title: The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women Intermittent oral iron supplementation during pregnancy. Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. A WHO collaborative study on iron supplementation in Burma and in Thailand. Effect of time of initiation and dose of prenatal iron and folic acid supplementation on iron and folate nutriture of Korean women during pregnancy. Supplementation with iron and riboflavin enhances dark adaptation response to vitamin A-fortified rice in iron-deficient, pregnant, nightblind Nepali women. The effects of oral iron supplementation on ferritin levels in pregnant Burmese women. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. Adherence to iron supplementation during pregnancy in Tanzania: determinants and hematologic consequences. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial. Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh. Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations Haematological response to supplements of iron and riboflavin to pregnant and lactating women in rural Gambia. [Effect of iron supplementation and its frequency during pregnancy]. Effect of oral iron supplementation during pregnancy on maternal and fetal iron status Iron supplementation in pregnancy: is less enough? [Clinical experience with iron supplementation in pregnancy]. Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy. Daily versus intermittent iron supplementation in pregnant women: hematological and pregnancy outcome. W.H.O. sponsored collaborative studies on nutritional anaemia in India. 1. The effects of supplemental oral iron administration to pregnant women. Maternal erythropoietin in singleton pregnancies: a randomized trial on the effect of oral hematinic supplementation. Iron prophylaxis in pregnancy: intravenous route versus oral route. [Therapy and iron supplements with ferritin iron during pregnancy. Randomized prospective study of 458 cases]. Iron deficiency and child and maternal health. The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. A randomized comparison of routine versus selective iron supplementation during pregnancy. Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Determinants of compliance with iron supplementation among pregnant women in Senegal. The effectiveness of weekly iron supplementation regimen in improving the iron status of Chinese children and pregnant women. Further Observations on the Relation between Iron and Folate Status in Pregnancy [Prevention of iron-deficiency anemia in pregnancy using early iron supplementation: a controlled trial]. Impact of daily versus weekly hematinic supplementation on anemia in pregnant women. Iron prophylaxis during pregnancy – How much iron is needed? A randomized dose– response study of 20–80 mg ferrous iron daily in pregnant women Weekly iron as a safe alternative to daily supplementation for nonanemic pregnant women. Impact of anaemia prophylaxis in pregnancy on maternal haemoglobin, serum ferritin & birth weight. A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. A prophylactic trial of iron and folic acid supplements in pregnant Burmese women. Providing iron/folic acid tablets free of charge improves compliance in pregnant women in Senegal.
abstract: Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria Background Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus , thus supplements are recommended . Adherence to current tablet-based supplements is documented to be poor . Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence . However , before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy , the bioavailability of the iron needs to be determined . Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women . Methods Eighteen healthy pregnant women ( 24 – 32 weeks gestation ) were r and omized to receive the supplements in a crossover design . Following ingestion of each supplement , the changes ( over baseline ) in serum iron and folate over 8 hours were determined . The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid ; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid . Results Overall absorption of iron from the powdered supplement was significantly lower than the tablet ( p = 0.003 ) . There was no difference in the overall absorption of folic acid between supplements . Based on the differences in the area under the curve and doses , the relative bioavailability of iron from powdered supplement was lower than from the tablet ( 0.22 ) . Conclusion The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports . However , since pills and capsules are known to be poorly accepted by some women during pregnancy , it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose .Trial Registration Clinical Trials.gov RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia ( IDA ) . OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly , thrice weekly and daily in preventing IDA in pregnancy . DESIGN A r and omised control trial . SETTING University antenatal clinic , ( UANC ) Galle . SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was r and omly given weekly ( n = 26 ) thrice weekly ( n = 35 ) and daily ( n = 31 ) to 92 women who were 14 to 24 weeks pregnant .  Haemoglobin ( Hb ) , serum ferritin ( SF ) and haematocrit ( Hct ) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out . RESULTS The risk of developing anaemia was significantly higher in the weekly ( odds ratio 15 , 95 % CI 1.4 - 165.6 , p < 0.03 ) and possibly higher in the thrice weekly ( odds ratio 3 , 95 % CI 0.3 - 30.3 , p = 0.3 ) groups . The risk of developing iron deficiency ( SF < 12 micrograms/l ) was also significantly higher in the weekly ( odds ratio 18 , 95 % CI 2.8 - 115.5 , p < 0.003 ) and thrice weekly ( odds ratio 10 , 95 % CI 1.6 - 64.8 , p < 0.02 ) groups . CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron The effect of daily rather than weekly iron supplementation was compared in women who were 8 - 24 wk pregnant . One group ( n = 68 ) received 60 mg Fe/d , the second group ( n = 71 ) received 120 mg Fe/wk , given at once . Supplementation lasted 11.3 wk on average , depending on gestational date at entry , and was not supervised . Hemoglobin increased in both groups ( P < 0.001 ) ; serum ferritin did not change significantly . There was no significant difference between groups for changes in hemoglobin and serum ferritin . In a subgroup of women with a hemoglobin concentration < 110 g/L at baseline ( n = 45 daily ; n = 54 weekly ) no significant within-group changes occurred in serum ferritin , but the change in the daily group was 4.1 micrograms/L higher than in the weekly group ( P = 0.049 ) . Compliance , as indicated by two positive stool tests , was approximately equal to 54.3 % in the daily group and 62.2 % in the weekly group . We conclude that for the complete sample of subjects , the treatment effect of daily compared with weekly supplementation was similar under conditions resembling a normal antenatal care program Studies on the treatment and prevention of iron deficiency anemia , in pregnant and nonpregnant women and in men , were conducted in Thail and and Burma . The effects of the dose of Fe , duration of Fe administration , additional supplementation with folate , mode of supplement delivery ( either supervised or unsupervised ) , and the presence of Hb(AE ) were studied . The frequency and severity of side effects were also recorded . Fe administration result ed in an increase in hemoglobin concentration in all anemic individuals but approximately 20 % failed to reach normality . The length of administration and the dose influenced the results . Frequency and severity of side effects increased with the dose of Fe administered . Folate supplementation did not affect the results . It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized BACKGROUND In Korea , it is customary to prescribe iron and folic acid supplements to pregnant women after the 20th wk of gestation ; however , little evidence exists to support this practice . OBJECTIVE The objective was to determine the effects of time of initiation and dose of prenatal iron and folic acid supplementation on the iron and folate nutriture of Korean women during pregnancy . DESIGN A total of 131 pregnant women were placed into 1 of 5 experimental groups , either the control group or 1 of 4 supplemented groups . The supplemented groups varied by time of initiation , which was either during the first trimester or at week 20 of gestation , and by dose of iron and folic acid supplements provided , which consisted of either 30 mg Fe plus 175 microg folic acid or 60 mg Fe plus 350 microg folic acid . All supplemented groups continued supplementation until delivery . RESULTS Improvements in iron and folate nutriture were highly dependent on when the supplement program was initiated , but both supplement doses were equally effective . In contrast , the influence of folic acid supplementation on maternal folate status was not as pronounced as was the influence of iron supplementation on iron status . CONCLUSION In pregnant Korean women , initiating iron and folic acid supplementation earlier during pregnancy may prevent the deterioration of iron and folate nutriture more than does increasing supplement doses in later stages of pregnancy BACKGROUND Nightblindness affects 16 - 52 % of pregnant women in areas of Nepal and in some cases persists after vitamin A treatment . Iron and riboflavin affect vitamin A utilization and photoreceptor function , respectively , and pilot data in the study population showed a high prevalence of iron and riboflavin deficiencies . OBJECTIVE The objective was to assess the effect of supplemental iron and riboflavin on pupillary threshold ( PT ) and plasma retinol in nightblind , pregnant Nepali women given vitamin A-fortified rice . DESIGN Nightblind pregnant women were r and omly assigned to receive , 6 d/wk under supervision for 6 wk , a vitamin A-fortified rice curry dish providing 850 microg retinal activity equivalents/d with either a 30-mg Fe and 6-mg riboflavin ( FeR + VA ) capsule or a placebo control ( VA only ) capsule . Hemoglobin , erythrocyte riboflavin , and plasma ferritin and retinol were measured before and after the intervention . Dark adaptation was assessed by PT score . RESULTS Women who were iron deficient at baseline ( n=38 ) had significantly greater improvement in PT score with  iron and riboflavin supplementation  than without ( P=0.05 ) . Iron and riboflavin supplements significantly reduced the prevalences of riboflavin deficiency ( from 60 % to 6 % ; P<0.0001 ) , iron deficiency anemia ( from 35 % to 15 % ; P<0.007 ) , and abnormal PT ( from 87 % to 30 % ; P<0.05 ) from baseline . Mean increases in erythrocyte riboflavin ( P<0.0001 ) and plasma ferritin ( P=0.01 ) were greater in the FeR + VA group than in the VA only group . CONCLUSIONS Iron deficiency may limit the efficacy of vitamin A to normalize dark adaptation in pregnant Nepali women . Further studies are needed to assess the effect of simultaneous delivery of iron and vitamin A for the treatment of nightblindness The usefulness of serum ferritin levels in assessing iron stores in pregnant women before and after supplementation with iron  was studied . One hundred thirty-five healthy pregnant women between 22 to 28 wk were r and omly allotted to daily dose regimes of 60 , 120 , or 240 mg of ferrous sulphate . The tablets were given after meals under strict personal supervision . Before supplementation , iron deficiency ( ferritin level less than 10 micrograms/L ) was present in 54.8 % of the pregnant women , compared to an incidence of 17.8 % when assessed by serum iron concentration of less than 50 micrograms/dl . The mean ferritin level of pregnant women was 14.15 micrograms/L and was less than one-half that of healthy single women and one-sixth of that of healthy males . Supplementation with oral iron for 12 wk produced an increase in ferritin levels in all the groups , but significant increases were seen only in women given 120 and 240 mg of ferrous sulphate with or without folic acid . However , there were no differences in final Hb levels among the supplemented groups We studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants . The subjects were 197 pregnant women selected at 28 wk + /- 21 d of gestation at a mother- and -child health center in Niamey , Niger . Ninety-nine women received 100 mg elemental Fe/d  throughout the remainder of their pregnancies and 98 received placebo . The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group . Three months after delivery , the prevalence of anemia was significantly higher in the placebo group . At delivery , there were no differences between the two groups in cord blood iron variables . Three months after delivery , serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group . Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group BACKGROUND According to our current underst and ing , 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 . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly 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 . RESULTS 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 . CONCLUSIONS 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 Limited adherence to iron supplementation is thought to be a major reason for the low effectiveness of anemia-prevention programs . In rural Tanzania , women at 21 - 26 wk of gestation were r and omly given either 120 mg of a conventional ( Con ) iron supplement or 50 mg of a gastric-delivery-system ( GDS ) iron supplement for 12 wk . Adherence was assessed by using a pill bottle equipped with an electronic counting device . Adherence in the GDS group was 61 % compared with 42 % for the Con group . In both groups , women experiencing side effects had about one-third lower adherence . Fewer side effects were observed in the GDS group . In a subgroup of women with a low initial hemoglobin concentration ( < or = 120 g/L ) , the response to the iron supplements suggested that both of the applied doses were unnecessarily high for adequate hematologic response in a population with a marginal hemoglobin concentration . The GDS group appeared to require a dose one-fourth as high as that of the Con group for an equal effect on improving hemoglobin to normal concentrations BACKGROUND The need for prophylactic iron during pregnancy is uncertain . OBJECTIVE We tested the hypothesis that administration of a daily iron supplement from enrollment to 28 wk of gestation to initially iron-replete , nonanemic pregnant women would reduce the prevalence of anemia at 28 wk and increase birth weight . DESIGN Between June 1995 and September 1998 , 513 low-income pregnant women in Clevel and were enrolled in the study before 20 wk of gestation . Of these , 275 had a hemoglobin concentration > /= 110 g/L and a ferritin concentration > /= 20 micro g/L and were r and omly assigned to receive a monthly supply of capsules containing either 30 mg Fe as ferrous sulfate or placebo until 28 wk of gestation . At 28 and 38 wk of gestation , women with a ferritin concentration of 12 to < 20 micro g/L or < 12 micro g/L received 30 and 60 mg Fe/d , respectively , regardless of initial assignment . Almost all the women received some supplemental iron during pregnancy . We obtained infant birth weight and gestational age at delivery for 117 and 96 of the 146 and 129 women r and omly assigned to receive iron and placebo , respectively . RESULTS Compared with placebo , iron supplementation from enrollment to 28 wk of gestation did not significantly affect the overall prevalence of anemia or the incidence of preterm births but led to a significantly higher mean ( + /- SD ) birth weight ( 206 + /- 565 g ; P = 0.010 ) , a significantly lower incidence of low-birth-weight infants ( 4 % compared with 17 % ; P = 0.003 ) , and a significantly lower incidence of preterm low-birth-weight infants ( 3 % compared with 10 % ; P = 0.017 ) . CONCLUSION Prenatal prophylactic iron supplementation deserves further examination as a measure to improve birth weight and potentially reduce health care costs BACKGROUND Iron deficiency anemia ( IDA ) is common in pregnant women , but previous trials aim ed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects . OBJECTIVE The objective was to assess the effect on  maternal IDA and iron deficiency ( ID , without anemia ) of supplementing pregnant women with a low dosage ( 20 mg/d ) of iron . Effects on iron status were assessed at the time of delivery and at 6 mo postpartum . Gastrointestinal side effects were assessed at 24 and 36 wk of gestation . DESIGN This was a r and omized , double-blind , placebo-controlled trial of a 20-mg daily iron supplement ( ferrous sulfate ) given from 20 wk of gestation until delivery . RESULTS A total of 430 women were enrolled , and 386 ( 89.7 % ) completed the follow-up to 6 mo postpartum . At delivery , fewer women from the iron-supplemented group than from the placebo group had IDA [ 6/198 , or 3 % , compared with 20/185 , or 11 % ; relative risk ( RR ) : 0.28 ; 95 % CI : 0.12 , 0.68 ; P < 0.005 ] , and fewer women from the iron-supplemented group had ID ( 65/186 , or 35 % , compared with 102/176 , or 58 % ; RR : 0.60 ; 95 % CI : 0.48 , 0.76 ; P < 0.001 ) . There was no significant difference in gastrointestinal side effects between groups . At 6 mo postpartum , fewer women from the iron-supplemented group had ID ( 31/190 , or 16 % , compared with 51/177 , or 29 % ; RR : 0.57 ; 95 % CI : 0.38 , 0.84 ; P < 0.005 ) . The rate of IDA between the groups did not differ significantly at 6 mo postpartum . CONCLUSION Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects BACKGROUND There is a growing interest in periconceptional iron supplementation in developing countries by research ers and policy makers ; however , there are no r and omized controlled trials that examine the effectiveness of this strategy in decreasing  anemia during pregnancy . OBJECTIVE The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy . DESIGN A r and omized , double-blind , controlled trial was conducted in rural Bangladesh . Married , nulliparous women were r and omly assigned to receive daily iron and folic acid ( IFA ; 60 mg ferrous fumarate and 400 microg folic acid ) ( n = 134 ) or folic acid ( FA ; 400 microg ) ( n = 138 ) in the form of a powdered supplement added to food . Women were followed until pregnancy or the end of 9 mo . Primary outcomes included hemoglobin , plasma ferritin , and plasma transferrin receptor concentrations . RESULTS Among 88 pregnant women , periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation . However , each 1 % increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline ( P = 0.03 ) , and those who initiated supplementation at a mean ( + /-SD ) time of 72.9 + /- 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 + /- 12.3 d after conception ( P = 0.01 ) . Among 146 nonpregnant women , IFA decreased anemia ( odds ratio : 0.19 ; 95 % CI : 0.04 , 0.95 ) and improved iron stores ( P = 0.001 ) more than did FA . CONCLUSION Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy . This trial was registered at www . clinical trials.gov as NCT00953134 Summary . Serum iron , serum iron‐binding capacity , serum ferritin and erythrocyte protoporphyrin were determined during uncomplicated pregnancy in 45 healthy women ; 22 were given oral iron  while the others were given a placebo . When iron was not given , 15 out of 23 women had exhausted iron stores and iron deficiency at term , as judged from low serum ferritin , low serum transferrin saturation and high erythrocyte protoporphyrin values . Only seven of them had a haemoglobin concentration between 10 and 11 g/dl at term but none had values < 10 g/dl . In the iron‐treated group ( n=22 ) none of the women developed iron deficiency . Serum ferritin was the most sensitive and specific test of iron deficiency . A practical procedure to detect iron deficiency and to control iron supplementation in pregnancy is suggested Eighty-one pregnant or lactating women living in a village in The Gambia were allocated to treatment groups to receive a daily placebo , riboflavin , ferrous sulphate or ferrous sulphate plus riboflavin . At the beginning of the study and at 3 and 6 weeks thereafter women were examined clinical ly and blood sample s collected for haematological and biochemical measurements . Pregnant women showed a wide range of response to supplement but among the lactating women an interesting pattern emerged : whereas the haematological status of the placebo group declined over 6 weeks , in the group receiving iron supplements this deterioration was reduced although not significantly . Riboflavin given in addition to iron result ed in a significant increase in circulating plasma iron and in iron stores , relative to the placebo The iron ( Fe ) nutritional status of 203 healthy pregnant women was assessed at the first prenatal visit ( To ) ( gestational age : 16.9 weeks + /- 3.81 . Women were r and omly assigned to one of three groups : G1 and G2 were supplemented with ferrous fumarate ( 60 mg elemental Fe ) daily or intermittently ( three times a week ) , respectively ; and GC was the control group , without supplementation . The follow up was carried out until 34 - 37 weeks of gestational age ( Tf ) , but only 43 % of pregnant women completed the trial . At To and Tf fasting blood sample s were collected and Hematocrit ( Hct ) , Hemoglobin ( Hb ) , Erythrocyte Protoporphyrin ( EP ) and Serum Ferritin ( FERR ) were determined . The percentage of women with abnormal biochemical values at To ( n = 203 ) was : Hb ( g/dl ) < 10.5 : 2.6 % ; PE ( microgram/dl of red blood cells ) > 70 : 4.8 % ; FERR ( ng/ml ) < 10 : 4.4 % . Results ( X + /- DE ) of women that completed the follow up were at To and Tf , respectively : Hct ( % ) : GC : 37.7 + /- 3.4 and 36.0 + /- 3.2 ( p < 0.05 ) ; G1 : 38.8 + /- 2.2 and 38.0 + /- 2.6 ; G2 : 39.0 + /- 2.7 and 37.7 + /- 3.7 ; Hb ( g/dl ) : GC : 12.5 + /- 1.2 and 11.9 + /- 1.3 ( p < 0.05 ) ; G1 : 12.6 + /- 1.1 and 12.8 + /- 1.1 ; G2 : 12.9 + /- 0.9 and 12.2 + /- 1.5 ; PE ( microgram/dl red blood cells ) : GC : 30 + /- 17 and 43 + /- 22 ( p < 0.01 ) ; G1 : 26 + /- 13 and 38 + /- 21 ( p < 0.01 ) ; G2 : 26 + /- 16 and 31 + /- 26 ; FERR ( ng/ml ) : GC : 75 + /- 67 and 31 + /- 49 ( p < 0.01 ) ; G1 : 46 + /- 34 and 19 + /- 10 ( p < 0.01 ) ; G2 : 43 + /- 11 and 11 + /- 7 ( p < 0.01 ) . These results show : a ) Fe administration was efficient to mitigate Hb decrease ; b ) Fe stores decreased during pregnancy regardless of Fe supplementation and frequency ; c ) EP values indicate that intermittent Fe administration was more efficient to maintain normal erythropoiesis The known increased need for iron during pregnancy appears to be met only in part by increased iron absorption and amenorrhea . Considerable dem and s are made on maternal iron stores and , since many women lack sufficient storage iron , pregnancy may be expected to cause iron deficiency . This may lead to anemia in pregnancy and post partum and could also have a bearing on the iron status of the fetus and the neonate . Based on these considerations , prophylactic supplementation of dietary iron is advocated but remains a disputed issue . In the present controlled , prospect i ve and longitudinal study changes in hematologic status , and in particular in iron stores , during pregnancy were investigated in 44 healthy Caucasian women with uncomplicated pregnancies and deliveries . They were r and omly assigned to a study group ( n = 21 ) receiving oral iron supplements from the 16th week of amenorrhea until 6 weeks post partum , and a control group ( n = 23 ) without iron supplementation .  Maternal concentrations of hemoglobin , serum iron , serum transferrin and serum ferritin were determined at 16 , 28 and 36 weeks of amenorrhea , at delivery , and 6 and 12 weeks post partum . The same variables were determined in cord blood . Iron supplementation appeared to prevent the physiologic fall in hemoglobin and serum iron concentrations which occurred in the control group , but had little influence on the observed rise in transferrin concentrations . Ferritin levels in serum , which are known to reflect mobilisable iron stores , fell to 30 % of the initial values in the control group and to 70 % in the study group . Six and 12 weeks post partum ferritin levels were still low in the nonsupplemented group ( Tab . I ) . ( ABSTRACT TRUNCATED AT 250 WORDS Background . The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component , prescribed for women in the second half of pregnancy OBJECTIVE To study the efficacy of iron supplementation during pregnancy and its influences on the outcome of pregnancy . METHODS A total of 369 pregnant women were enrolled in this study . According to the hemoglbin levels at recruitment , there were 2 groups : preventive ( Hb > or = 110 g/L ) and treatment ( Hb < 110 g/L ) groups . In the preventive group , women entered the study from 20 - 24 gestational weeks and were r and omly assigned to  materna treatment  ( n = 96 ) who took materna 1 tablet daily or control group ( n = 95 ) who took no other supplementation . In the treatment groups , women less than 36 gestational weeks were accepted . They were r and omly divided as materna ( n = 93 ) 1 tablet/d , ferrous sulfate 0.3 g tid/d ( n = 50 ) or Ferroids 1 tablet/d ( n = 35 ) groups . Both Hb and serum ferritin concentrations were determined at admission and immediately after delivery . In some cases serum ferritin in the umbilical vein were measured as well . Hemoglobin levels were examined every 4 weeks during the observational period . RESULTS In the preventive groups , maternal serum ferritin levels after materna treatment were significantly higher than that before treatment and the control group ( P < 0.05 ) . As for the anemia women , compared the serum ferritin concentration , materna treatment had significantly higher levels than that at admission ( P < 0.05 ) , and also higher than that in the ferrous sulfate or ferroids tratment groups ( P < 0.05 ) . The s-ferritin in the umbilical vein had no correlation with the paired maternal levels . There were no significant differences in the pregnancy outcomes among all the groups . CONCLUSION Materna can increase the iron storage and effectively improve the iron deficiency during pregnancy , and has no impact on the prgnancy outcomes Side-effects of iron supplementation lead to poor compliance . A weekly-dose schedule of iron supplementation rather than a daily-dose regimen has been suggested to produce fewer side-effects , thereby achieving a higher compliance . This study compared side-effects of iron supplementation and their impact on compliance among pregnant women in Bangladesh . These women were assigned to receive either weekly doses of 2 x 60 mg iron ( one tablet each Friday morning and evening ) or a daily dose of 1 x 60 mg iron .  Fifty antenatal care centres were r and omly assigned to prescribe either a  weekly- or a daily-supplementation regimen ( 86 women in each group ) . Side-effects were assessed by recall after one month of supplementation and used for predicting compliance in the second and third months of supplementation . Compliance was monitored using a pill bottle equipped with an electronic counting device that recorded date and time whenever the pill bottle was opened . Of five gastrointestinal side-effects ( heartburn , nausea , vomiting , diarrhoea , or constipation ) assessed , vomiting occurred more frequently in the weekly group ( 21 % ) than in the daily group ( 11 % , p<0.05 ) . Compliance ( ratio between observed and recommended tablet intake ) was significantly higher in the weekly-supplementation regimen ( 93 % ) than in the daily-supplementation regimen ( 61 % , p<0.05 ) . Overall , gastrointestinal side-effects were not significantly associated with compliance . However , the presence of nausea and /or vomiting reduced compliance in both the regimens-but only among women from the lower socioeconomic group . In conclusion , weekly supplementation of iron in pregnancy had a higher compliance compared to daily supplementation of iron despite a higher frequency of side-effects . The findings support the view that gastrointestinal side-effects generally have a limited influence on compliance , at least in the dose ranges studied . Efforts to further reduce side-effects of iron supplementation may not be a successful strategy for improving compliance and effectiveness of antenatal iron supplementation AIM To compare the hematological parameters and pregnancy outcome in women receiving daily versus weekly iron supplements during pregnancy . METHODS A prospect i ve r and omized controlled study was carried out at the Department of Obstetrics and Gynaecology of the All India Institute of Medical Sciences , New Delhi , India , during which 111 women were r and omized to receive either 100 mg elemental iron daily ( n=55 ) or 200 mg elemental iron weekly ( n=56 ) . Hemogram and serum ferritin level estimation were carried out at the beginning of pregnancy and within the 32 - 34-week period of gestation . Side-effects , compliance and the number of tablets consumed were noted for each group . The mean birth weight , period of gestation at delivery and mode of delivery were also compared between the two intervention groups . RESULTS There was no significant difference in the mean hemoglobin levels between the two intervention groups at the end of an average 17 weeks of iron supplementation . However , among anemic women who received daily supplementation , there was a greater rise in hemoglobin compared with those receiving supplementation weekly . The serum ferritin level was lower in the weekly supplemented group compared with that in the daily . There was no difference in the mean birth weight , period of gestation and mode of delivery between the two groups . Side-effects and non-compliance were significantly higher ( P<0.001 ) in the daily supplemented group . CONCLUSIONS Weekly iron supplementation is an effective option for prophylaxis in non-anemic pregnant women , but has less than optimal benefit in anemic women A W.H.O. sponsored collaborative study of the effects of iron supplementation to pregnant women was carried out in Delhi ( northern India ) and Vellore ( southern India ) . Supplementation was given under supervision from the 26th to the 36th or 38th week of pregnancy . A control group received only placebo ; one group received vitamin B12 and folic acid alone ; four groups received vitamin B12 , folate and a daily iron supplement ranging from 30 to 240 mg of elemental iron as ferrous fumerate , and one further group received 120 mg of iron without B12 or folate . Groups receiving no iron showed a fall in mean stet concentration . Those receiving iron showed a rise in haemoglobin , the best results being in the groups receiving 120 and 240 mg of iron together with vitamin B12 and folate . Even in these groups however there was still a high prevalence of anaemia and iron deficiency at the end of the trial period . Iron alone did not produce as good results as iron plus vitamin B12 and folate . The supplementation had no detectable effect on the birth weight of the children , nor on the haemoglobin concentration of the infants at three months of age . The daily absorption of iron in the pregnant women , as judged from the increase in haemoglobin mass , was not as satisfactory as expected . Possible reasons for this are discussed . It is concluded that to provide these women with adequate iron a daily oral supplementation of 120 mg of elemental iron or more is needed . This can only be achieved by medicinal means . Before supplementation can be recommended on a public health scale , further information regarding the cost and expected benefits of such measures must be obtained OBJECTIVE Our purpose was to study the effect of hematinic supplementation on the maternal erythropoietin response during singleton pregnancy . STUDY DESIGN In a r and omized , double-blind trial 97 patients with a first-trimester hemoglobin level > or = 14.0 gm/dl received either  iron and folic acid ( hematinic group , n = 53 ) or a placebo ( n = 44 ) .  Serial hemoglobin , hematocrit , and serum erythropoietin were recorded from maternal blood and from cord blood on delivery . Serum ferritin was measured in the first trimester , at 36 weeks ' gestation , and in cord blood . RESULTS In both groups ( 1 ) the mean hemoglobin was lower ( p < 0.01 ) at 40 weeks ' gestation than when first examined and ( 2 ) the mean serum erythropoietin was higher ( p < 0.01 ) . The mean serum ferritin was lower ( p < 0.001 ) in both groups at 36 weeks ' gestation than at presentation but higher ( p = 0.04 ) in the hematinic group than in the placebo group . The mean hemoglobin and hematocrit were similar in the two groups until the third trimester but thereafter were higher ( p < 0.05 ) in the hematinic group . The mean maternal serum erythropoietin was higher ( p < 0.05 ) in the placebo group than in the hematinic group after 24 weeks ' gestation . The mean cord blood hematologic values were similar in the two groups . CONCLUSION Maternal serum erythropoietin increased during pregnancy , but this response was reduced in the third trimester in the hematinic-supplemented group OBJECTIVE To assess and compare the efficacy and safety of two and three doses of intravenous iron sucrose with daily oral ferrous sulphate in the prophylaxis of iron deficiency anaemia in pregnant women . STUDY DESIGN 260 women with singleton pregnancy who met inclusion criteria and who gave informed consent were r and omised between the 21st and 24th week into either the intravenous iron group or the oral iron group . Of 130 women in the intravenous iron group , 75 women received two doses of 200 mg iron sucrose and 55 three doses of 200 mg iron sucrose . The first dose was administered between the 21st and 24th gestational weeks , the second between the 28th and 32nd and the third between the 35th and 37th . The women of the oral group were given oral tablets of 80 mg ferrous sulphate daily , beginning on the day of study enrolment and stopping on the day of delivery . RESULTS There was a non-significant trend to a higher frequency of responders ( haemoglobin > or = 11 g/dl ) in the intravenous iron group ( 75 vs. 80 % ) . There was a significant difference of repleted iron stores before delivery ( ferritin>50 microg/l ) in the group with three intravenous iron doses in comparison to the oral iron group ( 49 vs. 14 % ; p<0.001 ) . No differences were observed in regard to maternal and perinatal outcomes . CONCLUSIONS There was no clinical ly significant difference in the haematological , maternal and foetal outcomes in the parenteral route of iron prophylaxis in pregnant women A r and omized polycentric study was programmed to establish the effects of daily administration of ferritin iron from early pregnancy to puerperium . 254 women with normal iron balance at the beginning of their pregnancy were r and omized receiving no supplements or 40 mg iron daily . At the end of pregnancy iron balance was still normal only in one third of the pregnant women of the first group versus two third of the second group . 204 women who were iron-deficient received daily 40 or 120 mg of iron ; in this group anemia developed less frequently ( 13 % versus 29 % ) and iron balance normalized in one subject on four ; the great majority of these women remained iron-deficient . Unwanted effects of minimal or mild relevance , and almost always sporadic were observed in 6.5 % of cases and with the reduction or withdraw of the treatment in only 1.4 % of cases . These results showed that daily administration of ferritin iron during pregnancy is effective and well tolerated ; furthermore they suggest that the treatment must be done with at least 60 mg daily in women with normal iron balance and protracted also after the puerperium in iron deficient subjects BACKGROUND Iron deficiency is most commonly found in women of reproductive age and infants worldwide , but the influence of maternal iron deficiency on infant development is underexplored . OBJECTIVE The objective was to examine the relation between maternal iron status and mother-child interactions in a r and omized , double-blind , intervention trial conducted in South Africa . DESIGN Women were recruited into the study from a health clinic at 6 - 8 wk postpartum and were classified as either iron-deficient anemic ( IDA ) or iron-sufficient after blood analysis . IDA mothers received iron supplements of 125 mg FeSO(4 ) ( IDA-Fe ; n = 34 ) or placebo ( IDA-PL ; n = 30 ) daily from 10 wk to 9 mo postpartum . The control group ( n = 31 ) consisted of  iron-sufficient mothers . Free-play mother-child interaction sessions were videotaped in the clinic at 10 wk ( n = 80 ) and 9 mo ( n = 66 ) postpartum and coded per the Emotional Availability Scales ( 4 maternal scales : sensitivity , structuring , nonintrusiveness , and nonhostility ; 2 infant scales : responsiveness and involvement ) . RESULTS At 10 wk , scores for maternal sensitivity and child responsiveness were significantly greater in the control group than in the IDA groups ( P = 0.028 and 0.009 , respectively ) . At 9 mo , the control and IDA-Fe groups no longer differed . These 2 groups scored significantly better on the maternal sensitivity , structuring , and nonhostility scales and on the child responsiveness scale than did the IDA-PL group ( P = 0.007 - 0.032 ) , whose iron status remained low . CONCLUSION These data indicate that maternal iron deficiency negatively affects mother-child interactions and that iron supplementation protects against these negative effects OBJECTIVE The hypothesis that daily use of a prenatal supplement with iron from enrollment to third trimester to initially iron-replete , nonanemic pregnant women would reduce third-trimester anemia and improve birth outcomes was tested . STUDY DESIGN Eight hundred sixty-seven women in Raleigh , North Carolina , who were at < 20 weeks of gestation were enrolled ; 429 of these women had hemoglobin levels of > or = 110 g/L and ferritin levels of > or = 40 microg/L and were assigned r and omly to receive prenatal supplements with 30 mg of iron as ferrous sulfate ( n = 218 women ) or 0 mg of iron ( n = 211 women ) until 26 to 29 weeks of gestation . Intent-to-treat analysis was used for the outcomes of third-trimester iron status , birth weight , preterm birth , and small-for-gestational age . RESULTS Mean birth weight was higher by 108 g ( P = .03 ) , and the incidence of preterm delivery was lower ( 8 % vs 14 % ; P = .05 ) in the 30-mg group compared with the control group , respectively . Iron supplementation did not affect the prevalence of small-for-gestational age infants or third-trimester iron status . CONCLUSION Prophylactic iron supplementation that is begun early in pregnancy among low income women in the United States may have benefits beyond the reduction of iron deficiency anemia during pregnancy This trial compares routine and selective iron supplementation  during pregnancy to determine whether routine supplementation adversely affects fetal growth , increases infections and subjective adverse effects , and /or delays birth . At their first prenatal visit , 2912 pregnant women were r and omized into two groups ( 2694 gave birth ) . Compliance was satisfactory as measured by self-reports by mothers and hematocrit values in the third trimester . More women in the routinely supplemented group had subjected adverse effects . The groups were similar in regard to most of the other outcomes . In the selectively supplemented group , there was weak evidence for increase in sick-days , referrals to hospital outpatient clinic , cesarean section , blood transfusions , and infants who were diagnosed as having hyperviscosity . In the routine group , there were somewhat more women with gestations greater than or equal to 41 weeks and more dead infants . The subgroup analyses suggest that some of the apparently worse outcomes in the selective group were due to reactions of midwives and physicians to low hematocrit values The effect of iron supplementation , 66 mg elemental iron daily , from the 16th week of gestation to delivery , on iron status markers during uncomplicated pregnancies was assessed in a r and omised , double-blind , placebo controlled study of 207 healthy women ( 100 iron treated , 107 placebo treated ) and their newborn babies .  Haemoglobin ( Hb ) and serum ( S- ) human placental lactogen ( HPL ) were measured in all 207 females , while transferrin saturation , S-ferritin and S-erythropoietin ( EPO ) were measured in 120 females at monthly intervals . Hb : from 27th week of gestation to eight weeks post partum , the placebo treated group had significantly lower Hb levels than the iron treated group ( p less than 0.001 ) . Iron status markers : in the placebo group ( n = 57 ) , 92 % developed exhausted iron stores ( i.e. S-ferritin less than or equal to 20 micrograms/l ) , 65 % latent iron deficiency ( i.e. S-ferritin less than or equal to 20 micrograms/l and transferrin saturation less than 15 % ) , and 18 % iron deficiency anaemia ( i.e. S-ferritin less than or equal to 20 micrograms/l , transferrin saturation less than 15 % and Hb less than 110 g/l ) . In the iron treated group ( n = 63 ) , 54 % developed exhausted iron stores , 6 % latent iron deficiency , and none iron deficiency anaemia . S-EPO : the placebo group had significantly higher values than the iron treated group from the 27th week of gestation to one week post partum ( p less than 0.01 ) . S-HPL : levels were identical in placebo and iron treated females . Babies of iron treated mothers had higher S-ferritin than babies of placebo treated mothers ( p less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS A r and omized , double-blind , placebo-controlled community-based trial of oral iron supplementation ( 200 mg ferrous sulphate daily ) administered to multigravid pregnant women by traditional birth attendants ( TBAs ) was carried out in a rural area of The Gambia .  Iron supplementation led to a significant reduction in the prevalence of anaemia and of iron deficiency .  Iron supplementation was not accompanied by increased susceptibility to malaria infection ; there was no difference in the prevalence and severity of peripheral blood or placental malaria infection between the 2 groups of women . The birth weight of children born to women who received iron prophylaxis was increased by an average of 56 g. It is concluded that oral iron prophylaxis can be successfully delivered through TBAs integrated into a primary health care programme . This simple intervention can produce significant beneficial effects on the health of the mother without inducing increased susceptibility to malaria and has the potential for reducing perinatal mortality by increasing birth weight BACKGROUND Community iron supplementation programmes for pregnant women have lacked effectiveness , partly because of low compliance . OBJECTIVE To determine factors that influence compliance among pregnant women in Senegal . DESIGN Two hundred and twenty-one pregnant women , recruited from six health centres in Dakar during their first prenatal visit , were r and omly assigned to receive either a prescription to purchase iron/folic acid tablets ( control , n = 112 ) to be taken daily , according to official policy , or to receive free tablets ( treatment , n = 109 ) . Compliance was assessed 20 weeks after enrollment through interviews and pill count . Women with low or high compliance ( < 70 % or > or=70 % ) were asked to explain what influenced their adherence to supplementation . RESULTS Overall compliance was 69 % ; it was significantly higher in the treatment than in the control group ( 86 % vs. 48 % ; P < 0.0001 ) . Women with high compliance ( 58 % ) were motivated by : ( 1 ) the perception of improved health upon taking the tablets ( treatment = 24 % , control = 10 % ) ; ( 2 ) the insistence by midwives that they take the tablets ; and ( 3 ) the mention that the tablets would improve health . Women with low compliance ( 42 % ) reported : ( 1 ) the experience of side-effects that they associated with the tablets ( treatment = 13 % , control = 14 % ) ; ( 2 ) misunderst and ing that they needed to continue taking the tablets throughout pregnancy ( treatment = 0 % , control = 18 % ) ; and ( 3 ) forgetfulness . CONCLUSION Compliance with iron/folic acid supplementation in Senegal can be increased by providing women with clear instructions about tablet intake and educating them on the health benefits of the tablets It is evident that intermittent iron supplementation is better than daily supplementation in two aspects : iron absorption is more efficient and has insignificant side effects in contrast to the daily dose . The significantly higher daily iron loss observed in the daily iron supplemented groups rats also suggests alterations in total body iron metabolism . Based on serum ferritin distribution patterns , intermittent iron supplementation avoids temporary iron overload with daily iron supplemented . We conclude that weekly iron supplementation scheme is safer and easier to administer . This feasible strategy for the control of iron  deficient anemia  in pregnant women and children would be an effective iron-supplementation program ( Baily et al. , 1993 ) This study was planned to determine whether iron deficiency in pregnancy predisposed to the development of folate deficiency and also the smallest daily iron supplement that maintained haemoglobin levels in pregnancy . Three groups of women were given oral ferrous fumarate supplying 30 , 60 , and 120 mg of iron ;  a fourth group was given 1 g of parenteral iron in early pregnancy followed by oral iron ( 60 mg ) ; a fifth group received a placebo . Tablets were taken once daily . Oral iron 30 mg once daily maintained haemoglobin levels throughout pregnancy . Women whose marrows lacked demonstrable iron at the 37th week had a significantly higher incidence of megaloblastic haemopoiesis ( 28·7 % ) than those with demonstrable iron stores ( 15·3 % ) ; women taking oral iron did not have a lower frequency of megaloblastosis than those given a placebo . We concluded that iron does not have a direct effect on folate status in pregnancy , that the association of iron deficiency and megaloblastic anaemia in pregnancy is the result of poor nutrition , and that there is no cause- and -effect relation between them An iron supplementation trial versus placebo was performed in double blind on 191 attending at 3 month the antenatal clinic of Poissy maternity . Iron status of mothers and newborns was assessed at 3 , 5 , 7 month , during the delivery and 2 months after the delivery , using biochemical indicators ( hemoglobin level , serum ferritin ) . The compliance was good in 165 pregnant women ( 86 % of the initial sample ): 81 in the iron group , 84 in the placebo group . Among the placebo group , anemia ( Hb less than 11 g/dl ) was observed at the end of the pregnancy in 30 % of women . Depletion of iron stores started at 5 month . In the iron group , hemoglobin level increased significantly during the pregnancy and anemia was observed only in 3 % of women at the delivery . Iron status of newborns and two months after delivery was related to mothers iron status at delivery and particularly at the 7th month of pregnancy OBJECTIVE To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia  and to evaluate the association of maternal hemoglobin and fetal growth . DESIGN Prospect i ve . SETTING Tertiary care teaching hospital in an urban metropolis . METHOD 40 pregnant women received daily and 40 pregnant women received weekly oral therapy ( 335 mg of ferrous sulphate and 500 g folic acid ) for a period of 14 weeks . The age of each pregnant woman and their baseline anthropometric data ( weight , height and body mass index ) were estimated . Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks , 8 wks and 14 weeks . Serum ferritin values as a marker of iron status were also calculated in both the groups initially , at 14 weeks and at the time of delivery . Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration . RESULTS Forty subjects each were initially r and omized into groups I and II . The age of pregnant women along with their baseline anthropometric data were similar in both groups . A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up . The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers . An intention to treat analysis also showed similar results . The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy . Birth weight , crown heel length , head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels . CONCLUSION Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth Objective . To determine the lowest dose of iron preventative of iron deficiency and iron deficiency anemia in pregnancy BACKGROUND We undertook this study to compare the effectiveness and safety of antenatal daily and weekly supplementation with iron , folic acid , and vitamin B(12 ) in healthy , pregnant women who were not anemic at gestational week 20 . METHODS Women with singleton pregnancies and blood hemoglobin ( Hb ) > 115 g/L at gestational week 20 ( equivalent to 105 g/L at sea level ) were r and omly assigned to two groups , one consuming one tablet containing 60 mg iron , 200 mug folic acid and 1 mug vitamin B(12 ) daily ( DS , n = 56 ) ; the other consuming two tablets once weekly ( WS , n = 60 ) . Blood Hb and serum ferritin concentrations were measured every 4 weeks from weeks 20 to 36 , and pregnancy outcomes were evaluated . RESULTS Mild anemia and hypoferritinemia throughout pregnancy occurred less frequently in DS than WS . None of the 116 women had Hb concentrations < 103 g/L at any evaluation point . In contrast , hemoconcentration ( Hb > 145 g/L ) from gestational week 28 onwards occurred in 11 % in DS and 2 % in WS . We observed ex post facto that hemoconcentration at gestational week 28 was associated with a significantly higher relative risk of low birth weight ( RR 6.23 , 95 % CI 1.46 - 26.57 ) and premature delivery ( RR 7.78 , 95 % CI 1.45 - 24.74 ) . CONCLUSIONS In women who were nonanemic at gestational week 20 , both schemes ( DS and WS ) prevented the occurrence of Hb levels < 100 g/L. DS women had a higher incidence of hemoconcentration . Hemoconcentration was associated with increased risk of low birth weight and premature delivery A total of 418 pregnant women at 16 - 24 wk of gestation , from six subcentres of a rural block of Varanasi district were selected . Pregnant women ( 137 of 215 ) from 3 subcentres received the supplementation of 60 mg elemental iron as ferrous sulphate combined with 500 micrograms folic acid , daily for 100 days ( study group ) and 123 ( of 203 ) pregnant women from the other 3 subcentres  without supplementation ( control group ) could be evaluated for their pregnancy outcome . The haemoglobin and serum ferritin levels increased significantly in the study group . In the latter , the mean birth weight was 2.88 + /- 0.41 kg with low birth weight incidence of 20.4 per cent as compared to the control figures of 2.59 + /- 0.34 kg and 37.9 per cent respectively . The incidence of low birth weight was further reduced to 12.1 per cent if the supplementation could be started by 16 - 19 wk of gestation OBJECTIVE To study the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ( Hb ) > or = 13.2 g/dl . DESIGN A r and omised , double-blind , placebo-controlled trial . SETTING Routine health services . POPULATION Seven hundred and twenty-seven pregnant women with Hb > or = 13.2 g/dl in the early stage of the second trimester . METHODS Each woman took one ferrous sulphate [ DOSAGE ERROR CORRECTED ] tablet ( 150 g tablet , containing 50 mg of elemental iron ) [ DOSAGE ERROR CORRECTED ] daily in the case group ( n = 370 ) or placebo in the control group ( n = 357 ) throughout pregnancy . MAIN OUTCOME MEASURES Pregnancy outcome . RESULTS While there were no significant differences in demographic and obstetric characteristics between the two groups before any intervention , small-for-gestational-age birth rate and the number of women with hypertension disorder increased significantly in the case group in comparison with the control group ( 57 [ 15.7 % ] versus 36 [ 10.3 % ] , P = 0.035 , 10 [ 2.7 % ] versus 3 [ 8 % ] , P = 0.05 , respectively ) . CONCLUSIONS Our finding proves that routine iron supplementation in nonanaemic women is not rational and may be harmful Hemoglobin ( Hb ) concentration , serum iron level , iron binding capacity and blood folate ( Lactobacillus casei ) activity were determined in 310 unselected pregnant Burmese women .  Hb concentration was less than 11 g/dl in 72 % of the women ; the serum iron level was less than 50 mug/dl in 33 % ; serum folate activity was less than 3ng/ml in 13 % ; and red cell folate activity was less than 100 ng/ml in 17 % of the women . Ninety-six of the women in our study were r and omly divided into four groups , treated from the 22nd to the 25th week of pregnancy until full term with either ferrous sulfate containing 60 mg elemental iron twice daily , 5 mg folic acid twice daily , a combination of both , or a placebo only . At full term , Hb concentration fell in the groups given placebo or folic acid . On the other h and , in the groups given iron alone or iron plus folic acid there was an increase in Hb of 0.4 and 0.7 g/dl , respectively ( intergroup difference not statistically significant ) . Serum iron and blood folate levels fell in the groups not receiving the appropriate hematinic . In spite of deficient serum and red cell folate levels in 30 and 40 % , respectively , of the group on iron alone , the mean Hb concentration increased at full term and none of the women had a Hb concentration lower than 10 g/dl . Blood folate levels were lower in the iron-supplemented group than in the placebo group , indicating that iron deficiency does not aggravate the folate nutritional status Iron ( Fe ) deficiency and anemia during pregnancy remain highly prevalent in Senegal because of low compliance with Fe supplementation . Improving women 's access to supplements may increase compliance . Six prenatal centers in Dakar were r and omly assigned to either a control group in which women received routine prenatal visits , including prescriptions to purchase iron/folic acid tablets ( IFA ) according to the guidelines of the current Senegalese supplementation program ( n=112 ) , or to an intervention group in which women received free IFA ( n=109 ) in addition to routine prenatal care . Compliance was assessed 20 weeks after enrollment by pill count and interviews . Hemoglobin , erythrocyte protoporphyrin and serum ferritin were measured at baseline and follow-up . Compliance was 48 % and 86 % in the control and intervention groups , respectively ( P<0.001 ) . After adjustment for confounding , prevalence of anemia was 62 % in the control group versus 31 % in the intervention group ( P<0.001 ) ; prevalence of Fe deficiency was 49 % and 21 % in the control and intervention groups , respectively ( P<0.001 ) . Improving access to IFA for pregnant women visiting health centers could dramatically increase their compliance , improve Fe status and decrease the incidence of anemia
target: Conclusion Applying the CHERG rules , we recommend a 73 % reduction in anemia at term with daily iron ( alone ) supplementation or iron/folate ( combined ) vs. no intervention or placebo ; for inclusion in the LiST model .
background: Introduction Iron deficiency is the most prevalent nutrient deficiency in the world , particularly during pregnancy .
  According to the literature , anemia , particularly severe anemia , is associated with increased risk of maternal mortality .
  It also puts mothers at risk of multiple perinatal complications .
  Numerous studies in the past have evaluated the impact of supplementation with iron and iron-folate but data regarding the efficacy and quality of evidence of these interventions are lacking .
  This article aims to address the impact of iron with and without folate supplementation on maternal anemia and provides outcome specific quality according to the Child Health Epidemiology Reference Group ( CHERG ) guidelines .