Iron Supplementation In Pregnancy Research Articles

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.

Iron supplementation in pregnancy

Iron deficiency is the most common nutritional disorder in the world. Pregnant women are at especially high risk for iron deficiency and iron deficiency anemia. A considerable proportion of pregnant women in both developing and industrialized countries become anemic during pregnancy. The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia, especially in developing countries over the past 30 years. The major problem with iron supplementation during pregnancy is compliance. Despite many studies, the relationship between maternal anemia and adverse pregnancy outcome is unclear. However, there is now sufficient evidence that iron supplements increase hemoglobin and serum ferritin levels during pregnancy and also improve the maternal iron status in the puerperium, even in women who enter pregnancy with adequate iron stores. Recent information also suggests an association between maternal iron status in pregnancy and the iron status of infants postpartum. The necessity of routine iron supplementation during pregnancy has been debated in industrialized countries and routine supplementation is not universally practiced in all these countries. In view of existing data, however, routine iron supplementation during pregnancy seems to be a safe strategy to prevent maternal anemia in developing countries, where traditional diets provide inadequate iron and where malaria and other infections causing increased losses are endemic.

Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues

According to our current understanding, iron absorption with weekly iron supplements is not higher than that with daily supplements (ie, there is no mucosal block). However, community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one. Furthermore, when differences in absorption are found, they are commonly smaller than would be expected on the basis of differences in the amount of iron provided. The possibility of differential compliance between the regimens needs to be evaluated to explain these findings. Taking compliance into account, we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy. In Bangladesh, 50 antenatal centers were randomly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d. Compliance was monitored by using a pill bottle equipped with an electronic counting device. Hemoglobin concentrations were measured at baseline and after 4, 8, and 12 wk of supplementation. There was no differential effect per iron tablet between weekly and daily regimens. A 12-wk daily regimen (68% compliance) produced a small but significantly greater hemoglobin response than did the weekly regimen (104% compliance). The first 20 tablets consumed produced most of the effect; after 40 tablets, there was no further response. There was no evidence of a mucosal block in the daily regimen. Over 12 wk, 50% of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect. The weekly regimen provided a large part of this amount, explaining the limited difference in effect. It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary.

Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany

Objective: To determine the prevalence and risk factors of iron deficiency in pregnancy, since iron supplements are not routine in Germany. Study design: Soluble transferrin receptor (sTfR), ferritin, hemoglobin (Hb), C-reactive protein (CRP) and leucocyte counts were determined in venous blood samples of 378 women before delivery; 191 of them filled in a questionnaire. Statistical analysis was performed using SPSS 9.0.1. Results: CRP and leucocyte count correlated significantly with ferritin values, while sTfR values were independent. Iron deficiency (sTfR >3.3 mg/dl) was found in 40.7% of pregnant women, and anemia (Hb<11.0 g/dl) in 13.6%. Non-German nationality, low educational level and young maternal age were significant risk factors for iron deficiency, while alcohol use in pregnancy, iron and folic acid supplements were protective. After adjusting for all other factors in a logistic regression equation, not taking any iron supplements in pregnancy (odd ratios (OR) 3.3 and 95% confidence interval (CI) 1.1–9.4), and young maternal age (OR 2.86 and 95% CI 1.1–7.7) remained significant risks. Conclusion: Iron deficiency in pregnant women in Germany is prevalent; it could be prevented by routine iron supplements.

Iron supplementation in pregnancy--evidence and controversies.

Approximately 20% of women in industrialized countries have iron deficiency in pregnancy. This article focuses on the diagnostic problem of anemia and iron deficiency and discusses different strategies for iron supplementation in pregnancy. S-ferritin is commonly used to diagnose empty iron stores and is considered useful early in pregnancy as a diagnostic tool. Mean cellular volume (MCV), s-Fe and erythrocyte distribution width is too unspecific. Serum transferrin receptor (sTfR) is a relatively novel promising indicator of iron deficiency. Iron demands of the pregnant women are discussed as well as the dietary content of iron. Both beneficial and adverse effects of iron supplementation are outlined. It is not documented that supplementation has any substantial effect on birth weight or various complications in pregnancy. However, supplementation corrects the iron store and biochemical parameters of iron deficiency including hemoglobin concentration (Hb) and maintains the maternal iron stores in the puerperium. Recent literature also suggests that iron supply to the pregnant women may have beneficial effects on the iron content of neonates the first year of life.

A “conservative” approach to iron supplementation during pregnancy

A review of current knowledge about iron metabolism during pregnancy and the evidence from various studies on the effects of iron supplementation in pregnancy on maternal, fetal, and infant outcomes suggest that the implicit goal of current recommendations regarding iron supplementation may be to achieve the highest hemoglobin concentration possible. This goal is only weakly related to improved maternal and infant outcomes in the current pregnancy or to improved maternal iron stores long-term. Indeed, the claim that iron supplementation is universally innocuous is shown to be controversial. For women in developed countries who are generally clinically healthy and have access to adequate nutrition, the benefits of iron supplementation are unclear, and there may be risks. Thus, a better “conservative” approach may be that such women do not require routine iron supplementation during pregnancy. The midwifery philosophy of individualizing care based on a woman’s history and health status is one that should be taken in approaching the issue of iron supplementation in pregnancy.

Iron supplementation in pregnancy - evidence and controversies

Iron supplementation in pregnancy - evidence and controversies

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.

Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation

Iron supplementation in pregnancy is a controversial issue. The aim of this review was to summarize the results of relevant papers on this subject. Placebo-controlled studies on iron treatment in pregnancy were identified from the Cochrane database. Among fertile women, 20% have iron reserves of >500 mg, which is the required minimum during pregnancy; 40% have iron stores of 100-500 mg, and 40% have virtually no iron stores. The demand for absorbed iron increases from 0.8 mg/day in early pregnancy to 7.5 mg/day in late pregnancy. Dietary iron intake in fertile women is median 9 mg/day, i.e. the majority of women have an intake below the estimated allowance of 12 18 mg/day. Iron absorption increases in pregnancy, but not enough to prevent iron deficiency anemia in 20%, of women not taking supplementary iron. Iron-treated pregnant women have greater iron reserves, higher hemoglobin levels, and a lower prevalence of iron deficiency anemia than placebo-treated women both in pregnancy as well as postpartum. Furthermore, children born to iron-treated mothers have higher serum ferritin levels than those born to placebo-treated mothers. An iron supplement of 65 mg/day from 20 weeks of gestation is adequate to prevent iron deficiency anemia. In order to avoid iron deficiency in pregnancy, prophylactic iron supplement should be considered. Iron supplements may be administered on a general or selective basis. The selective approach implies screening with serum ferritin in early pregnancy, in order to identify women who can manage without prophylactic iron.

Iron Supplementation in Pregnancy

Eskeland, Benedicte; Malterud, Kirsti; Ulvik, Rune J.; Hunskaar, Steiner Author Information

Iron supplementation in pregnancy: can it be justified?

The provision of routine iron supplementation to correct ‘anaemia’ in pregnancy is common practice among many midwives and obstetricians. This article seeks to uncover the true nature of such anaemia and raises questions regarding the use and safety of iron supplementation. It will be demonstrated that a fall of haemoglobin in pregnancy is not an accurate measure of developing anaemia, rather just reflective of normal physiological changes. In this age of evidence-based practice when professionals are being urged to justify their actions, we need to challenge the assumption that failing haemoglobin levels requires correction and examine the usefulness of iron supplementation.

The role of prophylactic iron supplementation in pregnancy

The prevalence, causes and role of iron prophylaxis in pregnant women was studied. All women delivered at the National University Hospital, Singapore in 1993 had their haemoglobin estimated. If it was less than 11 g/dl, blood was taken for serum iron, ferritin, transferrin, red cell zinc protoporphyrin, serum folate, vitamin B12 and thalassemia screen to establish cause of anaemia. Data was also collected with regards to their antenatal progress and iron prophylaxis. Logistic regression, Chisquare test, Fischer's exact test and Mantel-Haenszel tests were also used to assess the relationships between categorical variables. The prevalence of anaemia at first antenatal visit was 20.6% while the prevalence of anaemia at delivery was 15.3%. The commonest cause of the anaemia in pregnancy was due to iron deficiency (81.3%). In the non-anaemic group, 90.7% were on prophylactic iron supplements compared to 50.6% in the anaemic group (P < 0.001). Of the 752 women found to be anaemic at booking, 591 received prophylactic iron supplements while 161 women did not. A total of 166 (28.1%) of those with iron supplements were anaemic at delivery, whereas 140 (87.0%) of those who did not receive prophylactic iron remained anaemic at delivery (P < 0.001). Of the 2516 non-anaemic women who received prophylactic iron, 118 (4.7%) developed anaemia at delivery while 133 (34.1%) out of the 390 women who did not receive prophylactic iron were anaemic at delivery (P < 0.001). Multivariate logistic regression analysis revealed the odds of anaemia for a woman not on iron therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76 to 14.13). A 55% reduction in odds of anaemia was estimated per 1 gm% increase in haemoglobin at booking. Prophylactic antenatal iron supplements not only prevent a fall but also improved haemoglobin levels during pregnancy. Those who were not on any iron supplements were 11 times more likely to develop anaemia in the present pregnancy.

Iron supplementation in pregnancy examined

Iron supplementation in pregnancy examined

Routine iron supplements in pregnancy are unnecessary.

Women commonly take iron supplements during pregnancy. Many feel tired when pregnant, commonly their haemoglobin concentrations fall and it is known that iron is taken up preferentially by the developing fetus. In such circumstances additional iron appears justified. However, scientific support for this approach is weak. In this article we ask whether the routine use of iron supplements alters the outcome for mother or child.

Evaluation of a gastric delivery system for iron supplementation in pregnancy

The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system (GDS). Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present (hemoglobin concentration 80-110 g/L). The participants were randomly assigned to one of three study groups given no iron, two FeSO4 tablets (100 mg Fe) daily, or one GDS capsule (50 mg Fe) daily. Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes, including serum transferrin receptor. There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement. We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily, a GDS offers significant advantages for iron supplementation of pregnant women.

Iron supplementation in pregnancy. General practitioners' compliance with official recommendations.

OBJECTIVE--To compare general practitioners' routines regarding iron supplementation in pregnancy with national recommendations. Mailed questionnaire to general practitioners. A county in western Norway. 184 general practitioners. Descriptive registration of reported routines regarding assessment and supplementation of iron. 11% of general practitioners reported complete adherence to the national programme recommending iron supplements for everyone in the second half of pregnancy and use of s-ferritin estimation if Hb falls below 11 g/dl. 36% of the doctors prescribed iron supplements routinely irrespective of iron status. 87% reported use of s-ferritin estimation in antenatal care; usually on indication of low Hb, almost 20% as a routine screening in all pregnancies. General practitioners' compliance with national recommendations for iron supplementation in pregnancy is very low and probably reveals a need both for a review of the national recommendations and for an approach to increase compliance with given standards.

Drug use in pregnancy at a referral and district hospital in northern India

AbstractThis is the Indian counterpart of the co‐operative study on drug use in pregnancy carried out under the auspices of WHO–EURO and co‐ordinated by the Mario Negri Institute, Milan (Italy). In all 1497 pregnant women were interviewed (1000 from the referral hospital and 497 from the city hospital) to collect the information.The mean age of the mothers was 25 years; 50% were hospitalized on the day of delivery; 50% of the deliveries were normal and the other 50% were assisted or operative. Congential malformations were seen in 2.0% of the newborns.The drugs taken throughout pregnancy were tetanus toxoid (TT) and nutritional supplements (iron, folic acid, calcium and multivitamins) and constituted the largest group (35%). Women on chronic therapy for medical or obstetrical problems related to the pregnancy were 1%. Overall 30.5% of the women received drugs during hospitalization for delivery. Local and general anaesthetics and oxytocics were the most used during this period.As the rate of operative deliveries was high 33% of the women received antimicrobials, analgesics and sedatives during puerperium. Nutritional supplements were used extensively during current or planned breast‐feeding.The routine use of iron supplements in pregnancy and the high rate of operative deliveries seemed to contrast to other countries which participated in this study.

Iron supplementation in pregnancy: Testing a new clinic protocol

Iron supplementation in pregnancy: Testing a new clinic protocol

The use of ferritin to assess the need for iron supplements in pregnancy

SummaryOf women who developed a low haemoglobin concentration in pregnancy. 84 percent had a booking ferritin concentration below 50μg/l. Two groups of patients were studied; one group had iron and folate supplements withheld. Of the unsupplemcnted patients, 18·4 per cent became anaemic (haemoglobin < 10·5 g/dl). In the group given oral iron and folate. only 4·8 per cent developed anaemia. Ferritin levels in early pregnancy can be used to predict the need for iron supplements.