Iron supplementation, maternal packed cell volume, and fetal growth. The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. Availability of iron from four prenatal multivitamin/multimineral products. Investigation of folic acid requirements in pregnancy. Iron supplements versus placebo during pregnancy: its effects on iron and folate status on mothers and newborns. Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. 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. Hemoglobin as a predictor of response to iron therapy and its use in screening and prevalence estimates. Adherence to iron supplementation during pregnancy in Tanzania: determinants and hematologic consequences. Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations Effect of oral iron supplementation during pregnancy on maternal and fetal iron status Supplementary iron dose in pregnancy anemia prophylaxis Iron supplementation during pregnancy A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women. ABSORPTION OF SUPPLEMENTAL IRON DURING PREGNANCY‐A LONGITUDINAL STUDY WITH REPEATED BONE‐MARROW STUDIES AND ABSORPTION MEASUREMENTS Iron status markers and serum erythropoietin in 120 mothers and newborn infants: Effect of iron supplementation in normal pregnancy 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. [Iron status markers in pregnant women. No clinically significant connection between the values during the second trimester, later in pregnancy and after delivery]. 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]. Serum erythropoietin during normal pregnancy: relationship to hemoglobin and iron status markers and impact of iron supplementation in a longitudinal, placebo-controlled study on 118 women. An Investigation of Folic Acid Requirements in Pregnancy. II Low dose iron supplementation does not cover the need for iron during pregnancy Iron supplementation during pregnancy--experiences of a randomized trial relying on health service personnel. Preinduction Cervical Softening with Endocervical Pge2 Gel: A multi‐center trial Pregnant women's absorption of iron from prenatal supplements. [Iron treatment by effervescent tablets (author's transl)]. Plexafer-F in the Management of Latent Iron Deficiency in Pregnancy Prevention of anaemia in pregnancy. Long-term follow-up of mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. A comparative trial of haematinic supplements in pregnancy. ORAL IRON PROPHYLAXIS DURING PREGNANCY‐A COMPARATIVE STUDY ON DIFFERENT DOSAGE REGIMENS A Comparison of Two Combined Iron-Folic Acid Preparations in the Prevention of Anaemia in Pregnancy
Previous studies have found that there is a correlation between mothers ' haemoglobin concentration or packed cell volume and infants ' birth weight , and that iron supplementation increases mothers ' haemoglobin concentration . The purpose of this study , using the data of a large r and omised trial on iron prophylaxis during pregnancy , was to find out whether iron supplementation causes fetal growth to deteriorate . At their first antenatal visit , 2912 pregnant women were r and omised into non-routine iron and routine iron supplementation . The mean length of gestation was shorter in the non-routine group . Birth weight did not differ between the groups , but due to longer gestations boys in the group receiving routine iron were taller than in the non-routine group . In both groups , whether studied by various values of packed cell volume or correlation coefficients , the lower the packed cell volume , the heavier and taller the infant and heavier the placenta . These negative correlations could be seen even with a packed cell volume measured early in pregnancy . St and ardising for blood pressure did not influence the correlation coefficients . The correlation between a high ratio for packed cell volume and poor fetal growth thus may not be caused by iron supplementation , nor mediated by blood pressure , but by some other mechanism 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 Iron absorption from four prenatal multivitamin/multimineral preparations was compared in 36 healthy pregnant women in their second or third trimester of pregnancy . The products studied were the currently marketed formulations of Stuartnatal 1 + 1 , Stuart Prenatal , Materna , and Natalins Rx . Each fasted subject received each of the four preparations , according to a r and omized sequence , at intervals of three to seven days between drug administrations . Stuartnatal 1 + 1 demonstrated the best iron absorption . Total iron absorbed from Stuartnatal 1 + 1 and Stuart Prenatal was well above the additional daily 3.5 mg recommended during pregnancy . Following administration of Materna the amount of iron was only slightly above that recommended , and following Natalins Rx it was well below . All formulations were generally well tolerated by the subjects Bertino , J. R. , Ward , J. , Sartorelli , A. C. , and Silber , R. ( 1965 ) . 7 . clin . Invest . , 44 , 1028 . Bothwell , T. H. , Hurtardo , A. V. , Donohue , D. M. , and Finch , C. A. ( 1957 ) . Blood , 12 , 409 . Callender , S. T. , and Malpas , J. S. ( 1963 ) . Brit . med . 7 . , 2 , 1516 . Cockburn , F. , Sherman , J. D. , Ingall , D. , and Klein , R. ( 1965 ) . Proc . Soc . exp . Biol . ( N.Y. ) , 118 , 238 . Conrad , M. E. , Berman , A. , and Crosby , W. H. ( 1962 ) . Gastroenterology , 43 , 385 . Dacie , J. V. , and Lewis , S. M. ( 1963 ) . Practical Haematology , 3rd ed . London . Davis , A. E. , and Badenoch , J. ( 1962 ) . Lancet , 2 , 6 . Finch , C. A. , Coleman , D. H. , Motulsky , A. G. , Donohue , D. M. , and Reiff , R. H. ( 1956 ) . Blood , 11 , 807 . Herbert , V. ( 1963 ) . Amer . 7 . clan . Nutr . , 12 , 17 . Gottlieb , C. W. , and Altschule , M. D. ( 1965 ) . Lancet , 2 , 1052 Iron and folate status of 203 pregnant women have been evaluated at 6 months gestation and on the same women and their newborn infants at delivery . The women who had , at 6 months gestation , a Hb level below 11 g/dl were systematic ally given iron supplements . Iron or placebo were r and omly allocated to the other women . At 6 months of pregnancy , one quarter of the women had a Hb level under 11 g/dl but one third had a serum ferritin level below 12 micrograms/l and more than half had low levels of serum and red cell folate . Iron supplements induced an increase both in Hb levels and in serum ferritin values ; however , no significant differences were observed in serum ferritin of the newborn infants , whether their mothers had received iron supplements or not . These results have led us to reconsider the value of ferritin levels at birth as an index of iron stores in the infant . Iron supplements had no effect on the folate status in mothers or infants or on the frequency of obstetrical complications . A significant relationship was found between maternal folate levels and length of gestation . Folate supplementation may reduce the incidence of premature delivery 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 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 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 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 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 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 This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia . One hundred and ten pregnant women were r and omly allocated to three groups : Group A receiving equivalent of 60 mg , group B 120 mg and Group C 240 mg , elemental iron as ferrous sulphate daily ; the content of folic acid was constant in all the three groups ( 0·5 mg ) . These women had at least consumed 90 tablets in 100±10 days . Blood was drawn at the beginning and at the end of the treatment . Fifty percent were anemic ( < 11g/100 ml ) . The hemoglobin levels rose similarly in all groups and the differences were statistically not significant . Fifty-six percent had depleted iron stores ( serum ferritin value < 12 μg/1 ) at the beginning of the study . Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant . The side effects increased with increasing doses of iron ; 32·4 % , 40·3 % and 72 % in group A , B and C respectively . Based on these findings , the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme . * * * DIRECT SUPPORT * * * A08BC044 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 Recent studies suggest that infant behavior and psychological test performance are impaired by iron deficiency and may be improved by iron . Comparable studies have not been performed in older population s. Young women early in pregnancy whose nutritional intake may be impaired by poverty constitute a high-risk population . Women aged 14 - 24 years coming for prenatal care at or before 16 weeks gestation whose hematocrits were greater than or equal to 31 % were r and omized in a double-blind trial to receive vitamins supplemented with iron ( experimental group ) or vitamins alone ( controls ) . Hematologic status and tests of short-term memory and attention span were assessed at entry and conclusion of the one-month treatment period . The experimental group showed significant improvement on the most sensitive measure of short-term memory and three subtests . On comparison of the change between initial and final scores , the experimental group showed significant or borderline greater improvement than controls on three tests . These results indicated a beneficial effect of iron therapy on psychometric test-score performance 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 In a r and omized , double‐blind , placebo controlled study of the effect of iron supplementation  during pregnancy  , iron status ( hemoglobin ( Hb ) , serum (S‐)transferrin saturation , S‐ferritin ) and S‐erythropoietin ( EPO ) were assessed in 120 healthy pregnant women at 14–16 weeks of gestation , and just before delivery ; 63 women were treated with 66 mg iron daily , and 57 with placebo .  There were no differences in baseline values in the two groups . At term , the iron treated group had significantly higher Hb , transferrin saturation , S‐ferritin ( median 22 μg/1 vs. 14 μg/1 , ( p<0.0001 ) and lower S‐EPO compared to the placebo treated group . In the iron group , 30.2 % had exhausted iron stores ( i.e. S‐ferritin < 20 μg/1 ) , 6.3 % latent iron deficiency ( S‐ferritin < 20 μg/1 and transferrin saturation < 15 % ) , and no patients had iron deficiency anemia ( S‐ferritin < 20 μg/1 and transferrin saturation < 15 % and Hb < 110 g/1 ) . In the placebo group , 93.0 % had exhausted iron stores , 54.4 % latent iron deficiency , and 17.5 % iron deficiency anemia ; S‐EPO was inversely correlated to iron status markers : Hb , rs = −0.51,p<0.001 ; transferrin saturation , rs= −0.65,p<0.0001 ; S‐ferritin , rs= − 0.31 , R<0.01 , suggesting that the elevation in S‐EPO was secondary to iron deficient erythropoiesis . Newborns to iron treated mothers had higher cord S‐ferritin , median 155 μg/1 , than newborns to placebo treated mothers , median 118 ug/1 ( p<0.02 ) ; there were no differences in birth weight , transferrin saturation , or S‐EPO . Supplemental iron in a dose of 65 mg/day from the second trimester is sufficient to prevent iron deficiency in pregnant Danish women 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 The aim of this r and omized , double blind , placebo controlled parallel study was to evaluate whether iron status markers in pregnant women , measured early in the second trimester , could be used to predict levels later in pregnancy , and post partum . One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation were included . Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron ( as fumarate ) daily , and 57 women to treatment with placebo .  Haemoglobin , serum transferrin saturation , and serum ferritin were measured every fourth week during gestation , prior to delivery , one week and eight weeks post partum . Correlation matrices during pregnancy and post partum were calculated for each iron status marker , both in iron and placebo treated women . Haemoglobin , transferrin saturation and serum ferritin values at inclusion displayed steadily declining correlation coefficients with values obtained later in pregnancy . There were no clinical ly relevant correlations to values obtained eight weeks or less prior to delivery , or post partum . Serum ferritin values at inclusion could not be used to predict values later in pregnancy or post partum . Haemoglobin , transferrin saturation and serum ferritin values measured in the beginning of the second trimester appear unsuitable as guidelines for an individual iron prophylaxis during the remaining period of pregnancy 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 Serum erythropoietin ( EPO ) and its relationship to hemoglobin ( Hb ) , iron status markers and iron supplementation during normal pregnancy was assessed in a longitudinal , placebo-controlled  study on 118 women , 61 took daily tablets containing 66 mg ferrous iron from the second trimester until delivery and 57 took placebo .  Blood sample s were obtained at 4-week intervals until delivery as well as post-partum . In the placebo-treated women , median serum EPO rose from 22.5 U/l at inclusion to 35.0 U/l at delivery ( P = 0.0001 ) . In the iron-treated women , median serum EPO rose from 23.9 to 29.9 U/l ( P = 0.0001 ) . Serum EPO showed a steeper increase in the placebo-treated women than in the iron-treated women ( P < 0.05 ) . After delivery , serum EPO became normal in both groups ( P = 0.0001 ) . Median Hb was lower in placebo-treated ( iron depleted ) than in iron-treated ( iron repleted ) women ( P < 0.05 ) . In the placebo-treated women there was a negative correlation and in the iron-treated women a positive correlation between serum EPO and Hb . In the placebo-treated women , inverse correlations existed between serum EPO and serum transferrin saturation and serum ferritin , reflecting the consequences of iron deficiency , whereas the iron-treated women displayed no correlation . A physiological , nonhypoxia-induced increase in EPO production accounts for the basic expansion of the red cell mass during pregnancy . In placebo-treated women , iron deficient erythropoiesis constitutes an additional hypoxic stimulus , which induces a further increase in serum EPO IN a previous investigation of the effects of grade d micro-doses of folic acid ( pteroyl glutamic acid ) in pregnancy suggestive evidence has been obtained that the minimal oral requirement may lie in the region of 300 pg./day . This conclusion was based largely upon the measurement of the fasting post-partum serum folate or L. casei activity in a group of patients from a population where poor dietary intake of folic acid was common . In patients receiving no prophylactic folic acid or IOO pg./day the median post-partum serum folate level was subnormal , in those receiving 3oo , ug./day it was normal and in those receiving 4sopg./day it was supranormal ( Willoughby and Jewell , 1966 ) . As an extension of this investigation the incidence of maternal anaemia has now been assessed among a population of 3599 patients r and omly allocated at their first ante-natal Objective ‐ To determine : 1 ) if 18 mg iron daily is sufficient to cover the iron need during normal pregnancy , and 2 ) if women , who will not need iron supplementation during pregnancy , can be identified by early screening This article reports the design and feasibility of a r and omized controlled trial of the benefits of routine iron prophylaxis during pregnancy . The multicenter trial , supported by a small budget , relied on health service personnel in Finnish maternity centers . Iron prophylaxis has had an established position in Finnish maternity care , and iron is freely available . This contributed to our decision to ask for informed consent after r and omization . During a year , 2960 mothers were recruited by midwives in 27 maternity health centers and r and omized into two groups : selective and routine iron supplementation . Mothers were followed until the postpartum checkup , and data were collected by five different question naires and abstract ed from the infant 's patient record . Adherence of the midwives to the study protocol was satisfactory , as was mothers ' compliance with recommended treatments . However , because the study was design ed to compare two treatment policies , problems of nonmasking hamper of the biologic effects of iron . This trial encourages the use of existing health services and their personnel in evaluation of medical technology In a prospect i ve , r and omized trial , a single dose of PGE2 gel , 0.5 mg ( 2.5 ml ) , was given to 416 low Bishop Score patients 12 h prior to indicated oxytocin induction and compared with 404 non‐gel controls .  Successful initial induction was achieved in 83 % of the treated and 58 % of the non‐treated subjects . In addition the induction — delivery interval was shortened ( median times 9.0 h vs. 11.3 h ) and fewer cesarean sections were performed ( 16 % vs. 21 % ) in the PGE2 gel series . The endocervical administration of PGE2 was well tolerated and , provided care is taken to avoid excess extra‐amniotic placement , systemic PGE2 effects are minimal A r and omized , double-blind , crossover study was carried out on  iron absorption  from three prenatal supplements by women in the first trimester of pregnancy . The supplements were given to fasting subjects as a single pill early in the morning , and iron absorption was determined from measurements of serum iron performed during the course of the day . Iron absorption from two of the supplements was substantially less than the 3.5 mg recommended for the prevention of iron deficiency during pregnancy . The third supplement , containing reduced amounts of calcium and magnesium , provided on the average 3.6 mg of absorbed iron to the subjects . These results support previous findings in nonpregnant subjects that the availability of iron in a prenatal supplement is affected by the overall composition of the supplement In a r and omized double-blind study the new effervescent iron tablet Loesferron was tested in 57 postpartum patients .  Hgb and red blood count rose significantly with this treatment . It was found that on effervescent tablet daily was sufficient for a satisfactory result of the treatment . No side effects were noted to this well tasting iron beverage . The reason is probably the prior dilution of the iron compound which delivers lower local iron potentials to the gastric mucosa The failure to prescribe in antenatal clinics a well tolerated form of supplementary oral iron that provides an adequate iron supply for the successful maintainance of active erythropoiesis in pregnant women largely accounts for the frequent development of latent iron deficiency in the child-bearing age . The potential value of Plexafer-F * , a slow release ferrous sulphate preparation supplemented with folic acid , in reducing the high incidence of latent iron deficiency in pregnancy was assessed by conducting a r and omized clinical trial of Plexafer-F and ordinary ferrous sulphate B.P. with folic acid in eighty women presenting early in pregnancy with latent iron deficiency . At the end of the trial , which was started at the sixteenth week of pregnancy and which lasted for twenty weeks , normal haematological values were obtained in thirty-eight out of forty patients ( 95 % ) taking Plexafer-F , but only in twenty-four out of forty patients ( 60 % ) taking ferrous sulphate . A simple screening test run on stool specimens provided during antenatal visits to check regular ingestion of the iron preparations prescribed , revealed regular drug intake and no intolerance in all the patients receiving Plexafer-F , against an intolerance leading to failure of regular drug intake in 37.5 % of patients receiving ordinary ferrous sulphate Summary The effect of small doses of iron and folic acid in a single tablet in preventing anaemia in pregnancy has been assessed . Fifty mg . elemental iron and 400μg . folic acid were found to be satisfactory daily supplements for both ‘ good ’ and ‘ bad ’ tablet takers . Tablet counting and an occasional chemical test for the presence of iron in the faeces were compared as indicators of tablet consumption and the latter found to be superior . The high incidence of faulty tablet consumption indicates the need for some check in anaemic patients in pregnancy OBJECTIVE A r and omized trial comparing women who were given iron only if needed and those given iron prophylactically  showed that routine prophylaxis is not crucial for mothers ' or infants ' health up to postpartum examination . This study investigated these infants ' and mothers ' subsequent health , as available in routine registers in a 7-year follow-up . STUDY DESIGN Original data ( N = 2693 ) were linked to the national population , birth , and hospital inpatient registers . RESULTS The outcomes in the two groups were very similar : there were no statistically significant differences in deaths after birth , number or timing of infants ' or mothers ' hospitalizations , reasons for mothers ' first hospitalization , number or timing of subsequent miscarriages or births , or problems or outcomes in the next birth . However , infants of the prophylactically supplemented group were more frequently hospitalized because of convulsions . CONCLUSION This study does not support routine iron prophylaxis for well-nourished pregnant women Four haematinic supplements -- Slow-Fe , FGF , Ferro-Gradumet and Ferro-Grad tfolic -- were prospect ively studied in 103 healthy pregnant patients . Significant differences in the mean cell counts , haematocrit values , haemoglobin levels , iron-binding capacities and serum folate levels were noted . The changes paralleled the elemental iron present in the compount . In this series , side effects principally vomiting and constipation , were more frequent in the lower dose iron group . Form both the haematological status aspect and the lack of side effects , Ferro-Grad Folic and Ferro-Gradumet were superior to both FGF and Slow-Fe ( old formulation ) The effect of oral iron prophylaxis on haemoglobin concentration ( Hb ) and haematocrit ( Hct ) has been studied in 300 pregnant women . From the 3rd to 4th month of pregnancy and until term the women were r and omly treated with 100 mg or 200 mg ferrous iron daily respectively as sustained‐release tablets ( Duroferon ® Duretter ® ) or 200 mg ferrous iron as rapidly disintegrating tablets Forty patients were given one of two iron-folic acid tablets starting from the first ante-natal visit and continuing to parturition . Haemoglobin levels were measured at the commencement , at the end of the study and on at least one other occasion . A comparison was made of haemoglobin levels and side-effects
BACKGROUND Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency , malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity .
OBJECTIVES The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters , and on pregnancy outcome .