The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. Vitamin A and iron status are improved by vitamin A and iron supplementation in pregnant Indonesian women. Evaluation of a gastric delivery system for iron supplementation in pregnancy. 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. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Hemoglobin as a predictor of response to iron therapy and its use in screening and prevalence estimates. 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. Serum zinc changes due to iron supplementation in teen-age pregnancy. Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations The impact of maternal anemia on perinatal mortality: a population-based, prospective cohort study in China. Effect of oral iron supplementation during pregnancy on maternal and fetal iron status World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme. A randomized trial investigating an iron-rich natural mineral water as a prophylaxis against iron deficiency in pregnancy. Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence from a large-scale community-based clinical trial. Iron supplementation in pregnancy: is less enough? Supplementation of iron alone and combined with vitamins improves haematological status, erythrocyte membrane fluidity and oxidative stress in anaemic pregnant women. Prospective cohort study of factors influencing the relative weights of the placenta and the newborn infant Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Haematinic treatment of anaemia increases the risk of Plasmodium vivax malaria in pregnancy. Iron supplementation during pregnancy W.H.O. sponsored collaborative studies on nutritional anaemia in India. 1. The effects of supplemental oral iron administration to pregnant women. Prevention of iron deficiency anemia in adolescent and adult pregnancies. Maternal erythropoietin in singleton pregnancies: a randomized trial on the effect of oral hematinic supplementation. Maternal Hemoglobin and Risk of Gestational Diabetes Mellitus in Chinese Women Iron supplementation increases prevalence and effects of malaria: report on clinical studies in Papua New Guinea. [Therapy and iron supplements with ferritin iron during pregnancy. Randomized prospective study of 458 cases]. ABSORPTION OF SUPPLEMENTAL IRON DURING PREGNANCY‐A LONGITUDINAL STUDY WITH REPEATED BONE‐MARROW STUDIES AND ABSORPTION MEASUREMENTS Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose–response trial The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia Stillbirths in an urban community in Pakistan. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial The effectiveness of weekly iron supplementation regimen in improving the iron status of Chinese children and pregnant women. Hemoglobin concentration in pregnancy and perinatal mortality: a London-based cohort study. [Prevention of iron-deficiency anemia in pregnancy using early iron supplementation: a controlled trial]. Chloroquine prophylaxis, iron/folic-acid supplementation or case management of malaria attacks in primigravidae in western Uganda: effects on congenital malaria and infant haemoglobin concentrations. Iron prophylaxis during pregnancy – How much iron is needed? A randomized dose– response study of 20–80 mg ferrous iron daily in pregnant women Routine iron supplementation in pregnancy has no effect on iron status of children at six months and four years of age. The effects of iron supplementation on serum copper and zinc levels in pregnant women with high-normal hemoglobin. A prophylactic trial of iron and folic acid supplements in pregnant Burmese women. Milk Fortif Ed with Iron Or Iron Supplementation to Improve Nutritional Status of Pregnant Women: An Intervention Trial from Rural Vietnam Hemoglobin changes during pregnancy and growth disturbances in the neonate Maternal zinc during oral iron supplementation in pregnancy: a preliminary study. Haematologic parameters and pregnancy outcome. A prospective cohort study in the third trimester.
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 In Indonesia , deficiencies of vitamin A and iron are of public health concern during pregnancy . We sought to determine the effects of vitamin A and iron supplementation on the vitamin A and iron status of pregnant Indonesian women . The women ( n = 27 ) were r and omly assigned to four groups . The modified relative dose response ( MRDR ) test for vitamin A status and hemoglobin , hematocrit and ferritin values were determined at baseline . Thereafter , daily supplements were administered : placebo [ Pl ] ( n = 7 ) , 8.4 micromol vitamin A [ A ] ( n = 7 ) , 1.07 mmol iron [ Fe ] ( n = 5 ) , and 8.4 micromol vitamin A plus 1.07 mmol iron [ A + Fe ] ( n = 8) . Post-treatment tests were performed after 8 wk . The MRDR value was reduced , i.e. , vitamin A status improved , more markedly by the combination of vitamin A and iron than by either nutrient alone ( P = 0.034 ) . The decrease in the MRDR relative to baseline was significant in the A + Fe group ( P = 0.008 ) . Iron status was also significantly improved in these women ( P < 0.05 ) with both iron and vitamin A supplementation . The mechanism of the enhancing effect of iron on the vitamin A-induced reduction in the MRDR is not known 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 r and omly 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 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 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 The use of hemoglobin as a predictor of response to iron therapy , for screening , and for prevalence estimates was studied . An Fe supplementation trial was performed in Quito , Ecuador , in which 412 pregnant women were r and omly assigned to treatment and control groups . Women in the treatment group received 390 mg ferrous sulfate/d for 2 mo . The prevalence of Fe deficiency as defined by response to therapy was found to be 60.8 % . Sensitivity and specificity were calculated at various cutoff points of hemoglobin . The estimates of sensitivity and specificity allow for the use of hemoglobin in screening for Fe deficiency anemia and in the estimation of the prevalence in population s with characteristics similar to those found in the sample of pregnant women in Quito . Hemoglobin was shown to be a good predictor of response to Fe treatment and a good estimate of prevalence of Fe deficiency when prevalence is high 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 Serum zinc and iron concentrations in a group of pregnant teen-agers supplemented with a multivitamin  were compared during pregnancy with a group supplemented with a multivitamin containing 18 mg Fe . Serum measurements were at 13 wk of gestational age ( pre study ) and during supplementation at 20 , 32 , and 38 wk , delivery , and 4 and 12 wk postpartum . Hematocrit measurements were used to adjust the measured metal concentrations for the diluting effect of the normal blood-volume increase . The non-Fe-group mean , adjusted serum Zn concentrations showed no change , but the serum Fe decreased to 28 % below pre study concentrations at 38 wk . In contrast , the Fe-supplementation group showed a progressive increase in Fe concentrations to a maximum of 38 % above pre study concentrations at 4 wk postpartum and a 35 % decrease from pre study Zn concentrations during the third trimester . The results of this study suggest that 18 mg Fe/d is adequate supplementation for nonanemic teen-age pregnancy and depresses the serum Zn concentration 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 PURPOSE To evaluate whether anemia during pregnancy is associated with increased risk of stillbirth and neonatal death . METHODS A prospect i ve cohort study , using data from a population -based pregnancy-monitoring system in 13 counties in East China ( 1993 - 1996 ) was conducted . Singleton live births ( n=163,313 ) and stillbirths ( n=1,354 ) delivered at 20 to 44 weeks to women with one or more hemoglobin measures during pregnancy were included . Stillbirth and neonatal mortality rates by anemia status in each trimester were estimated . Multivariable Cox proportional hazards regression models were used to evaluate the association between hemoglobin levels and mortality risk . RESULTS The stillbirth rates were 6.2 and 9.2 per 1,000 births in women with and without anemia ( hemoglobin < 10 g/dL ) , respectively . The protective effect of anemia was mainly in the third trimester . Hemoglobin of 9 g/dL in the third trimester was associated with reduced risk ( hazard ratio [ HR ] , 0.8 ; 95 % confidence interval [ CI ] , 0.7 - 0.97 ) . Maternal anemia was not associated with neonatal mortality . CONCLUSIONS Although maternal anemia was not associated with increased risk of mortality in the neonatal period , women with anemia during the third trimester had lower risk of stillbirth 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 As part of the Safe Motherhood Initiative , launched in 1987 , the World Health Organization have produced and promoted a partograph with a view to improving labour management and reducing maternal and fetal morbidity and mortality . This partograph has been tested in a multicentre trial in south east Asia involving 35,484 women . Introduction of the partograph with an agreed labour-management protocol reduced both prolonged labour ( from 6.4 % to 3.4 % of labours ) and the proportion of labours requiring augmentation ( from 20.7 % to 9.1 % ) . Emergency caesarean sections fell from 9.9 % to 8.3 % , and intrapartum stillbirths from 0.5 % to 0.3 % . Among singleton pregnancies with no complicating factors , the improved outcome was even more marked , with caesarean sections falling from 6.2 % to 4.5 % . The improvements took place among both nulliparous and multiparous women . The World Health Organisation partograph clearly differentiates normal from abnormal progress in labour and identifies those women likely to require intervention . Its use in all labour wards is recommended Spatone Iron-Plus is a naturally occurring mineral water from Trefriw Wells Spa in Conwy County , North Wales , UK . It contains approximately 0.20 mg of iron per millilitre as ferrous sulphate and has been shown to provide iron in a highly bio-available form . A 24 ml sachet contains approximately 5 mg of iron . Iron deficiency is common in the obstetric population . However , compliance with traditional iron supplements is poor because of gastrointestinal side-effects . We design ed a r and omized , double-blind , placebo-controlled trial . A total of 102 low-risk antenatal patients , who were noncompliant with routinely prescribed ferrous sulphate tablets  , were r and omized to receive 48 ml of Spatone water or placebo . The study was conducted between 22 and 28 weeks gestation . Primary outcome measures were compliance , gastrointestinal side-effects and changes in ferritin levels during the trial period . Compliance in the intervention group was 57 % compared with 67 % in the control group , P = 0.22 . Dyspepsia scores , as determined by a recognized and well-vali date d question naire , did not differ between the two groups . During the trial period , mean ferritin levels fell by 24 % in the Spatone Iron-Plus group compared with a mean fall of 51 % in ferritin levels among the control group , P = 0.016 Perinatal mortality is very high in Bangladesh . In this setting , few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes . We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur , a suburban area of Dhaka in Bangladesh , to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy . A total of 2007 women were followed after recruitment up to delivery , maternal death , or until they dropped out of the study . Of these , 1584 who gave birth formed our study subjects . The stillbirth rate was 39.1 per 1000 births [ 95 % confidence interval ( CI ) 39.0 , 39.3 ] and the perinatal mortality rate ( up to 3 days ) was 54.3 per 1000 births [ 95 % CI 54.0 , 54.6 ] among the study population . In the fully adjusted logistic regression model , the risk of perinatal mortality was as high as 2.7 times [ 95 % CI 1.5 , 4.9 ] more likely for women with hypertensive disorders , 5.0 times [ 95 % CI 2.3 , 10.8 ] as high for women who had antepartum haemorrhage and 2.6 times [ 95 % CI 1.2 , 5.8 ] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts . The inclusion of potential confounding variables such as poor obstetric history , sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality . Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy . The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies , calling for the specific components of the safe motherhood programme interventions that are design ed to manage these complications of pregnancy 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 Pregnancy is a condition exhibiting increased susceptibility to oxidative stress , and Fe plays a central role in generating harmful oxygen species . The objective of the present study is to investigate the changes in haematological status , oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins .  The study was a 2 months double-blind , r and omised trial . Pregnant women ( n 164 ) were allocated to four groups : group C was the placebo control group ; group I was supplemented daily with 60 mg Fe ( ferrous sulphate ) daily ; group IF was supplemented daily with Fe plus 400 μg folic acid ; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin , respectively . After the 2-month trial , Hb significantly increased by 15.8 , 17.3 and 21.8 g/l , and ferritin by 2.8 , 3.6 and 11.0 μg/l , in the I , IF and IM groups compared with placebo . Polarisation ( ρ ) and microviscosity ( η ) decreased significantly in other groups compared with placebo , indicating an increase in membrane fluidity . Significant decreases of ρ and η values compared with group C were 0.033 and 0.959 for group I , 0.037 and 1.074 for group IF and 0.064 and 1.865 for group IM , respectively . In addition , significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups , as well as increases of plasma retinol and urine riboflavin in group IM . The findings show that supplementation with Fe and particularly in combination with vitamins  could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity Abstract Objectives : To determine the demographic , environmental , and medical factors that influence the relative weights of the newborn infant and the placenta and compare this ratio with other factors known to predispose to adult ill health . Design : Prospect i ve cohort study . Setting : The tertiary referral centre for perinatal care in Perth , Western Australia . Subjects : 2507 pregnant women who delivered a single live infant at term . Main outcome measures : Placental weight , birth weight , and the ratio of placental weight to birth weight . Results : By multiple regression analysis the placental weight to birthweight ratio was significantly and positively associated with gestational age , female sex , Asian parentage , increasing maternal body mass index , increased maternal weight at booking , lower socioeconomic status , maternal anaemia , and increasing number of cigarettes smoked daily . There were no consistent relations between the placental weight to birthweight ratio and measures of newborn size . Conclusions : The ratio of placental weight to birth weight is not an accurate marker of fetal growth . In its role as a predictor of adult disease the ratio may be acting as a surrogate for other factors which are already known to influence health and may act before or after birth . Determining the role that relative growth rates of the fetus and placenta have in predisposing to adult disease requires prospect i ve study to account for the many confounding variables which complicate this hypothesis . Key messages Retrospective analyses have identified an association between a raised placental weight to birthweight ratio and hypertension in adulthood Accurate estimation of gestational age is crucial when interpreting the placental weight to birthweight ratio Environmental factors associated with alterations in the placental weight to birthweight ratio may not exert their effects exclusively in the antenatal period As a marker of fetal growth the potential usefulness of the placental weight to birthweight ratio is diminished because the ratio is influenced by a multiplicity of factors Prospect i ve study is required to clarify the role of intrauterine programming in the genesis of adult This paper addresses two questions : 1 ) What is the relation of hemoglobin in the second gestational month to preterm birth and low birth weight ? 2 ) How does the relation differ when hemoglobin in the fifth or eighth month or the lowest pregnancy hemoglobin are examined in place of first trimester values ? These relations were examined prospect ively in 829 women from Shanghai , China in 1991 - 1992 . The population was nearly homogeneous by race , parity , antenatal care , and smoking .  Rates of birth outcomes were compared between hemoglobin categories based on 10 g/liter groupings , with 110 - 119 g/liter as the reference group . Rates of low birth weight and preterm birth ( but not small-for-gestational age ) were related to early pregnancy hemoglobin concentration in a U-shaped manner . The relative risks ( 95 % confidence intervals ) for preterm birth in women by g/liter of hemoglobin were 2.52 ( 0.95 - 6.64 ) for > or = 130 g/liter , 1.11 ( 0.41 - 2.99 ) for 120 - 129 g/liter , 1.64 ( 0.77 - 3.47 ) for 100 - 109 g/liter , 2.63 ( 1.17 - 5.90 ) for 90 - 99 g/liter , and 3.73 ( 1.36 - 10.23 ) for 60 - 89 g/liter . Use of  hemoglobin values in the fifth or eighth month attenuated the association with preterm birth . When lowest pregnancy hemoglobin values were used , the association of anemia with both outcomes was obscured , and risk of preterm birth at high hemoglobin values increased dramatically Nutritional deficiency and malaria are 2 major causes of anaemia during pregnancy in tropical areas . The relationship between anaemia , its treatment with iron and folate , and malaria was studied in a prospect i ve cohort of 2112 pregnant Karen women on the north-western border of Thail and between 1993 and 1997 . The development of Plasmodium vivax malaria was associated with a past mean haematocrit > 30 % ( hazard ratio = 1.5 , 95 % CI 1.2 - 2 , P = 0.001 ) and recent ( < or = 30 d ) iron and folate supplementation ( hazard ratio = 1.7 , 95 % CI 1.1 - 2.6 , P = 0.01 ) . There were no associations with P. falciparum infections . Plasmodium vivax has a predilection for young erythrocytes , and these results suggest that pregnant women with larger numbers of circulating young red cells are at greater risk of developing P. vivax malaria . In P. vivax-endemic areas , systematic iron and folate supplementation confers both benefit and risk in pregnancy 192 pregnant women were consecutively r and omized to either a vitamin‐mineral pill or a vitamin mineral pill with a high iron content in a prospect i ve , open , r and omized investigation . The participants were advised about iron‐rich foodstuffs twice during pregnancy . Iron status of the mother proved to be without any significance for the outcome of pregnancy . A serum ferritin level of 80 pmol/l in mid‐pregnancy followed by a control in the last trimester was suggested as a guide in deciding of whether or not to prescribe supplementary iron during pregnancy 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 Worldwide attention over iron deficiency anemia ( IDA ) in pregnancy has shifted recently from providing supplements during pregnancy to attempting to ensure that women , especially adolescents , have adequate iron stores prior to conception . We sought to determine whether adolescent and /or adult women still need supplements during pregnancy to avoid IDA , even if iron stores are adequate , and whether the IDA translates into maternal and /or infant morbidity and mortality . DESIGN R and omized , double-blind clinical trial with placebo control . SETTING Multicenter clinic setting in central Wisconsin . PARTICIPANTS Adolescent women 18 years or less in their first pregnancy , and adult women 19 years or older , who were found to be healthy and iron sufficient at their first prenatal visit . METHODS Participants were r and omized to receive iron supplementation ( 60 mg/day elemental iron ) or placebo .  Serum ferritin of 12 ng/mL or less with simultaneous hemoglobin of 11 g/dL or less defined IDA . When IDA occurred at the second trimester , a therapeutic supplement of 180 mg of elemental iron per day was initiated . RESULTS Forty-seven percent of all placebo-supplemented and 16 % of all iron-supplemented patients exhibited IDA ( p<0.001 ) ; 59 % of adolescent placebo-supplemented and 20 % of adolescent iron-supplemented patients exhibited IDA ( p=0.021 ) . Nausea , vomiting , diarrhea , and constipation were not significantly different in the iron supplemented group compared to the placebo group , and no significant differences were seen in maternal or neonatal health , but the number of women studied was limiting for analysis of these adverse events . CONCLUSION IDA is common in healthy , iron-sufficient adolescent pregnant women during the second trimester , and body stores of iron decline in both adolescent and adult pregnancies . The incidence of IDA during adolescent and adult pregnancies is substantially reduced with 60 mg of elemental iron per day . However , there remains no clear evidence that maternal or neonatal health will benefit from correcting these deficits 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 examine the relationship between high maternal hemoglobin concentration at the initial antenatal visit and occurrence of  gestational diabetes mellitus ( GDM ) in the third trimester in nonanemic women . METHODS In a prospect i ve observational study , 762 nondiabetic Chinese women with singleton pregnancies , whose initial visit hemoglobin concentration and mean cell volume were 10 g/dL or more and 80 fL or more , respectively , recruited at 28–30 weeks , had blood drawn for repeat measurement of hemoglobin concentration and iron parameters . These women were categorized by their initial visit hemoglobin concentration into quartiles , and the incidence of GDM was analyzed together with the maternal characteristics and iron status . RESULTS The final study sample comprised 730 women . Compared with the rest , the group in the highest hemoglobin quartile ( more than 13 g/dL ) had a significantly higher incidence of GDM ( 18.7 % versus 10.9 % , P = .007 ) , as well as greater age , weight , and serum ferritin and iron concentrations . Logistic regression was used to examine the effects of high body mass index ( more than 25 kg/m2 ) , advanced age ( older than 34 years ) , parity of 1 or more , and hemoglobin in the highest quartile , on the incidence of GDM . Only advanced age ( odds ratio 3.79 , 95 % confidence interval 2.33 , 6.17 ) and hemoglobin in the highest quartile ( odds ratio 1.73 , 95 % confidence interval 1.08 , 2.78 ) emerged to be significant factors . CONCLUSION A high maternal hemoglobin ( more than 13 g/dL ) at the initial prenatal visit in Chinese women is an independent risk factor for GDM . This may reflect a better nutritional status in these women , as suggested by the increased iron status A placebo-controlled trial of intramuscular iron dextran prophylaxis for two-month-old infants was carried out on the north coast of Papua New Guinea where there is high transmission of malaria . The results indicate that the  placebo  group became relatively iron deficient whereas the iron dextran group had adequate iron stores and , in the absence of malaria , a higher mean haemoglobin . However in the iron dextran group there was a higher prevalence of malaria , as judged by parasite and spleen rates at 6- and 12-month follow-up ; a lower haemoglobin associated with malaria when compared with the placebo group and a greater reticulocytosis in response to malaria infection . Within the placebo group it was noticed that the malaria rates were lower at follow-up in those infants who had had a low birth haemoglobin . In neither group was there apparent suppression of marrow activity in the presence of malaria . Malaria infection in both groups was associated with a significantly raised serum ferritin level and transferrin saturation . Over-all these data give evidence for a protective role of iron deficiency against malaria and would argue against the injudicious use of iron replacement in areas where malaria is endemic 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 Abstract . Iron absorption , bone‐marrow smears and haematological parameters were repeatedly studied during pregnancy in 50 women . The same studies were repeated two months after delivery . The material was r and omly divided into two groups . Twenty‐four women were treated with 200 mg of ferrous iron daily while 26 were given placebo . The iron absorption was measured from radioiron‐labelled test doses of 100 mg ferrous iron in a whole‐body counter with high sensitivity BACKGROUND Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa . However , there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful . METHODS We did a r and omised , placebo-controlled trial , of children aged 1 - 35 months and living in Pemba , Zanzibar . We assigned children to daily oral supplementation with : iron ( 12.5 mg ) and folic acid ( 50 mug ; n=7950 ) , iron , folic acid , and zinc ( n=8120 ) , or placebo ( n=8006 ) ; children aged 1 - 11 months received half the dose . Our primary endpoints were all-cause mortality and admission to hospital . Analyses were by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59549825 . FINDINGS The iron and folic acid-containing groups of the trial were stopped early on Aug 19 , 2003 , on the recommendation of the data and safety monitoring board . To this date , 24 076 children contributed a follow-up of 25,524 child-years . Those who received iron and folic acid with or without zinc were 12 % ( 95 % CI 2 - 23 , p=0.02 ) more likely to die or need treatment in hospital for an adverse event and 11 % ( 1 - 23 % , p=0.03 ) more likely to be admitted to hospital ; there were also 15 % ( -7 to 41 , p=0.19 ) more deaths in these groups . INTERPRETATION Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death . In the presence of an active programme to detect and treat malaria and other infections , iron-deficient and anaemic children can benefit from supplementation . However , supplementation of those who are not iron deficient might be harmful . As such , current guidelines for universal supplementation with iron and folic acid should be revised 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 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 Background / Objectives : To compare the efficacy and side effects of low-dose vs high-dose iron supplements to correct anaemia in pregnancy . Subjects/ Methods : One hundred and eighty women with anaemia ( haemoglobin < 110 g l−1 ) in mid-pregnancy . The women were r and omly allocated to 20 ; 40 or 80 mg of iron daily for 8 weeks from mid-pregnancy . Results : One hundred and seventy-nine ( 99 % ) women completed the trial . At the end of treatment , there was a clear dose – response of increasing mean haemoglobin concentration with iron dose ( 111±13 g l−1 at 20 mg per day , 114±11 g l−1 at 40 mg per day and 119±12 g l−1 at 80 mg per day , P=0.006 ) . However , the incidence of anaemia did not differ statistically between groups . Compared with women in the 80 mg iron group , the odds ratio of anaemia was 1.9 ( 95 % CI : 0.8 , 4.3 , P=0.130 ) and 1.1 ( 95 % CI : 0.5 , 2.6 , P=0.827 ) , respectively , for women in the 20 mg iron group and the 40 mg iron group . The incidence of gastrointestinal side effects was significantly lower for women in the 20 mg iron group compared with women in the 80 mg iron group ; the odds ratio was 0.4 ( 95 % CI : 0.2 , 0.8 , P=0.014 ) for nausea , 0.3 ( 95 % CI : 0.2 , 0.7 , P=0.005 ) for stomach pain and 0.4 ( 95 % CI : 0.2 , 0.9 , P=0.023 ) for vomiting . Conclusions : Low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with high-dose supplements 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 Nutritional anaemia , thought to be caused by iron deficiency , affects 50 - 70 % of pregnant women in the developing world . The influence of vitamin A and iron supplementation was studied in anaemic pregnant women in West Java , in a r and omised , double-masked , placebo-controlled field trial . 251 women aged 17 - 35 years , parity 0 - 4 , gestation 16 - 24 weeks , and haemoglobin between 80 and 109 g/L were r and omly allocated to four groups : vitamin A ( 2.4 mg retinol ) and placebo iron tablets ; iron ( 60 mg elemental iron ) and placebo vitamin A ; vitamin A and iron ; or both placebos , all daily for 8 weeks . Maximum haemoglobin was achieved with both vitamin A and iron supplementation ( 12.78 g/L , 95 % Cl 10.86 to 14.70 ) , with one-third of the response attributable to vitamin A ( 3.68 g/L , 2.03 to 5.33 ) and two-thirds to iron ( 7.71 g/L , 5.97 to 9.45 ) . After supplementation , the proportion of women who became non-anaemic was 35 % in the vitamin-A-supplemented group , 68 % in the iron-supplemented group , 97 % in the group supplemented with both , and 16 % in the placebo group . Improvement in vitamin A status may contribute to the control of anaemic pregnant women OBJECTIVE The purpose of this study was to determine stillbirth risk factors and gestational age at delivery in a prospect i ve developing country birth cohort . STUDY DESIGN At 20 - 26 weeks of gestation , 1369 Pakistani women were prospect ively enrolled in the study ; the gestational age was determined by ultrasound evaluation , and risk factors and pregnancy outcomes were assessed . RESULTS The stillbirth rate was 33.6 of 1000 births , despite the fact that 96 % of the women received prenatal care , 83 % of the women were attended by skilled providers in the hospital , and a 20 % of the women underwent cesarean delivery . Fifty-one percent of stillbirths occurred at > or = 37 weeks of gestation and 19 % occurred from 34 - 36 weeks of gestation . Only 4 % of the births had congenital anomalies . Hemoglobin of < 8 g/dL , vaginal bleeding , and preeclampsia were associated with increased stillbirth risk . CONCLUSION In this developing country with reasonable technical re sources defined by hospital delivery and a high cesarean delivery rate , stillbirth rates were much higher than rates in the United States . That most of the stillbirths were term and did not have congenital anomalies and that the death appeared to be recent suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care Abstract Objective : To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women . Design : Double blind cluster r and omised controlled trial . Setting : Rural community in south eastern Nepal . Participants : 4926 pregnant women and 4130 live born infants . Interventions : 426 communities were r and omised to five regimens in which pregnant women received daily supplements of folic acid , folic acid-iron , folic acid-iron-zinc , or multiple micronutrients all given with vitamin A , or vitamin A alone ( control ) . Main outcome measures : Birth weight , length , and head and chest circumference assessed within 72 hours of birth . Low birth weight was defined < 2500 g. Results : Supplementation with maternal folic acid alone had no effect on birth size . Folic acid-iron  increased mean birth weight by 37 g ( 95 % confidence interval −16 g to 90 g ) and reduced the percentage of low birthweight babies ( < 2500 g ) from 43 % to 34 % ( 16 % ; relative risk=0.84 , 0.72 to 0.99 ) . Folic acid-iron-zinc had no effect on birth size compared with controls . Multiple micronutrient supplementation  increased birth weight by 64 g ( 12 g to 115 g ) and reduced the percentage of low birthweight babies by 14 % ( 0.86 , 0.74 to 0.99 ) . None of the supplement combinations reduced the incidence of preterm births . Folic acid-iron and multiple micronutrients increased head and chest circumference of babies , but not length . Conclusions : Antenatal folic acid-iron supplements modestly reduce the risk of low birth weight . Multiple micronutrients confer no additional benefit over folic acid-iron in reducing this risk . What is already known on this topic Deficiencies in micronutrients are common in women in developing countries and have been associated with low birth weight and preterm delivery What this study adds In rural Nepal maternal supplementation with folic acid-iron reduced the incidence of low birth weight by 16 % A multiple micronutrient supplement of 14 micronutrients , including folic acid , iron , and zinc , reduced low birth weight by 14 % , thus conferring no advantage over folic 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 ) OBJECTIVE Failure of fetal growth during pregnancy , and preterm birth , are the major causes of stillbirth and early neonatal death . The objective of the study was to determine the association between maternal hemoglobin concentration during pregnancy and perinatal mortality . STUDY DESIGN The design was prospect i ve , using data on 222,614 first singleton pregnancies in the St Mary 's Maternity Information System data base in the Northwest Thames region of London . RESULTS The association of perinatal mortality with maternal hemoglobin at first antenatal check was not statistically significant ( P>.10 ) , but a statistically significant ( P<.001 ) U-shaped pattern was found with lowest recorded maternal hemoglobin concentration . Both early neonatal mortality and stillbirth rates were statistically significantly ( P<.005 ) associated with lowest maternal hemoglobin concentration . The relationship of lowest hemoglobin with early neonatal mortality was largely mediated by the effect of preterm birth , and that between lowest hemoglobin and stillbirth by fetal growth restriction . The lowest perinatal mortality was associated with a lowest recorded maternal hemoglobin concentration of between 9 - 11 g/dL. CONCLUSION There is an optimal range of lowest hemoglobin concentration in pregnancy , and on either side of this perinatal mortality is increased . The effect of lowest hemoglobin is largely mediated through associations with preterm birth and fetal growth restriction 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 A r and omized , double-blind , placebo-controlled trial , which compared the effects of three interventions ( weekly chloroquine prophylaxis , daily iron and weekly folic-acid supplementation , and case management of malaria ) on congenital malaria , maternal haemoglobin ( Hb ) and foetal outcome , was conducted among primigravidae resident in Hoima district , Ug and a. Among 473 babies examined at birth or within 7 days of birth , 198 ( 42 % ) were parasitaemic , the level of parasitaemia in an infant being strongly correlated with those of placental ( P < 0.01 ) and maternal , peripheral parasitaemia ( P < 0.01 ) . However , 33 ( 17 % ) of the parasitaemic babies were born to mothers who had placental but not peripheral parasitaemia , 22 ( 11 % ) to mothers who had peripheral but not placental parasitaemia , and 12 ( 6 % ) to mothers with neither peripheral nor placental parasitaemia . Overall , 163 babies were each examined for malarial parasites at birth and 1 month later . Of the 76 ( 47 % ) found to have parasitaemia at birth , 37 ( 23 % ) appeared aparasitaemic at the 1-month follow-up but 28 ( 17 % ) were still parasitaemic at that time . Among the babies born to the mothers who only received case management of malaria during pregnancy , parasitaemia at birth was associated with infant anaemia at birth ( i.e. < 140 g Hb/litre ; P = 0.03 ) . Infants found to be parasitaemic at the 1-month follow-up had lower mean concentrations of Hb at that time than their aparasitaemic counterparts ( P= 0.03 ) . Parasitaemia at birth was not significantly associated with low birthweight , in any of three intervention groups . The intervention given to the mother had no significant effect on the parasitaemia of her baby , either at birth or at the age of 1 month . Congenital malaria per se may have little influence on birthweight but may have an impact on infant anaemia . In conclusion , congenital parasitaemia was not associated with birthweight , but was related to anaemia at birth in infants born to women who had only received active case management during their pregnancies Objective . To determine the lowest dose of iron preventative of iron deficiency and iron deficiency anemia in pregnancy The iron status at 6 months and 4 years of children born to women who were r and omly allocated to receive 20 mg of iron daily in the second half of pregnancy did not differ from children of mothers in the control group . OBJECTIVE To evaluate the effect of iron supplementation on serum copper and zinc levels . METHOD In a r and omized , double-blind , placebo-controlled trial , 66 pregnant women with hemoglobin 13.2 g/dL or greater between the 13th and 18th week of pregnancy were r and omized into case and control groups . From the 20th week until the end of pregnancy the case group received one ferrous sulfate tablet containing 50 mg elemental iron daily , while the control group received placebo .  Hemoglobin , ferritin , copper , and zinc levels at 24 - 28 and 32 - 36 weeks of pregnancy were measured and compared . RESULTS In the case group , serum copper levels in the second and third trimester were significantly lower than the control group ( P<0.01 and P<0.001 , respectively ) . Serum zinc levels in the case group in the second and third trimester were also significantly lower than the control group ( P<0.001 ) . CONCLUSION Iron supplementation in pregnant women with hemoglobin greater than 13.2 g/dL reduces serum levels of copper and zinc 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 Anemia is still the major nutritional problem among pregnant women in Southeast Asia . The objective of this study was to measure hemoglobin status and reduction of underweight in a group of pregnant women who received iron-fortified or nonfortified milk  , and another group who received iron supplements ( tablets ) or placebo . The 44 women in the iron-fortified milk group received 15 mg of iron per day per 400 ml of milk , and 41 women received placebo . The 40 women in the iron supplement group received 60 mg of iron per day , and 43 women received nonfortified milk . During this intervention trial , all women were supervised from the 14th to the 18th week of gestation until delivery . Blood was sample d at 0 , 5 , 10 , and 16 weeks of intervention . After the 16th week of intervention , the changes in hemoglobin ( ΔHb ) concentrations in both treatment groups ( the iron-fortified milk and the iron tablet groups ) were not significantly different ( ΔHb : −0.5 ± 0.9 and −0.3 ± 0.9 g/L , respectively ) , but the changes were significantly greater in the nonfortified milk and placebo groups ( ΔHb : −1.2 ± 0.9 and −1.1 ± 0.8 g/L , respectively ; p < .01 ) . The change in transferrin saturation ( ΔTS ) in the iron-fortified milk group ( ΔTS : 3.4 ± 12.9 % ) was greater than that in the placebo and nonfortified milk groups ( ΔTS : −10.1 ± 9.8 % and −11.6 ± 10.7 % , respectively ) ( p < .01 ) . The weight gain of the subjects during intervention did not differ significantly in the fortified and nonfortified milk groups ( Δweight : 5.0 ± 2.0 and 5.8 ± 2.1 kg , respectively ) , but was higher than in the iron tablet group ( Δweight : 4.6 ± 3.1 kg p < .05 ) and the placebo group ( Δweight : 3.8 ± 2.5 kg ; p < .001 ) . Iron supplementation and fortification were seen to be effective in promoting weight gain in pregnant Vietnamese women . For women who are underweight , the administration of iron-fortified milk has additional benefits to those of supplementation , most likely due to additional energy and nutrient inputs The extent to which anemias of pregnancy affect \ length of gestation and fetal growth varies among the many reports [ l , 2,6,11,12,18,22 ] . Because the hemoglobin ( Hb ) normally decreases during pregnancy , results obtained at varying times during pregnancy ( e.g. during the first or the third trimester ) are not comparable . Investigations about the role of the relative changes of hemoglobin during pregnancy have not been done . This study pursues that question from the data of the prospect i ve Study on  Pregnancy and Child Development of the Germany Research Council ( Deutsche Forschungsgemeinschaft ) 1 . To investigate the possible effect of iron ingestion on maternal zinc status , one group of women was given 94 mg of iron per day as ferrous sulphate with multivitamins during the second and third trimesters of their pregnancies and another , control , group was given a placebo of multivitamins without iron . 2 . The subjects given iron developed significantly lower plasma zinc concentrations than those in the control group . This effect on zinc was maximal by 6 weeks , whilst that on maternal iron status was slower . 3 . There was no parallel decrease of zinc concentration in maternal mixed leucocytes , or of plasma heatlabile alkaline phosphatase activity , suggesting that there was a redistribution of zinc between plasma and tissues . 4 . The results indicate that iron supplementation during pregnancy alters the disposition of zinc in the mother The relationship between haematologic parameters and pregnancy outcome was investigated in a prospect i ve study , taking important covariates into consideration . A question naire asking information about smoking , alcohol consumption and iron intake was completed by a consecutive series of 796 ambulatory singleton pregnant women at 31 - 32 weeks of gestation . Subsequently , haematologic parameters were measured . After delivery , birth weight , gestation length and blood pressure values during pregnancy were abstract ed from the obstetricians ' records . Low birth weight ( less than 2.500 g ) and preterm birth ( less than 37 weeks ) , were significantly more frequently seen in women with high haemoglobin ( greater than or equal to 8.0 mmol/l ) or high haematocrit ( greater than 38 % ) values , with Mantel-Haenszel odds ratios varying from 2.4 to 4.2 . Also a high erythrocyte count ( greater than or equal to 4.5/pl ) was correlated with low birth weight , while for mean corpuscular volume ( MCV ) no such relationships were found . Pregnancy induced hypertension was positively associated with haemoglobin , haematocrit and erythrocyte count , but could not fully explain the relationships between these parameters and adverse outcomes . Using multiple logistic regression with low birth weight and or preterm birth as the dependent variable , the effect of haematocrit still was demonstrable after controlling for smoking , hypertension , parity , alcohol consumption and iron intake . These results are in agreement with the hypothesis that a higher blood viscosity is a risk factor for suboptimal placenta-perfusion
OBJECTIVES To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes ; and to evaluate potential exposure-response relations of dose of iron , duration of use , and haemoglobin concentration in prenatal period with pregnancy outcomes .