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. Iron status markers during pregnancy. No relationship between levels at the beginning of the second trimester, prior to delivery and post partum. Investigation of folic acid requirements in pregnancy. Iron supplements versus placebo during pregnancy: its effects on iron and folate status on mothers and newborns. Intermittent oral iron supplementation during pregnancy. Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. Evaluation of a gastric delivery system for iron supplementation in pregnancy. A WHO collaborative study on iron supplementation in Burma and in Thailand. Intermittent iron supplementation regimens are able to maintain safe maternal hemoglobin concentrations during pregnancy in Venezuela. Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. 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. Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. 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 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. Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations Selective iron supplementation based on serum ferritin values early in pregnancy: are the Norwegian recommendations satisfactory? Effect of oral iron supplementation during pregnancy on maternal and fetal iron status Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation A randomized trial investigating an iron-rich natural mineral water as a prophylaxis against iron deficiency in pregnancy. Oral versus high dose parenteral iron supplementation in pregnancy. Can iron status be improved in each of the three trimesters? A community-based study† Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomised controlled trial Iron supplementation in pregnancy: is less enough? [Clinical experience with iron supplementation in pregnancy]. Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy. Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Impact of nutritional supplements on hematological profile of pregnant women. Changes in blood manganese levels during pregnancy in iron supplemented and non supplemented women. Supplementary iron dose in pregnancy anemia prophylaxis Iron supplementation during pregnancy Daily versus intermittent iron supplementation in pregnant women: hematological and pregnancy outcome. Effect of dose and formulation on iron tolerance in pregnancy. Maternal erythropoietin in singleton pregnancies: a randomized trial on the effect of oral hematinic supplementation. A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women. High Third‐Trimester Ferritin Concentration: Associations With Very Preterm Delivery, Infection, and Maternal Nutritional Status ABSORPTION OF SUPPLEMENTAL IRON DURING PREGNANCY‐A LONGITUDINAL STUDY WITH REPEATED BONE‐MARROW STUDIES AND ABSORPTION MEASUREMENTS Monitoring oral iron therapy with protoporphyrin/heme ratios in pregnant women 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. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial Comparison of total blood volume in normal, preeclamptic, and nonproteinuric gestational hypertensive pregnancy by simultaneous measurement of red blood cell and plasma volumes. [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]. Impact of daily versus weekly hematinic supplementation on anemia in pregnant women. 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 The response to iron supplementation of pregnant women with the haemoglobin genotype AA or AS. Iron supplementation during pregnancy--experiences of a randomized trial relying on health service personnel. Iron prophylaxis during pregnancy – How much iron is needed? A randomized dose– response study of 20–80 mg ferrous iron daily in pregnant women Pregnant women's absorption of iron from prenatal supplements. Erythrocyte indices in pregnancy: effect of intermittent iron supplementation. Facts and artifacts about anemia and preterm delivery. Weekly iron as a safe alternative to daily supplementation for nonanemic pregnant women. Plexafer-F in the Management of Latent Iron Deficiency in Pregnancy Side-effect studies on a new sustained release iron preparation. Prevention of anaemia in pregnancy. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups A prophylactic trial of iron and folic acid supplements in pregnant Burmese women. Long-term follow-up of mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. The Effectiveness of Weekly Iron Supplementation in Pregnant Women of Rural Northern Malawi Prophylactic iron supplementation in pregnant women in Norway. A comparative trial of haematinic supplements in pregnancy. ORAL IRON PROPHYLAXIS DURING PREGNANCY‐A COMPARATIVE STUDY ON DIFFERENT DOSAGE REGIMENS Folate Status Throughout Pregnancy and in Postpartum Period A Comparison of Two Combined Iron-Folic Acid Preparations in the Prevention of Anaemia in Pregnancy [Anti-anemia therapy with prophylactic administration of Fe2+ in normal pregnancy and its effect on prepartum hematologic parameters in the mother and neonate].
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 OBJECTIVE To evaluate whether levels of iron status markers ( haemoglobin , serum transferrin saturation , serum ferritin ) in pregnant women , measured in the beginning of the second trimester , could be used to predict levels later in pregnancy , pre partum and post partum . DESIGN R and omized , double-blind , placebo-controlled parallel study . SETTING The Birth Clinic at the Department of Obstetrics , Herning Hospital , Herning , Denmark . SUBJECTS One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation . INTERVENTIONS Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron ( as fumarate ) daily , and 57 women to treatment with placebo . MAIN OUTCOME MEASURES Haemoglobin , serum transferrin saturation , and serum ferritin were measured every 4th week during gestation , prior to delivery , and 1 and 8 weeks post partum . RESULTS Correlation matrices during pregnancy and post partum were calculated for each iron status marker separately in iron-treated 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 8 weeks or less prior to delivery , and no correlations to values post partum . Serum ferritin values at inclusion could not be used to predict values later in pregnancy or post partum . CONCLUSION Haemoglobin , transferrin saturation and serum ferritin values measured in the beginning of the second trimester appear to be unsuitable as guidelines for an individual iron prophylaxis in pregnant women 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 RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia ( IDA ) . OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly , thrice weekly and daily in preventing IDA in pregnancy . DESIGN A r and omised control trial . SETTING University antenatal clinic , ( UANC ) Galle . SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was r and omly given weekly ( n = 26 ) thrice weekly ( n = 35 ) and daily ( n = 31 ) to 92 women who were 14 to 24 weeks pregnant .  Haemoglobin ( Hb ) , serum ferritin ( SF ) and haematocrit ( Hct ) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out . RESULTS The risk of developing anaemia was significantly higher in the weekly ( odds ratio 15 , 95 % CI 1.4 - 165.6 , p < 0.03 ) and possibly higher in the thrice weekly ( odds ratio 3 , 95 % CI 0.3 - 30.3 , p = 0.3 ) groups . The risk of developing iron deficiency ( SF < 12 micrograms/l ) was also significantly higher in the weekly ( odds ratio 18 , 95 % CI 2.8 - 115.5 , p < 0.003 ) and thrice weekly ( odds ratio 10 , 95 % CI 1.6 - 64.8 , p < 0.02 ) groups . CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy 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 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 Daily iron supplementation programs for pregnant women recommend amounts of iron that are considered by some to be excessive , and either lower-dose or less frequent iron supplementation regimens have been proposed . A r and omized , placebo-controlled study was performed to assess and compare the relative effectiveness of a weekly ( WS ) or twice weekly ( TW ) iron supplementation schedule in maintaining or achieving hemoglobin ( Hb ) levels at term considered to carry minimal maternal and fetal risk ( 90 - 130 g/L ) . Pregnant women ( n = 116 ) at wk 10 - 30 of gestation ( 63 WS and 53 TW ) were enrolled in the study ( 52 in WS and 44 TW completed the study ) . Women were r and omly allocated to receive a 120-mg oral dose of iron as ferrous sulfate and 0.5 mg of folic acid weekly ( n = 52 ) or 60 mg iron and 0.25 mg folic acid and a placebo twice weekly ( n = 44 ) . Hb , hematocrit , serum ferritin , and transferrin saturation were estimated at baseline and at 36 - 39 wk of gestation . Baseline dietary data and the presence and intensity of intestinal helminthic infections were assessed . The duration of supplementation was 14 + /- 4 wk and the median level of adherence was 60.5 % . Hb concentrations improved in women following the TW regimen and in women following WS who had low baseline Hb levels . About 89 % of WS women and 95 % of TW women maintained Hb levels at term ( between 90 g/L and 130 g/L ) , a range associated with optimal pregnancy outcomes . One woman in the TW group exhibited higher Hb levels that potentially carried perinatal risk ( > 130 g/L ) . Intermittent iron and folic acid supplementation may be a valid strategy when used as a preventive intervention in prenatal care setting In the context of limited effectiveness of iron supplementation programs , intermittent iron supplementation is currently under debate as a possible alternative strategy that may enhance the effectiveness of operational programs . This field-based trial assessed the outcome of twice weekly iron supplementation compared to daily in Pakistan . A double-blind , r and omized , clinical trial was conducted in Northern Pakistan . Anemic pregnant women ( n = 191 ) were assigned to receive daily ( 200 mg ferrous sulfate ) or twice weekly ( 2 x 200 mg ferrous sulfate ) iron supplementation .  Hemoglobin was measured at baseline and at 4-wk intervals for up to 12 wk . Serum ferritin was measured at baseline and 8 or 12 wk . Analysis was by intention to treat . The two groups did not differ in age , parity , sociodemographic characteristics , hemoglobin or serum ferritin concentrations at baseline . Women who received iron daily had a greater rise in hemoglobin compared with women who received iron twice weekly ( 17.8 + /- 1.8 vs. 3.8 + /- 1.2 g/L , P < 0.001 ) . The serum ferritin concentrations increased by 17.7 + /- 3.9 microgram/L ( P < 0.001 ) in the daily supplemented group and did not change in the twice weekly group . Daily iron supplementation remained superior to twice weekly supplementation after controlling initial hemoglobin Z-scores and duration of treatment . The body mass index ( BMI ) modified the effect of daily versus twice weekly iron supplementation . For every unit increase in BMI , the difference between the two treatment groups was reduced by 0.0014 ( final hemoglobin Z-score ; P = 0.027 ) . We recommend continuation of daily iron supplementation as opposed to intermittent iron supplementation in pregnant women in developing countries The usefulness of serum ferritin levels in assessing iron stores in pregnant women before and after supplementation with iron  was studied . One hundred thirty-five healthy pregnant women between 22 to 28 wk were r and omly allotted to daily dose regimes of 60 , 120 , or 240 mg of ferrous sulphate . The tablets were given after meals under strict personal supervision . Before supplementation , iron deficiency ( ferritin level less than 10 micrograms/L ) was present in 54.8 % of the pregnant women , compared to an incidence of 17.8 % when assessed by serum iron concentration of less than 50 micrograms/dl . The mean ferritin level of pregnant women was 14.15 micrograms/L and was less than one-half that of healthy single women and one-sixth of that of healthy males . Supplementation with oral iron for 12 wk produced an increase in ferritin levels in all the groups , but significant increases were seen only in women given 120 and 240 mg of ferrous sulphate with or without folic acid . However , there were no differences in final Hb levels among the supplemented groups We studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants . The subjects were 197 pregnant women selected at 28 wk + /- 21 d of gestation at a mother- and -child health center in Niamey , Niger . Ninety-nine women received 100 mg elemental Fe/d  throughout the remainder of their pregnancies and 98 received placebo . The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group . Three months after delivery , the prevalence of anemia was significantly higher in the placebo group . At delivery , there were no differences between the two groups in cord blood iron variables . Three months after delivery , serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group . Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group BACKGROUND Little is known about the benefits of prenatal multivitamin and mineral supplements in reducing  low birth weight .  OBJECTIVE We conducted a r and omized , double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient ( MM ) supplements with those of iron supplements during pregnancy on birth size . DESIGN Pregnant women ( n = 873 ) were recruited before 13 wk of gestation and received supplements 6 d/wk at home , as well as routine antenatal care , until delivery . Both supplements contained 60 mg Fe , but the MM group also received 1 - 1.5 times the recommended dietary allowances of several micronutrients . RESULTS At recruitment , the women in the 2 groups were not significantly different in age , parity , economic status , height , or hemoglobin concentration but differed significantly in marital status ( 4.6 % and 2.0 % of women in the MM and iron-only groups , respectively , were single mothers ) and mean ( + /- SD ) body mass index ( in kg/m(2 ) ; 24.6 + /- 4.3 and 23.8 + /- 3.9 in the iron-only and MM groups , respectively ) . Losses to follow-up ( 25 % ) and compliance ( 95 % ) did not differ significantly between the groups . In intent-to-treat analyses ( MM group : n = 323 ; iron-only group : n = 322 ) , mean ( + /- SD ) birth weight ( 2.981 + /- 0.391 and 2.977 + /- 0.393 kg in the MM and iron-only groups , respectively ) and birth length ( 48.61 + /- 1.82 and 48.66 + /- 1.83 cm in the MM and iron-only groups , respectively ) did not differ significantly between the groups . CONCLUSION These findings suggest that MM supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation BACKGROUND According to our current underst and ing , iron absorption with weekly iron supplements is not higher than that with daily supplements ( ie , there is no mucosal block ) . However , community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one . Furthermore , when differences in absorption are found , they are commonly smaller than would be expected on the basis of differences in the amount of iron provided . The possibility of differential compliance between the regimens needs to be evaluated to explain these findings . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d . Compliance was monitored by using a pill bottle equipped with an electronic counting device .  Hemoglobin concentrations were measured at baseline and after 4 , 8 , and 12 wk of supplementation . RESULTS There was no differential effect per iron tablet between weekly and daily regimens . A 12-wk daily regimen ( 68 % compliance ) produced a small but significantly greater hemoglobin response than did the weekly regimen ( 104 % compliance ) . The first 20 tablets consumed produced most of the effect ; after 40 tablets , there was no further response . CONCLUSIONS There was no evidence of a mucosal block in the daily regimen . Over 12 wk , 50 % of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect . The weekly regimen provided a large part of this amount , explaining the limited difference in effect . It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary 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 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 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 Background . The aims of the present study were to evaluate the recommendations by comparing compliance and adequacy of iron status at 6 weeks postpartum between one group given advice only and one group given advice plus iron supplement .  In the latter group the efficacies of two iron preparations of different strengths and types were compared The known increased need for iron during pregnancy appears to be met only in part by increased iron absorption and amenorrhea . Considerable dem and s are made on maternal iron stores and , since many women lack sufficient storage iron , pregnancy may be expected to cause iron deficiency . This may lead to anemia in pregnancy and post partum and could also have a bearing on the iron status of the fetus and the neonate . Based on these considerations , prophylactic supplementation of dietary iron is advocated but remains a disputed issue . In the present controlled , prospect i ve and longitudinal study changes in hematologic status , and in particular in iron stores , during pregnancy were investigated in 44 healthy Caucasian women with uncomplicated pregnancies and deliveries . They were r and omly assigned to a study group ( n = 21 ) receiving oral iron supplements from the 16th week of amenorrhea until 6 weeks post partum , and a control group ( n = 23 ) without iron supplementation .  Maternal concentrations of hemoglobin , serum iron , serum transferrin and serum ferritin were determined at 16 , 28 and 36 weeks of amenorrhea , at delivery , and 6 and 12 weeks post partum . The same variables were determined in cord blood . Iron supplementation appeared to prevent the physiologic fall in hemoglobin and serum iron concentrations which occurred in the control group , but had little influence on the observed rise in transferrin concentrations . Ferritin levels in serum , which are known to reflect mobilisable iron stores , fell to 30 % of the initial values in the control group and to 70 % in the study group . Six and 12 weeks post partum ferritin levels were still low in the nonsupplemented group ( Tab . I ) . ( ABSTRACT TRUNCATED AT 250 WORDS Background . The aim was to define reference values for hemoglobin , hematocrit and erythrocyte indices , i.e. erythrocyte count , mean corpuscular volume ( MCV ) , mean corpuscular hemoglobin ( MCH ) , mean corpuscular hemoglobin concentration ( MCHC ) , in normal pregnancy and after a normal delivery in non‐iron‐supplemented and iron supplemented women 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 OBJECTIVE To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron . METHOD A total of 220 pregnant women with a singleton pregnancy and hemoglobin between 8 to 11 g% at 16 - 24 weeks gestation were identified and r and omly divided into two groups . Group A was started on daily oral iron therapy of 100 mg of elemental iron . Group B was given 250 mg of iron sorbitol intramuscularly and repeated at an interval of 4 - 6 weeks . Blood indices were evaluated at the beginning of study and at 36 weeks to see the effect after iron supplementation in the two groups . The data were analyzed using SPSS software , version 10.1 . RESULTS Definitive and comparable improvement in hemoglobin and all the blood indices ( hematocrit , MCH , MCHC , MCV , Serum iron and TIBC ) was observed . The absolute change in hemoglobin and hematocrit was 1.18+/-0.68 g% and 4.02+/-2.59 % in oral group , 1.34+/-0.77 g% and 4.93+/-3.65 % in parenteral group , respectively . Serum ferritin showed statistically significant absolute rise ( 10.43+/-7.92 microg/dl ) after parenteral iron supplementation as compared to oral iron supplementation ( 9.76+/-4.78 microg/dl ) . Obstetric outcome was comparable in two groups . CONCLUSION Two treatment regimens are biologically equivalent in terms of hematological response . Two high doses of intramuscular iron can be a good substitute to meet iron requirement in pregnancy Objective : Intervention with iron supplementation , deworming , and information , education and communication ( IEC ) to improve the haematological status among each of the three trimesters of pregnant women in a rural community . Design : A community-based study was carried out using a two-group pre – post experimental design in a rural community . Setting : Two rural blocks in Vellore district were selected for the study . KV Kuppam block with a population of 120 , 000 and the adjacent Gudiyatham block with a population of 132 , 000 served as study and control areas for the study .Subjects : Using a multistage sampling , initially 50 % of the panchayats , the local village administrative units , were r and omly selected and all pregnant women were the subjects . In the pre-intervention survey 458 and 387 pregnant women had haemoglobin tested and the post-intervention survey covered 403 and 425 pregnant women in the study and control areas , respectively . Similarly serum ferritin was tested in a r and omly selected sub- sample with 254 and 191 pregnant women before intervention and in 216 and 223 pregnant women after intervention in both study and control areas , respectively . Intervention : Iron supplementation and deworming were provided to all pregnant women in the study area from the fourth month of their pregnancy . An intensive information , education and communication was carried out with facts on anaemia and diet modification to each pregnant woman , using a one-to-one approach in the community , and a group method in the mobile clinics . This was carried out for a period of 18 months . Results : A significant decrease in the prevalence of anaemia was found , from 56.1 % to 25.07 % ( P<0.001 ) , 73.4 % to 49.2 % ( P<0.001 ) and 68.8 % to 56.8 % ( P<0.01 ) among women in the first , second and third trimesters , respectively , in the intervention area . Significant ( P<0.001 ) increases in the mean haemoglobin of 0.85 g/dl ( 95 % CI 10.18–10.84 , 11.09–11.63 ) , 0.59 g/dl ( 95 % CI 9.98–10.34 , 10.55–10.95 ) and 0.36 g/dl ( 95 % CI 9.93–10.33 , 10.25–10.73 ) were also observed in each of the groups . Conclusion : A comprehensive community-based intervention with iron supplementation , helminthic treatment and increase in knowledge using IEC through effective strategies can improve the haematological status of pregnant women in each trimester . Sponsorship : Mother Care Project , John Snow Inc. , Funded by the United States Agency for International Development (USAID).European Journal of Clinical Nutrition ( 2000 ) 54 , BACKGROUND Neonatal mortality is the biggest contributor to global mortality of children younger than 5 years , and low birthweight is a crucial underlying factor . We tested the hypotheses that antenatal multiple micronutrient supplementation would increase  infant birthweight and gestational duration . METHODS We did a double-blind , r and omised controlled trial in Dhanusha district , Nepal . Women attending for antenatal care with singleton pregnancies at up to 20 weeks ' gestation were invited to participate . Participants were r and omly allocated either routine iron and folic acid supplements ( control ; n=600 ) or a multiple micronutrient supplement providing a recommended daily allowance of 15 vitamins and minerals ( intervention ; n=600 ) . Supplementation began at a minimum of 12 weeks ' gestation and continued until delivery . Primary outcome measures were birthweight and gestational duration . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N88625934 . FINDINGS Birthweight was available for 523/600 infants in the control group and 529/600 in the intervention group .  Mean birthweight was 2733 g ( SD 422 ) in the control group and 2810 g ( 453 ) in the intervention group , representing a mean difference of 77 g ( 95 % CI 24 - 130 ; p=0.004 ) and a relative fall in the proportion of low birthweight by 25 % . No difference was recorded in the duration of gestation ( 0.2 weeks [ -0.1 to 0.4 ] ; p=0.12 ) , infant length ( 0.3 cm [ -0.1 to 0.6 ] ; p=0.16 ) , or head circumference ( 0.2 cm [ -0.1 to 0.4 ] ; p=0.18 ) . INTERPRETATION In a poor community in Nepal , consumption of a daily supplement containing a recommended daily allowance of 15 micronutrients in the second and third trimesters of pregnancy was associated with increased birthweight when compared with a st and ard iron and folic acid preparation . The effects on perinatal morbidity and mortality need further comparisons between studies . Published online March 3 , 2005 http://image.thelancet.com/extras/04art11045web.pdf Background . The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component , prescribed for women in the second half of pregnancy OBJECTIVE To study the efficacy of iron supplementation during pregnancy and its influences on the outcome of pregnancy . METHODS A total of 369 pregnant women were enrolled in this study . According to the hemoglbin levels at recruitment , there were 2 groups : preventive ( Hb > or = 110 g/L ) and treatment ( Hb < 110 g/L ) groups . In the preventive group , women entered the study from 20 - 24 gestational weeks and were r and omly assigned to  materna treatment  ( n = 96 ) who took materna 1 tablet daily or control group ( n = 95 ) who took no other supplementation . In the treatment groups , women less than 36 gestational weeks were accepted . They were r and omly divided as materna ( n = 93 ) 1 tablet/d , ferrous sulfate 0.3 g tid/d ( n = 50 ) or Ferroids 1 tablet/d ( n = 35 ) groups . Both Hb and serum ferritin concentrations were determined at admission and immediately after delivery . In some cases serum ferritin in the umbilical vein were measured as well . Hemoglobin levels were examined every 4 weeks during the observational period . RESULTS In the preventive groups , maternal serum ferritin levels after materna treatment were significantly higher than that before treatment and the control group ( P < 0.05 ) . As for the anemia women , compared the serum ferritin concentration , materna treatment had significantly higher levels than that at admission ( P < 0.05 ) , and also higher than that in the ferrous sulfate or ferroids tratment groups ( P < 0.05 ) . The s-ferritin in the umbilical vein had no correlation with the paired maternal levels . There were no significant differences in the pregnancy outcomes among all the groups . CONCLUSION Materna can increase the iron storage and effectively improve the iron deficiency during pregnancy , and has no impact on the prgnancy outcomes Side-effects of iron supplementation lead to poor compliance . A weekly-dose schedule of iron supplementation rather than a daily-dose regimen has been suggested to produce fewer side-effects , thereby achieving a higher compliance . This study compared side-effects of iron supplementation and their impact on compliance among pregnant women in Bangladesh . These women were assigned to receive either weekly doses of 2 x 60 mg iron ( one tablet each Friday morning and evening ) or a daily dose of 1 x 60 mg iron .  Fifty antenatal care centres were r and omly assigned to prescribe either a  weekly- or a daily-supplementation regimen ( 86 women in each group ) . Side-effects were assessed by recall after one month of supplementation and used for predicting compliance in the second and third months of supplementation . Compliance was monitored using a pill bottle equipped with an electronic counting device that recorded date and time whenever the pill bottle was opened . Of five gastrointestinal side-effects ( heartburn , nausea , vomiting , diarrhoea , or constipation ) assessed , vomiting occurred more frequently in the weekly group ( 21 % ) than in the daily group ( 11 % , p<0.05 ) . Compliance ( ratio between observed and recommended tablet intake ) was significantly higher in the weekly-supplementation regimen ( 93 % ) than in the daily-supplementation regimen ( 61 % , p<0.05 ) . Overall , gastrointestinal side-effects were not significantly associated with compliance . However , the presence of nausea and /or vomiting reduced compliance in both the regimens-but only among women from the lower socioeconomic group . In conclusion , weekly supplementation of iron in pregnancy had a higher compliance compared to daily supplementation of iron despite a higher frequency of side-effects . The findings support the view that gastrointestinal side-effects generally have a limited influence on compliance , at least in the dose ranges studied . Efforts to further reduce side-effects of iron supplementation may not be a successful strategy for improving compliance and effectiveness of antenatal iron supplementation 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 Eighty one pregnant women ( 20 + /- 2 weeks of gestation ) were assessed for their nutritional status . They were divided into three groups ; Group I women ( n = 30 ) were given 200 mg ferrous sulphate ( FeSO4 ) tablet per day for 15 weeks , Group II women ( n = 25 ) were given FeSO4 tablets along with 2,000,000 IU of vitamin A as single dose in beginning of study ; and Group III women ( n = 26 ) were not given any supplements and served as controls . To study impact of supplements on hematological profile of pregnant women , Hb , PCV , RBC , TS% , TIBC and serum levels of iron , zinc , copper , manganese and vitamin A were assessed at 20 + /- 2 weeks and 36 + /- 2 weeks of gestation by st and ard techniques . Pregnant women in Group I ( Fe suppl ) and group II ( Fe + vitamin A suppl ) had significantly ( p < 0.01 ) higher Hb , PCV , RBC , TS% and serum iron levels than the controls . Group II had significantly ( p < 0.05 ) higher values of these indices as compared to Group I. Levels of serum zinc , copper , manganese were not affected by supplements . Iron supplements improved the hematological profile of pregnant mothers but Fe + vitamin A supplements were more beneficial Blood manganese levels and iron status indices were determined each trimester in 66 healthy pregnant women . Twenty-five were r and omly assigned to iron supplementation , 19 to placebo and 22 received dietary advise aim ed at increasing their dietary intake of fibre . Iron supplemented women had significantly higher levels of blood haemoglobin compared to the levels of the two other groups , and higher serum ferritin levels compared to the placebo group . No significant difference in blood manganese levels was observed among the three groups of women . There was a significant increase in blood manganese levels from one trimester to the next , which was slightly more pronounced in non supplemented women . The median values in the three trimesters were 154 ( range 79 - 360 ) nmol/L , 190 ( range 98 - 408 ) nmol/L , and 230 ( range 133 - 481 ) nmol/L , respectively . Pregnancy seems to change manganese status or otherwise influence manganese metabolism irrespective of iron status and iron supplementation 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 AIM To compare the hematological parameters and pregnancy outcome in women receiving daily versus weekly iron supplements during pregnancy . METHODS A prospect i ve r and omized controlled study was carried out at the Department of Obstetrics and Gynaecology of the All India Institute of Medical Sciences , New Delhi , India , during which 111 women were r and omized to receive either 100 mg elemental iron daily ( n=55 ) or 200 mg elemental iron weekly ( n=56 ) . Hemogram and serum ferritin level estimation were carried out at the beginning of pregnancy and within the 32 - 34-week period of gestation . Side-effects , compliance and the number of tablets consumed were noted for each group . The mean birth weight , period of gestation at delivery and mode of delivery were also compared between the two intervention groups . RESULTS There was no significant difference in the mean hemoglobin levels between the two intervention groups at the end of an average 17 weeks of iron supplementation . However , among anemic women who received daily supplementation , there was a greater rise in hemoglobin compared with those receiving supplementation weekly . The serum ferritin level was lower in the weekly supplemented group compared with that in the daily . There was no difference in the mean birth weight , period of gestation and mode of delivery between the two groups . Side-effects and non-compliance were significantly higher ( P<0.001 ) in the daily supplemented group . CONCLUSIONS Weekly iron supplementation is an effective option for prophylaxis in non-anemic pregnant women , but has less than optimal benefit in anemic women BACKGROUND The National Nutritional Anaemia Prophylaxis Programme ( NNAPP ) in India was launched in 1971 . However , anaemia continues to be a major public health problem . Partial coverage of the population , inadequate dose of the iron supplement , defective absorption due to intestinal infestations and problems with formulation have been recognized as factors responsible for its failure . Therefore , the bioavailability of iron from different formulations containing 60 mg of elemental iron and of tablets with varying doses of elemental iron was undertaken . METHODS One hundred and fifteen women were r and omly allotted to receive different formulations and doses of iron and then undergo iron tolerance tests . They received ferrous sulphate tablets containing 60 mg , 120 mg and 180 mg of elemental iron ; formulations containing 60 mg of elemental iron as pure ferrous sulphate salt , ferrous fumarate tablets , ferrous fumarate syrup , excipients added to pure ferrous sulphate salts , powdered ferrous sulphate tablets , iron tablets distributed by the NNAPP and pure ferrous salt in gelatin capsules . RESULTS The data obtained from 32 subjects were excluded because of non-compliance , intolerance of the medication and lack of results of blood tests .  Data from the remaining 83 subjects indicated that increasing the dose of elemental iron from 60 mg to 180 mg improved the bioavailability of iron , but was associated with unacceptable side-effects . Also , liquid formulations of iron had a better bioavailability , with ferrous fumarate syrup and gelatin capsules being the most superior . CONCLUSION Providing the iron formulation with a high bioavailability should enable the NNAPP to be more successful in decreasing the prevalence of anaemia 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 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 Objective To determine whether a high concentration of serum ferritin during the third trimester is a marker of sub clinical maternal infection and very preterm delivery and is associated with maternal nutritional status . Methods A total of 1162 gravidas was followed prospect ively from entry to prenatal care ( 15.0 ± 4.9 completed weeks ' gestation ) in Camden , New Jersey , between 1985 and 1995 . Multiple logistic regression and analysis of covariance were used to examine the influence of serum ferritin on the outcomes of interest . Results High concentrations of serum ferritin ( at or above the 90th percentile ) at week 28 , but not at entry to prenatal care , increased risk of preterm and very preterm delivery , but the risk changed if the concentration of ferritin declined from entry . If the concentration declined as expected , high ferritin concentration had no influence on outcome . If the concentration increased , then high ferritin concentration at week 28 was associated with very preterm delivery ( adjusted odds ratio [ AOR ] 8.77 ; 95 % confidence interval [ CI ] 3.90 , 19.72 ) , preterm delivery ( AOR 3.81 ; 95 % CI 1.93 , 7.52 ) , low birth weight ( AOR 5.15 ; 95 % CI 2.47 , 10.72 ) , clinical chorio-amnionitis ( AOR 2.56 ; 95 % CI 1.01 , 6.52 ) , and symptoms of “ flu ” as an index of unmeasured infection ( AOR 6.02 ; 95 % CI 1.16 , 31.17 ) . Factors associated with failure of the ferritin concentration to decline included iron deficiency anemia earlier in pregnancy ( AOR 3.98 ; 95 % CI 1.17 , 8.98 ) and lower levels of serum and red cell folate . Conclusion High serum ferritin concentration in the third trimester , result ing from a failure of ferritin to decline , is associated with very preterm delivery and markers of maternal infection . Iron deficiency anemia and other indicators reflecting poor maternal nutritional status earlier in pregnancy underlie this relationship 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 Abstract Assessment of the efficacy of iron therapy has usually been done in population s/ patients by monitoring changes in hemoglobin concentration , serum iron , percent transferrin saturation , and serum ferritin . In this study the protoporphyrin heme ( P/H ) ratio ( a measure of free erythrocyte protoporphyrin ) was measured before and after iron therapy in three groups of pregnant women , who received 60 mg ( group A ) , 120 mg ( group B ) , and 240 mg ( group C ) of elemental iron with folic acid ( 0.5 mg ) per day for a period of 12 weeks , to evaluate its efficacy to monitor iron therapy . The three groups were comparable regarding the initial mean Hb concentration and serum ferritin levels . The initial mean P/H ratios were markedly elevated in all three groups and were different in the three groups , being highest in group A ( 113.2±92.6 ) , intermediate in group B ( 87.5±62.5 ) , and lowest in group C ( 69.8±43.3 ) . The initial P/H ratio was significantly higher in group A than in group C ( p<0.05 ) . This probably affected the efficacy of iron therapy in the three groups . The P/H ratio decreased significantly in each of the three groups after iron therapy ( A and B : p<0.001 ; C p<0.01 ) . Mean Hb concentration and serum ferritin increased in all three groups post therapy ; however , the magnitude of change in P/H ratio in all three groups was much greater . This indicated that the predominant contributory factor for anemia was iron deficiency in this group of pregnant women . Serum iron and percent transferrin saturation are difficult to interpret in our population , as iron is freely available over the counter and is prescribed as soon as anemia is detected in patients ; therefore , the reduction in P/H ratio may be used to monitor response to iron therapy in population groups 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 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 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 OBJECTIVE Our purpose was to demonstrate reduced blood volume in preeclampsia compared with nonproteinuric gestational hypertension and normal pregnancy by use of independent measures of red blood cell and plasma volumes . STUDY DESIGN Red blood cells labeled with a nonradioactive stable isotope of chromium and Evans ' blue were infused in subjects with preeclampsia or gestational hypertension and normotensive pregnant controls . Blood was sample d eight times over 60 minutes for dye concentration and at 30 minutes for chromium analysis . RESULTS Total blood and plasma volumes are decreased in preeclampsia ( 2660 + /- 382 mL/m2 and 1790 + /- 332 mL/m2 , respectively ) compared with normotensive subjects ( 3217 + /- 391 mL/m2 , P < 0.001 and 2279 + /- 325 mL/m2 , P < .001 ) and gestational hypertension ( 3139 + /- 272 mL/m2 , P < .001 and 2132 + /- 265 mL/m2 , P = .003 ) . Total body/peripheral hematocrit ratio is increased in preeclampsia . CONCLUSIONS Blood volume , by measurement of red blood cell and plasma volumes , is reduced and has altered distribution in preeclampsia but is normal in gestational hypertension 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 OBJECTIVE To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia  and to evaluate the association of maternal hemoglobin and fetal growth . DESIGN Prospect i ve . SETTING Tertiary care teaching hospital in an urban metropolis . METHOD 40 pregnant women received daily and 40 pregnant women received weekly oral therapy ( 335 mg of ferrous sulphate and 500 g folic acid ) for a period of 14 weeks . The age of each pregnant woman and their baseline anthropometric data ( weight , height and body mass index ) were estimated . Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks , 8 wks and 14 weeks . Serum ferritin values as a marker of iron status were also calculated in both the groups initially , at 14 weeks and at the time of delivery . Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration . RESULTS Forty subjects each were initially r and omized into groups I and II . The age of pregnant women along with their baseline anthropometric data were similar in both groups . A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up . The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers . An intention to treat analysis also showed similar results . The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy . Birth weight , crown heel length , head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels . CONCLUSION Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth 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 The influence of haemoglobin genotype on the response to iron supplementation was studied in a r and omized , double blind , placebo-controlled trial involving 497 multigravid pregnant women from a rural area of The Gambia . Women were r and omly allocated to receive either oral iron ( 60 mg elemental iron per day ) or placebo . At 36 weeks of pregnancy , women who had received oral iron during pregnancy had higher mean haemoglobin , packed cell volume , plasma iron and ferritin levels than did women who received placebo . Iron supplementation of pregnant women with the AA haemoglobin genotype also result ed in increases in the packed cell volume ( PCV ) and haemoglobin level measured after delivery , and in the birth weight of the infant . However , in AS women PCV and haemoglobin level at delivery were lower in the supplemented group and supplementation was also associated with reduced birth weights . In malaria endemic areas , pregnant women with the haemoglobin genotype AS may not benefit from iron supplementation during pregnancy 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 Objective . To determine the lowest dose of iron preventative of iron deficiency and iron deficiency anemia in pregnancy 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 BACKGROUND Erythrocyte indices change in pregnancy , mainly due to physiological haemodilution and iron-deficient erythropoiesis . The present study was undertaken to determine the haematological indices during different periods of gestation in women receiving daily iron supplements  and compare them with those in women receiving weekly iron supplements . METHODS Pregnant women < 20 weeks of gestation attending the antenatal clinic at the All India Institute of Medical Sciences were r and omized to receive either 100 mg elemental iron daily or 200 mg elemental iron weekly . The haemoglobin , haematocrit , mean corpuscular volume , mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration were estimated at baseline , after 1 month , 3 months and at 34 weeks of gestation . RESULTS Changes consistent with physiological haemodilution in mid-term pregnancy were noted and the values at 34 weeks of gestation were not significantly different between the two groups . CONCLUSION The effects of intermittent iron supplementation on the erythrocyte indices in pregnancy are comparable with those observed with daily supplementation The effect of anemia ( hematocrit less than or equal to 0.34 ) on subsequent preterm birth was prospect ively studied in 35,423 pregnancies . The incidence of preterm birth among women with and without anemia at each week during the third trimester was compared . Early in the third trimester , there was a weak association between anemia and preterm delivery . However , anemia early in the third trimester did not account for the substantial increase in preterm birth seen among black women .  Anemia after 30 weeks ' gestation was not associated with preterm birth . Among women delivering term infants weighing 2500 g or more , the mean hematocrit rose 0.029 among black women and 0.021 among white women from 25 weeks to term . Compared with hematocrits at 40 weeks ' gestation , the odds ratios for anemia reached a maximum at 28 weeks and fell sharply as term approached . When the hematocrits of women in term labor were compared with those of women in preterm labor , a spurious dose-response effect for anemia was created . We conclude that anemia is not a strong factor in the pathogenesis of preterm birth and that comparison of hematocrits from women who are in preterm and term labor produces biased results BACKGROUND We undertook this study to compare the effectiveness and safety of antenatal daily and weekly supplementation with iron , folic acid , and vitamin B(12 ) in healthy , pregnant women who were not anemic at gestational week 20 . METHODS Women with singleton pregnancies and blood hemoglobin ( Hb ) > 115 g/L at gestational week 20 ( equivalent to 105 g/L at sea level ) were r and omly assigned to two groups , one consuming one tablet containing 60 mg iron , 200 mug folic acid and 1 mug vitamin B(12 ) daily ( DS , n = 56 ) ; the other consuming two tablets once weekly ( WS , n = 60 ) . Blood Hb and serum ferritin concentrations were measured every 4 weeks from weeks 20 to 36 , and pregnancy outcomes were evaluated . RESULTS Mild anemia and hypoferritinemia throughout pregnancy occurred less frequently in DS than WS . None of the 116 women had Hb concentrations < 103 g/L at any evaluation point . In contrast , hemoconcentration ( Hb > 145 g/L ) from gestational week 28 onwards occurred in 11 % in DS and 2 % in WS . We observed ex post facto that hemoconcentration at gestational week 28 was associated with a significantly higher relative risk of low birth weight ( RR 6.23 , 95 % CI 1.46 - 26.57 ) and premature delivery ( RR 7.78 , 95 % CI 1.45 - 24.74 ) . CONCLUSIONS In women who were nonanemic at gestational week 20 , both schemes ( DS and WS ) prevented the occurrence of Hb levels < 100 g/L. DS women had a higher incidence of hemoconcentration . Hemoconcentration was associated with increased risk of low birth weight and premature delivery 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 The side-effects of a new sustained release oral ferrous sulphate preparation have been evaluated in three separate double-blind studies . Each tablet contained 100 mg of ferrous iron and the dosage employed in all studies was 2 tablets daily . In a large series of blood donors r and omly divided into three groups the frequency and type of side-effects were compared to ferrous sulphate tablets and placebo . In two series of pregnant women the side-effects were studied with a cross-over technique using ferrous sulphate tablets as reference . Placebo was also included as a reference in one of these studies . In all series the frequency of nausea and epigastric pain was about the same for the sustained release preparation as for placebo . In all series ferrous sulphate tablets gave a significantly higher frequency of nausea than the sustained release tablets and placebo . Also the frequency of epigastric pain was found to be higher in blood donors but this could not be verified in pregnant women 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 Abstract Objective : To assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups . Design : Retrospective analysis of 153602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy data base during 1988 - 91 . The haemoglobin measurement used was the lowest recorded during pregnancy . Setting : North West Thames region . Subjects : 115262 white women , 22206 Indo-Pakistanis , 4570 Afro-Caribbeans , 2642 mediterraneans , 3905 black Africans , 2351 orientals , and 2666 others . Main outcome measures : Birth weight and rates of low birth weight ( < 2500 g ) and preterm delivery ( < 37 completed weeks ) . Results : Maximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85 - 95 g/l ; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95 - 105 g/l . A similar pattern occurred in all ethnic groups . Conclusions : The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight ; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery . This phenomenon is seen in all ethnic groups . Some ethnic groups have higher rates of low birth weight and preterm delivery than white women , and they also have higher rates of low haemoglobin concentrations . This increased rate of “ anaemia , ” however , does not account for their higher rates of low birth weight , which occurs at all haemoglobin concentrations . Key messages Key messages Failure of the haemoglobin concentration to fall during pregnancy was associated with a five to sevenfold increase in the incidence of low birth weight and preterm birth Routine haematinic administration in pregnancy is unnecessary on fetal grounds for most pregnancies The mean corpuscular volume may be a better indicator of maternal iron deficiency , but this needs prospect i ve 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 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 A weekly iron/folate supplement was compared with a st and ard daily iron/folate supplement in pregnant women living in rural Malawi . Women were enrolled as they attended the local antenatal clinic , stratified by grade of anaemia and then r and omized to receive either 60 mg iron/0.25 mg folate per day ( n=211 ) or 120 mg iron/0.50 mg folate once a week ( n=202 ) . Supplementation was continued for a minimum of 8 weeks ( 10 weeks on average ) and was self administered by the women at home . Initial haemoglobin values for the daily ( μ=105.7g/l ) and weekly ( μ=104.4g/l ) groups as well as final haemoglobin values ( 107.5 g/l and 105.6 g/l , respectively ) did not differ significantly between the two groups . Haemoglobin values increased by similar levels in both groups with the subset of anaemic women increasing by an average of 6.3 g/l in the daily group ( n=70 ) and 5.9 g/l in the weekly group ( n=66 ) for all women . For compliant , anaemic women , the increases were 7.4 g/l and 6.6 g/l for the daily and weekly groups , respectively . Compliance , as indicated by self reporting and by regular counts of remaining tablets , was significantly higher in the weekly group ( 76 % compared with 60 % , P < 0.05 ) , however compliance was identical in both groups when assessed by a stool test for elemental iron . Reported side effects were significantly reduced in the weekly group ( 6 % compared with 17 % , P < 0.05 ) . We conclude that a weekly iron supplement given to pregnant women in rural Malawi has similar haematologic effects , and an improved side effect profile , in comparison with a st and ard daily supplement when administered through an existing primary healthcare programme , although both regimens are relatively unsuccessful in the reduction of anaemia prevalence during pregnancy In the present study 67 non-anaemic women were r and omly allocated to either 100 mg or 15 mg iron daily at about the 10 . week of pregnancy . At about week 18 , 30 and 36 of pregnancy , as well as 6 weeks after delivery , hemoglobin and the serum concentrations of ferritin , vitamin B12 , folates , Zn , Cu and Se were monitored . Dietary allowances of other minerals and vitamins are also increased in pregnancy , and the 15 mg iron tablet was enriched with Zn ( 10 mg ) , Cu ( 2 mg ) , Se ( 50 microg ) , vitamin B12 ( 3 microg ) , and folate ( 0.1 mg ) . Neither ferritin , nor Cu , Zn or Se concentrations differed statistically significantly between the treatment groups during pregnancy . Ferritin and Zn appeared to decrease approximately parallel to the hemodilution , whereas Cu concentrations increased from a non-pregnant reference mean of 18 micromol Cu/L to a maximum mean of nearly 33 micromol Cu/L during pregnancy . Se decreased concomitantly to about 1.0 micromol Se/L. Serum folate ( around 15 micromol/L ) was essentially unaffected by pregnancy in the group given multivitamin/mineral supplementation , whereas the mean concentration fell below 10 micromol/L in the group supplemented with 100 mg iron daily . Our results indicate that supplementation of 15 mg Fe daily during pregnancy results in a small reduction of hemoglobin . It is suggested that additional supplementation with folate might be of importance to maintain the serum folate concentration during pregnancy 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 The serial trends of the  whole blood folate level  in two groups of patients have been followed throughout pregnancy and up to six weeks postpartum . In those  receiving iron alone the whole blood folate remained normal until the test at six weeks after delivery , at which time over half were in the deficient range . There appears to be a delay before this test reflects the current folate status when this changes rapidly . In those receiving iron plus 330 μg . of folic acid a day the results at this time were close to those at the beginning of pregnancy . Subnormal whole blood folate , red cell folate , and serum folate values occurred close to term in patients receiving iron alone , but were not found in those also receiving folic acid .  Megaloblastic changes occurred at term in three patients receiving iron alone in whom the whole blood folate had repeatedly been low in early pregnancy . The observations are consistent with the previous suggestion that 300 μg . of folic acid daily is a suitable supplement to prevent deficiency in late pregnancy and the puerperium 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 Eighty-four non-anaemic pregnant women were treated , starting between the 20th-24th week of Pregnancy , with Actiferrin Compositum--1 capsule per day -- from the 36th with 2 capsules per day up to childbirth . The group was compared with the results in 57 non-anaemic not treated pregnant women .  Haematological parameters were recorded before the onset of treatment , during the first stage of labour and in neonates on the first day after delivery . By means of the non-paired t-test no significant differences were disclosed between the groups ; nevertheless the percentage values of haemoglobin , haematocrit , erythrocytes and serum iron were higher in the treated group , as compared with the non-treated one . Also the ferritin values in neonates of the non-treated group were lower , as compared with the treated group . The paired t-test was highly significant in the Actiferrin treated patients as regards haemoglobin , haematocrit and transferrin values . The results provide evidence that it is indicated to administer as a routine measure Actiferrin Compositum to all pregnant women as prevention of pre-partum anaemia of the mother and low ferritin levels in the neonate
BACKGROUND It has been suggested that routine intake of supplements containing iron or combination of iron and folic acid during pregnancy improves maternal health and pregnancy outcomes .
OBJECTIVES To assess the efficacy , effectiveness and safety of routine antenatal daily or intermittent iron supplementation with or without folic acid during pregnancy on the health of mothers and newborns .