotoxic chemotherapy.

e13049 Background: The mechanism of gastrointestinal toxicity of chemotherapy including nausea and vomiting especially in late phase remains unclear. Nausea and vomiting are also known as major side effects of iron supplementation in pregnancy or anemia patients. The relationship between serum iron level and toxicity of chemotherapy was investigated. Methods: A total of 17 patients with solid tumor treated with cytotoxic chemotherapy were examined. The blood samples were taken before and on day 2 or 3 of chemotherapy. The changes of serum iron, unsaturated iron capacity (UIBC) and ferritin were measured to analyze the relationship with adverse effect. Results: The number of patients received each chemotherapy were 5 for carboplatin /gemcitabine, 2 for calboplatin/etoposide, calboplatin/paclitaxel, and irinotecan, and 1 for cisplatin/etoposide, calboplatin/pemetrexed, amurubicin, docetaxel, gemcitabine and pemetrexed. Mean values of iron, UIBC and ferritin before and after chemotherapy were 60.5±18.0 vs. 220.5±17.0μg, 202.5±42.8 vs. 23.0±45.7μg, and 211.4±103.8 vs. 263.5±164.2 ng/ml, respectively. Statistically there were no significant correlation between iron level and adverse effects, however there were tendency that nausea and vomiting of grade 3 or 4 were observed more in patients with higher iron level. Conclusions: Regardless of various chemotherapy regimens, the iron levels on day 2 or 3 of chemotherapy were markedly increased in all patients. Correspondingly, UIBC were extremely decreased and reached to 0μg in 4 patients sufffering severe nausea and vomiting. These results imply that increased radial iron in serum is one of causes of gastrointestinal toxicity, which may be a target of minimizing complications of cancer chemotherapy.

Iron Interventions for Women and Children in Low-Income Countries ,

The WHO estimates that 41% of women and 27% of children suffer from anemia due to iron deficiency. The consequences of iron deficiency anemia include suboptimal mental and motor development in young children, increased risk of maternal mortality, and decreased economic productivity of adults. Recent research also provides evidence that maternal iron deficiency in pregnancy increases neonatal morbidity and mortality. This short review briefly highlights how iron interventions might be positioned within 4 global health initiatives: making pregnancy safer, saving newborn lives, infant and young child feeding, and fortification. The importance of iron nutrition is recognized in the context of child nutrition, fortification, and biofortification, and it is likely that meaningful advances will be made through these initiatives in the coming decade. However, iron nutrition is not yet well integrated into the programmatic agendas for reducing morbidity and mortality of pregnant women and neonates. Iron supplementation in pregnancy has been advocated for decades as a means of controlling anemia, but this outcome has not been sufficient to motivate strong programs and policies, and the evidence base is still sparse for high-priority clinical outcomes. To act on the current evidence for maternal and neonatal health will require stronger advocacy within circles that have not traditionally included nutritionists. Successful implementation will require greater attention to antenatal care for pregnancy women and prioritization of iron-promoting actions (including iron supplementation and deworming) within that platform.

Iron deficiency anaemia in pregnancy – what are the solutions?

PurposeIron deficiency anaemia (IDA) is a common problem in pregnancy and may influence the health of both mother and child. The purpose of this paper is to discuss current prevention and treatment strategies for pregnancy IDA and describe alternative methods, such as food‐based approaches that may be another way forward.Design/methodology/approachA literature review was conducted to locate and summarise up‐to‐date published studies within the field.FindingsThere is good evidence that iron supplements may be used to prevent and treat IDA in pregnancy. However, there is much debate about “the optimal” dose to recommend. High doses may contribute to oxidative stress and cause gastrointestinal symptoms while there still remain problems with compliance, even for lower dose iron supplements. Encouraging the daily consumption of functional foods containing suitable levels of iron may therefore be an alternative way to improve pregnancy iron status.Research limitations/implicationsThere is a wealth of important studying the health implications of iron supplements in pregnancy. More work is needed to establish whether functional foods containing iron could be an alternative way to help improve iron status.Originality/valueMost papers and research focus on supplement use as a preventative measure and treatment for IDA; few discuss other approaches.

Routine iron supplementation in pregnancy.

Iron deficiency anemia is the micronutrient deficiency most prevalent in the world primarily affecting young children and pregnant or puerperal women. It is also associated with an increase in perinatal and maternal morbidity and mortality. Increasing iron demands in pregnancy are common knowledge, however the evidence of a clinical effect of routine iron supplementation in uncomplicated pregnancy is controversial. To determine if routine iron supplementation in uncomplicated pregnancy has clinical effects for the mother or newborn. A systematic review was conducted in the electronic databases Medline, Cochrane Library, Medscape, DARE, United States Preventive Services Task Force and National Guideline Clearinghouse using the keywords iron and pregnancy. Articles published until August 2008 were chosen for the review. The Strength of Recommendation Taxonomy (SORT) was used to grade the level of evidence. Routine iron supplementation in uncomplicated pregnancy increases or maintains the levels of blood iron and ferritin and results in a substantial reduction of women with low hemoglobin. However, this supplementation does not have detectable effects in any of the important clinical outcomes (p.e. preterm labor, duration of pregnancy, cesarean rate, birthweight, perinatal mortality or Apgar at birth). Iron supplementation is also responsible for some undesired effects. The evidence seems to show that there are no clinical improvements to recommend routine iron supplementation in all pregnancies. Women who show signs or symptoms of anemia at any time during pregnancy should be evaluated.

Iron supplementation and gestational diabetes in midpregnancy

Iron supplementation in pregnancy seems beneficial for neonatal/maternal outcomes, but it was associated with diabetes and hypertension in the general population. We investigated the association between iron supplementation during midpregnancy and metabolic/hypertensive abnormalities in 500 consecutive gestational diabetes mellitus (GDM) and 500 normoglycemic women. Iron-supplement users (n = 212/1000) showed significantly higher values of prepregnancy body mass index (BMI), actual BMI, waist circumference, blood pressure, fasting glucose, Homeostasis-Model-Assessment-Insulin-Resistance, and lower high-density lipoprotein-cholesterol than nonusers. The prevalence of GDM (70.8% vs 44.4%), hypertension (25.9% vs 9.8%), metabolic syndrome (25.9% vs 10.4%) was significantly higher in the former with a 2- to 3-fold-increased risk at multiple regression analyses. Most glucose values of the oral glucose tolerance test were significantly higher in iron supplemented women, both in GDM and normoglycemic individuals. Iron supplementation is associated with glucose impairment and hypertension in midpregnancy; its potential harmful effects might be carefully debated regarding its effectiveness.

Iron Supplementation in Pregnancy: More Harm than Good?

Iron Supplementation in Pregnancy: More Harm than Good?

Unnecessary iron supplementation in pregnancy can be harmful: intergenerational implications

Unnecessary iron supplementation in pregnancy can be harmful: intergenerational implications

Iron supplementation in pregnancy—does the preparation matter?

To assess the use, side effects and discontinuation rates of iron preparations during pregnancy. Six hundred and twelve randomly selected postpartum women completed a questionnaire on iron supplement use in the second and third trimesters. Of the 517 women (84.5%) reported using iron supplements, 453 were eligible for the study. The most common preparation was ferrous fumarate (46.8%, P < 0.01), followed by ferrous sulfate (31.8%), ferric polymaltose (12.4%), and ferric bisglycinate (7.3%). Almost half the participants (45%) reported at least one adverse effect, especially constipation (27.4%, P < 0.01), nausea (10.8%). Multivitamin preparations and ferric bisglycinate were associated with the fewest side effects (23.7, 21.2% respectively, P < 0.01), and ferrous fumarate and immediate-release ferrous sulfate with the most (56.3, 53.7% respectively). Eighty-three women discontinued their originally prescribed iron preparation, mainly (89%) due to side effects. Discontinuation rates were lowest for the multivitamin and ferric bisglycinate (10.5, 9.1%, respectively). In most cases, the specific preparation was recommended by the women's physician (76%). Ferrous fumarate-containing multivitamin preparations and ferric bisglycinate, although infrequently recommended as the first-line of iron supplementation, may be associated with less side effects and better compliance.

Demographic factors determining compliance to iron supplementation in pregnancy in Oyo State, Nigeria

Iron deficiency anaemia in pregnancy has irreversible negative consequence on infant cognitive development and increases maternal morbidity and mortality. Iron supplementation ameliorates this effect. The salutary effect of iron supplementation on improvement of haemoglobin levels in pregnancy has been documented in various studies. However factors affecting the compliance of women with prescribed iron supplements are yet to be well studied, particularly at primary care levels. This study describes the compliance rate and demographic factors influencing use of iron supplements among pregnant women at primary care level. This is a cross sectional descriptive study. Five hundred and ninety seven women attending randomly selected primary care centres were studied. Demographic characteristics and information on use of iron supplements were collected. Haemoglobin level was also determined for each woman. Compliance rate was 37.5%. Prevalence of anaemia was higher among noncompliant women than those complying (18% v 15%, chi2 7.5, p = 0.006). Haemoglobin level was higher among women complying with iron supplements compared with those not complying (11.4 g/dl v 11.0 g/dl, t = 9.3, p = 0.002). Single and teenage mothers and those aged 35 years and above were less likely to be compliant. Married women, those in urban location, and those aged 20-29 years were more compliant with iron supplementation. Pregnancy among teenage and single mothers is associated with a significantly higher risk of non-compliance with iron supplementation. Further studies are recommended to understand the reasons for non-compliance among these groups of women.

WITHDRAWN: Iron supplementation in pregnancy.

Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters, and on pregnancy outcome. The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. Acceptably controlled trials of iron supplementation for pregnant women. Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. Twenty trials were included. Iron supplementation raised or maintained the serum ferritin above 10 milligrams per litre. It resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Iron supplementation, however, had no detectable effect on any substantive measures of either maternal or fetal outcome. One trial, with the largest number of participants of selective versus routine supplementation, showed an increased likelihood of caesarean section and post-partum blood transfusion, but a lower perinatal mortality rate (up to 7 days after birth). Iron supplementation appears to prevent low haemoglobin at birth or at six weeks post-partum. There is very little information on pregnancy outcomes for either mother or baby. There are few data derived from communities where iron deficiency is common and anaemia is a serious health problem.

Oral administration of lactoferrin increases hemoglobin and total serum iron in pregnant womenThis paper is one of a selection of papers published in this Special Issue, entitled 7th International Conference on Lactoferrin: Structure, Function, and Applications, and has undergone the Journal's usual peer review process.

Iron deficiency anemia (IDA) during pregnancy continues to be of world-wide concern. IDA is a risk factor for preterm delivery and subsequent low birth weight, and possibly for poor neonatal health. Iron supplementation in pregnancy is a widely recommended practice, yet intervention programs have met with many controversies. In our study, 300 women at different trimesters of pregnancy were enrolled in a trial of oral administration of ferrous sulfate (520 mg once a day) or 30% iron-saturated bovine lactoferrin (bLf) (100 mg twice a day). Pregnant women refusing treatment represented the control group. In this group hemoglobin and total serum iron values measured after 30 d without treatment decreased significantly, especially in women at 18-31 weeks of pregnancy. In contrast, after 30 d of oral administration of bLf, hemoglobin and total serum iron values increased and to a greater extent than those observed in women treated orally for 30 d with ferrous sulfate, independently of the trimester of pregnancy. Unlike ferrous sulfate, bLf did not result in any side effects. These findings lead us to hypothesize that lactoferrin could influence iron homeostasis directly or through other proteins involved in iron transport out of the intestinal cells into the blood.

Anemia in early pregnancy among Canadian women presenting for abortion

In an urban clinic providing abortions, it was noted that many women presenting for abortion were anemic. The U.S. National Health and Nutrition Examination Survey III established prevalence of anemia, defined as a hemoglobin lower than 120 g/ L, at 5.1% of the non-pregnant women in the population [1]. There are observational studies that associate anemia diagnosed prior to midpregnancy with increased risk of pre-term delivery, low birth weight, and fetal mortality [2,3]. A metaanalysis of trials of iron supplementation in pregnancy showed no detectable effect on any substantive functional measures of either maternal or fetal outcome [4]. The purpose of this study was to determine the prevalence of anemia in this population, identify

Oral versus high dose parenteral iron supplementation in pregnancy

Objective To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron. Method A total of 220 pregnant women with a singleton pregnancy and hemoglobin between 8 to 11 g% at 16–24 weeks gestation were identified and randomly divided into two groups. Group A was started on daily oral iron therapy of 100 mg of elemental iron. Group B was given 250 mg of iron sorbitol intramuscularly and repeated at an interval of 4–6 weeks. Blood indices were evaluated at the beginning of study and at 36 weeks to see the effect after iron supplementation in the two groups. The data were analyzed using SPSS software, version 10.1. Results Definitive and comparable improvement in hemoglobin and all the blood indices (hematocrit, MCH, MCHC, MCV, Serum iron and TIBC) was observed. The absolute change in hemoglobin and hematocrit was 1.18±0.68 g% and 4.02±2.59% in oral group, 1.34±0.77 g% and 4.93±3.65% in parenteral group, respectively. Serum ferritin showed statistically significant absolute rise (10.43±7.92 μg/dl) after parenteral iron supplementation as compared to oral iron supplementation (9.76±4.78 μg/dl). Obstetric outcome was comparable in two groups. Conclusion Two treatment regimens are biologically equivalent in terms of hematological response. Two high doses of intramuscular iron can be a good substitute to meet iron requirement in pregnancy.

Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: A prospective study

Objective We evaluated the effect of iron supplementation on biochemical indicators of iron status, namely hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptor (sTfR), during pregnancy. Methods A prospective study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 μg of folic acid for 100 d from 19 wk of gestation. The indicators of iron status (Hb, SF, and sTfR) at 19, 27, and 35 wk of gestation were analyzed. The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic ( n = 35) and non-anemic ( n = 38) at 19 wk. Results All three indicators of iron status during supplementation (27 and 35 wk) were similar to the presupplementation status. The sTfR as an indicator correlated negatively with presupplementation Hb levels ( r = −0.417). Based on sTfR level in iron-adequate pregnant women, a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy. When the response was tested in anemic pregnant women, iron supplementation improved mean Hb ( P < 0.05) at the end of 35 wk (96 ± 8.8 to 110 ± 20.2 g/L) of gestation, with no change in SF. Conversely, non-anemic pregnant women showed a significant increase in SF and a decrease in Hb (122 ± 11.6 to 112 ± 15.2 g/L) at 35 wk of gestation. A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women. Conclusions These observations suggest that, during pregnancy, sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator.

P1109* EFFECT OF IRON SUPPLEMENTATION IN PREGNANCY ON IQ OF CHILDREN AT 4 YEARS OF AGE

Introduction: Evidence from animal studies has consistently demonstrated that inadequate iron nutrition during pregnancy leads to permanent structural and functional changes in the brain of offspring. However, there are no human trials specifically designed to examine the effect of iron supplementation in pregnancy on childhood neurodevelopment. Our aim was to assess the IQ of children at 4 years of age whose mothers had previously participated in a double blinded randomised controlled trial (RCT) of iron supplementation in pregnancy [1]. Methods: Families who participated in the RCT [1] during 1997–1999 were invited to participate in a follow up study when the children were 4 years of age. The IQ of the children was assessed using the Stanford– Binet Intelligent Test (4th Ed). Weight, height and head circumference were measured and iron status was assessed. Additional information on possible confounders of child development such as home environment and length of breastfeeding are also collected. Results: Seventy-seven percent (303/391) of the children from the original trial consented to participate in the follow up study, 8% (31/391) were lost to follow up and 15% (57/391) refused to participate. Data collection is complete for 290/303 children and 13 children remain to be assessed to complete the study. Results collected to date show that the mean age of children at assessment is 4.17 ± 0.23 years. The mean total IQ for children assessed thus far (n=290) is 109 ± 11, while verbal IQ is 109 ± 12, visual IQ is 104 ± 10, quantitative reasoning IQ is 114 ± 12 and short-term memory IQ is 104 ± 12. Mean haemoglobin at assessment is 123 ± 7 g/L (n=210) and mean serum ferritin is 21 ± 12 ug/l (n=209). Data collection is ongoing and will be completed by the end of December 2003. Primary comparisons will be made between the IQ of children from iron supplemented mothers and the IQ of children from placebo supplemented mothers. Adjustment will be made for possible confounding variables. We are unable to perform the statistical analysis for the primary comparisons at this stage as we can not unblinded the trial until all data collection is complete. Conclusion: If iron supplementation in pregnancy results in higher IQ of children, we believe that this will necessitate a reevaluation of the critical period of iron nutrition for influencing neurodevelopment.

Guidelines for iron supplementation in pregnancy: compliance among 431 parous Scandinavian women.

The need for iron in pregnancy is rarely met by dietary food intake alone. Therefore, guidelines on iron supplementation have been developed to ensure optimal maternal and foetal iron provision. Today, the World Health Organization recommends iron supplementation during the second half of pregnancy. Our aim was to study compliance to these guidelines among 431 parous Scandinavian women. In addition, the association between maternal socio-demographic and lifestyle factors, maternal haemoglobin (Hb) values and non-compliance was assessed. The women were interviewed about iron use at gestational weeks 25, 33 and 37 at the three Scandinavian study sites, Trondheim, Bergen and Uppsala. In all, 27% of the women used iron supplements continuously during the second half of pregnancy, hence complying with the guidelines. Further, 41% of the women reported periodical and 32% no use of iron supplementation during the second half of pregnancy. In the multivariable analyses, high Hb-concentration, living in Uppsala [OR: 3.1 (1.6-6.0)] or Bergen [OR: 4.7 (2.4-9.3)] as opposed to Trondheim, and smoking during pregnancy [OR: 2.0 (1.1-3.5)] were associated with non-compliance to guidelines. We conclude that maternal Hb values, demographic factors and smoking during pregnancy are among the factors associated with non-compliance to guidelines on iron supplementation during pregnancy.

Impact of daily and weekly iron supplementation to women in pregnancy and puerperium on haemoglobin and iron status six weeks postpartum: results from a community-based study in Bangladesh

Background: Anaemia and iron-deficiency anaemia in women are global problems that are prevalent throughout the reproductive cycle. Data are scarce on whether iron supplementation in pregnancy and puerperium has a sustained effect on haemoglobin concentration. Objective: To assess whether there is a dose effect of iron supplementation in pregnancy and puerperium on haemoglobin 6 weeks after delivery, and compare the effectiveness of daily and weekly dose regimens at 6 weeks postpartum. Design: 50 antenatal centres were assigned randomly to 1×60 mg iron daily or 2×60 mg once weekly. Data are reported for 146 women (daily, n=67; weekly, n=79): haemoglobin, serum ferritin (sFt) and serum transferrin receptors (sTfR) at baseline and at 6 weeks postpartum. Tablet intake was monitored using pill-bottles equipped with electronic counting devices. Results: There was a dose effect of iron supplementation on haemoglobin concentration at 6 weeks postpartum. Endpoint attaine d haemoglobin, sFt and sTfR did not differ between daily and weekly groups, although a larger increment of sFt was found in the daily group (p=0.03). Conclusions: Effects of iron supplementation in pregnancy and puerperium were observed at 6 weeks after delivery. The size of the effect was dependent on the number of tablets, not on daily or weekly regimen. It is not known whether the effects of iron supplementation in pregnancy are sustained into the next pregnancy. Keywords: Bangladesh, haemoglobin, iron status, iron supplementation, pregnancy, puerperium.

Impact of daily and weekly iron supplementation to women in pregnancy and puerperium on haemoglobin and iron status six weeks postpartum: results from a community-based study in Bangladesh

Background: Anaemia and iron-deficiency anaemia in women are global problems that are prevalent throughout the reproductive cycle. Data are scarce on whether iron supplementation in pregnancy and puerperium has a sustained effect on haemoglobin concentration. Objective: To assess whether there is a dose effect of iron supplementation in pregnancy and puerperium on haemoglobin 6 weeks after delivery, and compare the effectiveness of daily and weekly dose regimens at 6 weeks postpartum. Design: 50 antenatal centres were assigned randomly to 1×60 mg iron daily or 2×60 mg once weekly. Data are reported for 146 women (daily, n=67; weekly, n=79): haemoglobin, serum ferritin (sFt) and serum transferrin receptors (sTfR) at baseline and at 6 weeks postpartum. Tablet intake was monitored using pill-bottles equipped with electronic counting devices. Results: There was a dose effect of iron supplementation on haemoglobin concentration at 6 weeks postpartum. Endpoint attaine d haemoglobin, sFt and sTfR did not differ between daily and weekly groups, although a larger increment of sFt was found in the daily group (p=0.03). Conclusions: Effects of iron supplementation in pregnancy and puerperium were observed at 6 weeks after delivery. The size of the effect was dependent on the number of tablets, not on daily or weekly regimen. It is not known whether the effects of iron supplementation in pregnancy are sustained into the next pregnancy. Keywords: Bangladesh, haemoglobin, iron status, iron supplementation, pregnancy, puerperium.