Impact of twice weekly versus daily iron supplementation during pregnancy on maternal and fetal haematological indices: a randomized clinical trial. Adherence and Costs of Micronutrient Supplementation in Pregnancy in a Double-Blind, Randomized, Controlled Trial in Rural Western China Iron supplementation, maternal packed cell volume, and fetal growth. Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China Effect of iron content on the tolerability of prenatal multivitamins in pregnancy Modifying effects of wealth on the response to nutrient supplementation in pregnancy on birth weight, duration of gestation and perinatal mortality in rural western China: double-blind cluster randomized controlled trial. The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. A randomized cross over trial of tolerability and compliance of a micronutrient supplement with low iron separated from calcium vs high iron combined with calcium in pregnant women [ISRCTN56071145] Availability of iron from four prenatal multivitamin/multimineral products. Utilization of iron from an animal-based iron source is greater than that of ferrous sulfate in pregnant and nonpregnant women. Folate supplements during pregnancy. Adapting iron dose supplementation in pregnancy for greater effectiveness on mother and child health: protocol of the ECLIPSES randomized clinical trial Iron status markers during pregnancy. No relationship between levels at the beginning of the second trimester, prior to delivery and post partum. Can an iron-rich staple food help women to achieve dietary targets in pregnancy? Investigation of folic acid requirements in pregnancy. Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women Comparative study--efficacy, safety and compliance of intravenous iron sucrose and intramuscular iron sorbitol in iron deficiency anemia of pregnancy. Iron supplements versus placebo during pregnancy: its effects on iron and folate status on mothers and newborns. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Intermittent oral iron supplementation during pregnancy. Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. Evaluation of a gastric delivery system for iron supplementation in pregnancy. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic Acid supplements. 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. Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women. Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. Effect of time of initiation and dose of prenatal iron and folic acid supplementation on iron and folate nutriture of Korean women during pregnancy. 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. Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. 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. Effect of iron supplementation during pregnancy on the intelligence quotient and behavior of children at 4 y of age: long-term follow-up of a randomized controlled trial. 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. Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial. Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh. Role of iron supplementation in promoting maternal and fetal outcome Impact of Prophylactic Iron Supplementation in Healthy Pregnant Women on Maternal Iron Status and Birth Outcome [Deficiency of folates in pregnancy: effect of supplementary folic acid]. Universal iron supplementation: a simple and effective strategy to reduce anaemia among low-income, postpartum women. Iron requirement in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations Haematological response to supplements of iron and riboflavin to pregnant and lactating women in rural Gambia. Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trial 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 Gastric delivery system for iron supplementation 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. Comparison of oxidative stress in pregnancies with and without first trimester iron supplement: a randomized double-blind controlled trial 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 Personalised iron supply for prophylaxis and treatment of pregnant women as a way to ensure normal iron levels in their breast milk Iron supplementation in pregnancy: is less enough? Supplementation of iron alone and combined with vitamins improves haematological status, erythrocyte membrane fluidity and oxidative stress in anaemic pregnant women. [Clinical experience with iron supplementation in pregnancy]. Preterm delivery but not intrauterine growth retardation is associated with young maternal age among primiparae in rural Nepal. Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Effect of iron supplementation during pregnancy on the behaviour of children at early school age: long-term follow-up of a randomised controlled trial. Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy. Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. Antenatal and postnatal iron supplementation and childhood mortality in rural Nepal: a prospective follow-up in a randomized, controlled community trial. 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. Comparison of effect of daily versus weekly iron supplementation during pregnancy on lipid peroxidation. 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. Effects of prenatal multimicronutrient supplements on birth weight and perinatal mortality: a randomised, controlled trial in Guinea-Bissau Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Effect of dose and formulation on iron tolerance in pregnancy. Side Effects of Oral Iron Prophylaxis in Pregnancy – Myth or Reality? No effect of maternal micronutrient supplementation on early childhood growth in rural western China: 30 month follow-up evaluation of a double blind, cluster randomized controlled trial Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial Maternal erythropoietin in singleton pregnancies: a randomized trial on the effect of oral hematinic supplementation. Iron prophylaxis in pregnancy: intravenous route versus oral route. Determinants of compliance to antenatal micronutrient supplementation and women's perceptions of supplement use in rural Nepal. 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 Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia. Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal. 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 Micronutrient supplementation and pregnancy outcomes: double-blind randomized controlled trial in China. The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. Effect of education and pill count on hemoglobin status during prenatal care in Nepalese women: a randomized controlled trial. A randomized comparison of routine versus selective iron supplementation during pregnancy. Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: a prospective study. Megaloblastic anaemia of pregnancy: a clinical and laboratory study with particular reference to the total and labile serum folate levels Effects of Maternal Multimicronutrient Supplementation on the Mental Development of Infants in Rural Western China: Follow-up Evaluation of a Double-Blind, Randomized, Controlled Trial Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose–response trial The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia Determinants of compliance with iron supplementation among pregnant women in Senegal. A randomized trial investigating an iron-rich bread as a prophylaxis against iron deficiency in pregnancy Lack of inhibition of the anti-malarial action of sulfadoxine-pyrimethamine by folic acid supplementation when used for intermittent preventive treatment in Gambian primigravidae. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial A combination of iron and retinol supplementation benefits iron status, IL-2 level and lymphocyte proliferation in anemic pregnant women. [Folic acid and pregnancy, a real problem?]. [Iron status markers in pregnant women. No clinically significant connection between the values during the second trimester, later in pregnancy and after delivery]. Body iron and individual iron prophylaxis in pregnancy—should the iron dose be adjusted according to serum ferritin? 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. Preinduction Cervical Softening with Endocervical Pge2 Gel: A multi‐center trial 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. Reduction of Incidence of Prematurity by Folic Acid Supplementation in Pregnancy Erythrocyte indices in pregnancy: effect of intermittent iron supplementation. Moderate NaFeEDTA and ferrous sulfate supplementation can improve both hematologic status and oxidative stress in anemic pregnant women. Facts and artifacts about anemia and preterm delivery. [Iron treatment by effervescent tablets (author's transl)]. 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. The effect of maternal micronutrient supplementation on early neonatal morbidity in rural Nepal: a randomised, controlled, community trial Routine iron supplementation in pregnancy has no effect on iron status of children at six months and four years of age. Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. The effects of iron supplementation on serum copper and zinc levels in pregnant women with high-normal hemoglobin. A prophylactic trial of iron and folic acid supplements in pregnant Burmese women. Long-term follow-up of mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. Iron status markers in nonanemic pregnant women with and without iron supplementation. The Effectiveness of Weekly Iron Supplementation in Pregnant Women of Rural Northern Malawi Prophylactic iron supplementation in pregnant women in Norway. Milk Fortif Ed with Iron Or Iron Supplementation to Improve Nutritional Status of Pregnant Women: An Intervention Trial from Rural Vietnam 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]. Adherence and tolerability of iron-containing prenatal multivitamins in pregnant women with pre-existing gastrointestinal conditions Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal. Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial. Providing iron/folic acid tablets free of charge improves compliance in pregnant women in Senegal. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial
A r and omized clinical trial examined the efficiency and tolerability of twice weekly versus daily iron supplementation during pregnancy . A total of 370 pregnant women were r and omly assigned to receive either daily or twice weekly iron supplementation  during pregnancy . There were no significant differences in initial and delivery haemoglobin and haematocrit levels between the 2 groups . Ferritin concentrations were significantly lower in the twice weekly group at delivery , but hypoferritinaemia ( ferritin < 15 microg/L ) was not observed in either group . The frequency of nausea , vomiting and constipation were significantly lower in the twice weekly group . Birth weight and length were significantly higher in the daily supplemented group . In non-anaemic mothers , a smaller dose of iron may be sufficient and also might prevent the complications of iron excess Background Efforts to determine the impact of prenatal multivitamin supplementation on birth outcome have been carried out in several developing countries . A review of factors that would impact the effectiveness of prenatal supplementation under normal field conditions is currently lacking and will be required for exp and ed supplementation programs . An efficacy trial of a multiple micronutrient supplement for pregnant women was conducted in rural western China , and additional information on side effects , rates of adherence , program inputs , and cost was also gathered . Objectives To examine reports of side effects and rates of adherence to prenatal multiple micronutrient supplementation in comparison with supplementation with folic acid and with iron – folic acid , and to describe inputs and costs associated with prenatal supplementation in China . Methods A cluster-r and omized , double-blind , controlled trial was conducted in two rural counties in northwest China . All pregnant women in villages were r and omly assigned to take daily supplements of folic acid , iron – folic acid , or a recommended daily allowance of 15 vitamins and minerals from enrollment until delivery . Information was collected from the women on side effects and adherence . Program inputs and costs of supplementation were tracked . Descriptive statistics were used for the analysis . The biological effectiveness of prenatal multiple micronutrient supplements is reported elsewhere . Results Less than 4 % of women withdrew from the study because of side effects . Adherence to supplementation was high : the supplements were consumed on more than 90 % of the days on which they were available for consumption . The mean number of supplements consumed was high at 165 capsules , and about 40 % consumed the recommended 180 supplements during pregnancy . Conclusions High adherence to a prenatal supplement schedule can be achieved when mothers have frequent contact with trained health workers and a reliable supply of supplements 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 OBJECTIVE : To determine the impact of iron deficiency anemia ( IDA ) in pregnancy on young child development . METHODS : A 2-year follow-up of 850 children born to women who participated in a double-blind cluster r and omized controlled trial of prenatal micronutrient supplementation in western rural China . These women were r and omly assigned to receive either daily folic acid , iron/folic acid ( 60 mg iron ) , or multiple micronutrients ( with 30 mg iron ) during pregnancy . Children were categorized into the prenatal-IDA and prenatal – non-IDA groups based on the mother ’s hemoglobin in the third trimester . Each group contained 3 subgroups based on mother ’s treatment : folic acid , iron/folic acid , and multiple micronutrients .  Bayley scales of infant development were administered to the children to assess their development at 3 , 6 , 12 , 18 , and 24 months of age . RESULTS : Compared with the prenatal – non-IDA group , the prenatal-IDA group showed a significantly lower mental development index at 12 , 18 , and 24 months of age . The adjusted mean difference was 5.8 ( 95 % confidence interval [ CI ] , 1.1–10.5 ) , 5.1 ( 95 % CI , 1.2–9.0 ) , and 5.3 ( 95 % CI , 0.9–9.7 ) , respectively . Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal – non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients . CONCLUSIONS : Prenatal IDA in the third trimester is associated with mental development of the child . However , prenatal supplementation with sufficient iron protects child development even when the woman ’s IDA was not properly corrected in pregnancy Background Gastrointestinal irritability can deter pregnant women from starting or continuing prenatal multivitamin supplementation . In a previous study , suboptimal tolerability was observed among pregnant women taking a large tablet ( 18 mm × 8 mm × 8 mm ) multivitamin with high elemental iron content ( 60 mg as ferrous fumarate ) . The objective of the present study was to compare rates of adherence and reported adverse events among pregnant women who were r and omized to commence supplementation with a small-tablet prenatal multivitamin , containing either low or high iron content . Methods Pregnant women who called the Motherisk Program ( Hospital for Sick Children , Toronto ) and had not started taking or had discontinued any multivitamin due to adverse events were included in this prospect i ve , r and omized , open-label , 2-arm study . Women were r and omized to take a small-size ( 16 mm × 9 mm × 4 mm ) , low elemental iron content ( 35 mg as ferrous fumarate ) multivitamin ( ' 35 mg ' group ) ; or a small-size ( 5 mm radius , 5 mm thickness ) , high elemental iron content ( 60 mg as ferrous sulphate ) multivitamin ( ' 60 mg ' group ) . Follow-up interviews documented pill intake and adverse events . Rates of adherence and adverse events were compared between groups using chi-squared tests and Kaplan-Meier survival curves . Results Of 167 r and omized women , 92 in the ' 35 mg ' group and 75 in the ' 60 mg ' group were included in the analysis . Despite ideal conditions and regular follow-ups , mean adherence based on pill intake recall , in both groups was approximately 50 % . No statistically significant difference was detected in proportions of women who actually started taking either multivitamin . Among those who started , no difference was detected in rates of adherence or reported adverse events . Conclusion The present results suggest that iron content is not a major determinant of adherence to prenatal multivitamins . Combined with our previous study , tablet size may be the more definitive factor affecting adherence BACKGROUND There have been few reports of differential responses to nutrition interventions in women and children from poor households . Women from poor households have greater nutritional risks and are potentially a target group for programmes . We assessed the modifying effects of household wealth on responses to micronutrient supplements in pregnancy on newborn anthropometry and perinatal mortality . METHODS A cluster r and omized double-blind controlled trial conducted in two rural counties in northwestern China . All pregnant women in villages were r and omly allocated from enrolment until delivery to daily supplementation with folic acid ( control ) , iron/folic acid or multiple micronutrients ( MMNs ) with a recommended allowance of 15 vitamins and minerals . Wealth was based on a score from an inventory of household assets . RESULTS In the pregnant women from the poorest one-third of the households , MMN supplements significantly increased birth weight by 68 g [ 95 % confidence interval ( CI ) 4 - 131 g ] , reduced low birth weight by 60 % [ relative risks ( RRs ) 0.40 , 95 % CI 0.21 - 0.78 ] and tended to reduce early neonatal mortality by 52 % ( RR 0.48 , 95 % CI 0.17 - 1.36 ) compared with folic acid . Iron/folic acid significantly increased the duration of gestation by 0.41 weeks ( 95 % CI 0.18 - 0.65 ) , reduced pre-term birth by 45 % ( RR 0.55 , 95 % CI 0.32 - 0.93 ) and significantly reduced early neonatal mortality by 90 % ( RR 0.10 , 95 % CI 0.01 - 0.79 ) compared with folic acid . Iron/folic acid and MMN supplements had no significant effects in women from wealthier households . CONCLUSIONS In rural China , women from the poorest households had the largest perinatal outcome responses to micronutrient supplementation . In these women , st and ard iron/folic acid provided more protection for neonatal survival than MMN supplements Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria Background Prenatal micronutrient combinations with high iron content are associated with high rates of gastrointestinal symptoms . This coupled with nausea and vomiting of pregnancy results in women often discontinuing their multivitamins . A new prescription supplement ( PregVit ® ) that separates iron from calcium in two tablets – morning and evening , has lower elemental iron content ( 35 mg ) , but results in similar extent of iron absorption when compared to another supplement containing ( 60 mg ) of elemental iron ( Materna ® ) . The objectives of this study were to compare tolerability and compliance with PregVit ® vs. a supplement with high iron content ( Materna ® ) , in pregnant women . Methods R and omized , crossover open labeled study in 135 pregnant women attending outpatient clinics in Ontario and Quebec . Results Use of PregVit ® was associated with a 30 % reduction in constipation rate as compared to Materna ® . Both products demonstrated similar compliance rates . Compliance of Materna ® was negatively associated with the severity of nausea and vomiting of pregnancy . No such correlation was found for PregVvit ® . Conclusion PregVit ® , a supplement with lower iron content ( 35 mg ) , has significantly decreased constipation rates as compared to 60 mg iron- Materna and has similar compliance rates . High iron content in multivitamin supplements is associated with adverse effects in pregnancy 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 Heme iron absorption during pregnancy and the role of hepcidin in regulating dietary heme iron absorption remains largely unexplored . The objective of this research was to examine relative differences in heme ( animal based ) and nonheme ( ferrous sulfate ) iron utilization . This study was undertaken in 18 pregnant ( ages 16 - 32 y ; wk 32 - 35 of gestation ) and 11 nonpregnant women ( ages 18 - 27 y ) . Women were r and omly assigned to receive both an animal-based heme meal ( intrinsically labeled (58)Fe pork ) and labeled ferrous sulfate ( (57)Fe ) fed on alternate days . Blood sample s obtained 2 wk postdosing were used to assess iron status indicators and serum hepcidin and iron utilization based on RBC incorporation of iron isotopes . Heme iron utilization was significantly greater than nonheme iron utilization in the pregnant ( 47.7 ± 14.4 vs. 40.4 ± 13.2 % ) and nonpregnant women ( 50.1 ± 14.8 vs. 15.3 ± 9.7 % ) . Among pregnant women , utilization of nonheme iron was associated with iron status , as assessed by the serum transferrin receptor concentration ( P = 0.003 ; r(2 ) = 0.43 ) . In contrast , heme iron utilization was not influenced by maternal iron status . In the group as a whole , women with undetectable serum hepcidin had greater nonheme iron utilization compared with women with detectable serum hepcidin ( P = 0.02 ; n = 29 ) ; however , there were no significant differences in heme iron utilization . Our study suggests that iron utilization from an animal-based food provides a highly bioavailable source of dietary iron for pregnant and nonpregnant women that is not as sensitive to hepcidin concentrations or iron stores compared with ferrous sulfate In a controlled , prospect i ve trial , the effects of giving ferrous sulphate 50 mg daily to 76 pregnant women was compared with giving ferrous sulphate 50 mg daily plus folic acid 0.5 mg daily to 82 women in 12 general practice s in South-east Engl and .No differences in obstetric complications were found between the two groups , although the evidence of some of the listed complications may be too rare for detection in a sample of patients of this size Abstract Background Currently , there is no consensus regarding iron supplementation dose that is most beneficial for maternal and offspring health during gestation . Recommended iron supplementation dose does not preempt anemia in around 20 % of the pregnancies , nor the risk of hemoconcentration in 15 % . This deficit , or excess , of iron prejudices the mother-child wellbeing . Therefore the aims of the study are to determine the highest level of effectiveness of iron supplementation adapted to hemoglobin ( Hb ) levels in early pregnancy , which would be optimum for mother-child health . Methods / Design Design : R and omized Clinical Trial ( RCT ) triple-blinded Setting : 10 Primary Care Centers from Catalunya ( Spain ) Study subjects : 878 non-anemic pregnant women at early gestation stage , and their subsequent newborns Methods : The study is structured as a RCT with 2 strata , depending on the Hb levels before week 12 of gestation . Stratum # 1 : If Hb from 110 to 130 g/L , r and omly assigned at week 12 to receive iron supplement of 40 or 80 mg/d . Stratum # 2 : If Hb > 130 g/L , r and omly assigned at week 12 to receive iron supplement of 40 or 20 mg/d . Measurements : In the mother : socio-economic data , clinical history , food item frequency , lifestyle and emotional state , and adherence to iron supplement prescription . Biochemical measurements include : Hb , serum ferritin , C reactive protein , cortisol , and alterations in the HFE gene ( C282Y , H63D ) . In children : ultrasound fetal biometry , anthropometric measurements , and temperament development . Statistical analyses , using the SPSS program for Windows , will include bivariate and multivariate analyses adjusted for variables associated with the relationship under study . Discussion Should conclusive outcomes be reached , the study would indicate the optimal iron supplementation dose required to promote maternal and infant health . These results would contribute towards developing guidelines for good clinical practice .Trial registration This clinical trial is registered at http://www . clinical trialsregister.eu as EudraCT number 2012 - 005480 - 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 Habitual iron intakes during pregnancy are typically lower than dietary guidelines , a risk for iron deficiency . The aim of this study was to determine whether regular consumption of bread naturally rich in iron could help women to achieve dietary targets . Thirty-three primiparous mothers were r and omized to eat 3–4 slices of iron-rich or control bread daily for 6 weeks . Two 24-h-prompted ( multiple-pass ) dietary recalls were completed , and vali date d algorithms were used to determine the amount of ‘ available iron ’ from the diet . Regular consumption of iron-rich bread helped pregnant women to achieve UK dietary recommendations ; the quantity of bread consumed by the participants contributed 27 % versus 9 % UK Reference Nutrient Intake ( RNI ) ( 14.8 mg/d ) in the intervention versus the control group . Levels of total ‘ available iron ’ were similar in both groups and correlated positively with total dietary iron ( r = 0.78 , P = 0.0001 ) , vitamin C ( r = 0.43 , P = 0.017 ) and non-haem iron ( r = 0.77 , P = 0.0001 ) . Findings from this study show that iron-rich staple foods can help women  reach dietary targets for iron . This is an area of great potential that could be of particular benefit to low-income/ethnically diverse population groups who have some of the lowest iron intakes . Further research using fortified staple foods containing higher levels of iron is now warranted to establish physiological benefits 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 Background Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus , thus supplements are recommended . Adherence to current tablet-based supplements is documented to be poor . Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence . However , before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy , the bioavailability of the iron needs to be determined . Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women . Methods Eighteen healthy pregnant women ( 24 – 32 weeks gestation ) were r and omized to receive the supplements in a crossover design . Following ingestion of each supplement , the changes ( over baseline ) in serum iron and folate over 8 hours were determined . The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid ; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid . Results Overall absorption of iron from the powdered supplement was significantly lower than the tablet ( p = 0.003 ) . There was no difference in the overall absorption of folic acid between supplements . Based on the differences in the area under the curve and doses , the relative bioavailability of iron from powdered supplement was lower than from the tablet ( 0.22 ) . Conclusion The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports . However , since pills and capsules are known to be poorly accepted by some women during pregnancy , it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose .Trial Registration Clinical Trials.gov OBJECTIVE ( 1 ) To determine an alternative iron supplementation with better efficacy , compliance & safety in treatment of iron deficiency anemia during pregnancy , ( 2 ) to reduce blood transfusion during pregnancy , labor and puerperium . MATERIAL AND METHOD A prospect i ve comparative study . A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia . They were divided in 3 groups ( A , B and C ) . Group A ( n = 15 ) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage , in group B ( n = 20 ) iron sucrose was administered according to deficit calculated as per formula but 200 mg of iron was given for storage instead of 500 mg , to reduce cost . While group C received intra muscular iron Sorbitol in the dose used as practice . RESULTS Mean hemoglobin in group A and B was 8.0 + /- 1.1 g/dl and 8.9 + /- 0.7 respectively , in group C , it was 8.8 + /- 0.9 g/dl . In group A & B initial hemoglobin was assessed 3 weeks post therapy which showed an average rise of 2.8 g/dl ( group A ) and 1.9 g/dl ( group B ) and second assessment of Hemoglobin was done prior to delivery ( ave : 6.6 weeks ) showed a total rise of 3.8 g/dl ( group A ) and 2.4 g/dl ( group B ) . Pre delivery mean Hemoglobin in group A and B was 11.8 g/dl and 11.3 g/dl respectively . In group C , the Hemoglobin was assessed only prior to delivery ( average : 8.4 weeks from the start of therapy ) , and a rise of 1.4 g/dl was observed with pre delivery mean Hemoglobin of 10.2 g/dl . Target hemoglobin levels i.e. 11 g/dl was achieved by 80 % in Group A , 70 % in Group B and 28 % in Group C by the time of delivery . Blood transfusion was not required in any group . In group A and B one patient had moderate abdominal pain , 2 had weakness and shivering and 3 had phlebitis at the site where intravenous canula was retained . None of patient discontinued the therapy due to any adverse effect . In group C majority complained of pain at injection site while 5 patients dropped out from the study due to intolerance . CONCLUSION Intravenous iron therapy is safe , convenient and more effective then intramuscular iron therapy in treatment of iron deficiency anemia during pregnancy . The intravenous iron therapy can replace blood transfusion in antenatal period 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 Iron deficiency anemia is a serious health problem that affects the physical and cognitive development of children . Therefore , it is important to develop cost-effective interventions to improve the hematologic status of the millions of children affected by this condition worldwide . We studied 69 Guatemalan infants who had been r and omly assigned to one of three groups at the time of delivery : 1 ) cord clamping immediately after delivery ( n = 21 ) ; 2 ) clamping when the cord stopped pulsating , with the infant placed at the level of the placenta ( n = 26 ) ; or 3 ) clamping when the cord stopped pulsating , with the newborn placed below the level of the placenta ( n = 22 ) . Maternal and infant hematologic assessment s were performed at the time of delivery and 2 mo postpartum . At baseline the groups had similar socioeconomic , demographic , and biomedical characteristics and the newborns had similar hematocrit status . Two months after delivery , infants in the two groups with delayed cord clamping had significantly higher hematocrit values and hemoglobin concentrations than did those in the early-clamping group . The percentage with hematocrit values < 0.33 was 88 % in the control group compared with 42 % in group 2 and 55 % in group 3 ( P = 0.01 ) . These results suggest that waiting until the umbilical cord stops pulsating ( approximately 1 min after delivery ) is a feasible low-cost intervention that can reduce anemia in infants in developing countries RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia ( IDA ) . OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly , thrice weekly and daily in preventing IDA in pregnancy . DESIGN A r and omised control trial . SETTING University antenatal clinic , ( UANC ) Galle . SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was r and omly given weekly ( n = 26 ) thrice weekly ( n = 35 ) and daily ( n = 31 ) to 92 women who were 14 to 24 weeks pregnant .  Haemoglobin ( Hb ) , serum ferritin ( SF ) and haematocrit ( Hct ) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out . RESULTS The risk of developing anaemia was significantly higher in the weekly ( odds ratio 15 , 95 % CI 1.4 - 165.6 , p < 0.03 ) and possibly higher in the thrice weekly ( odds ratio 3 , 95 % CI 0.3 - 30.3 , p = 0.3 ) groups . The risk of developing iron deficiency ( SF < 12 micrograms/l ) was also significantly higher in the weekly ( odds ratio 18 , 95 % CI 2.8 - 115.5 , p < 0.003 ) and thrice weekly ( odds ratio 10 , 95 % CI 1.6 - 64.8 , p < 0.02 ) groups . CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron The effect of daily rather than weekly iron supplementation was compared in women who were 8 - 24 wk pregnant . One group ( n = 68 ) received 60 mg Fe/d , the second group ( n = 71 ) received 120 mg Fe/wk , given at once . Supplementation lasted 11.3 wk on average , depending on gestational date at entry , and was not supervised . Hemoglobin increased in both groups ( P < 0.001 ) ; serum ferritin did not change significantly . There was no significant difference between groups for changes in hemoglobin and serum ferritin . In a subgroup of women with a hemoglobin concentration < 110 g/L at baseline ( n = 45 daily ; n = 54 weekly ) no significant within-group changes occurred in serum ferritin , but the change in the daily group was 4.1 micrograms/L higher than in the weekly group ( P = 0.049 ) . Compliance , as indicated by two positive stool tests , was approximately equal to 54.3 % in the daily group and 62.2 % in the weekly group . We conclude that for the complete sample of subjects , the treatment effect of daily compared with weekly supplementation was similar under conditions resembling a normal antenatal care program 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 In rural China , many pregnant women in their third trimester suffer from anemia ( 48 % ) and iron deficiency ( ID ; 42 % ) , often with coexisting deficiencies of retinol and riboflavin . We investigated the effect of retinol and riboflavin supplementation in addition to iron plus folic acid on anemia and subjective well-being in pregnant women . The study was a 2-mo , double-blind , r and omized trial . Subjects ( n = 366 ) with anemia [ hemoglobin ( Hb ) < /= 105 g/L ] were r and omly assigned to 4 groups , all receiving 60 mg/d iron and 400 mug/d folic acid . The iron+folic acid ( IF ) group ( n = 93 ) served as reference , the iron+folic acid+retinol group ( IFA ) ( n = 91 ) was treated with 2000 mug retinol , the iron+folic acid+riboflavin group ( IFB ) ( n = 91 ) with 1.0 mg riboflavin , and the iron+folic acid+retinol+riboflavin group ( IFAB ) ( n = 91 ) with retinol and riboflavin . After the 2-mo intervention , the Hb concentration increased in all 4 groups ( P < 0.001 ) . The increase in the IFAB group was 5.4 + /- 1.1 g/L greater than in the IF group ( P < 0.001 ) . The reduced prevalence of anemia ( Hb < 110g/L ) and ID anemia were significantly greater in the groups supplemented with retinol and /or riboflavin than in the IF group . Moreover , gastrointestinal symptoms were less prevalent in the IFA group than in the IF group ( P < 0.05 ) and improved well-being was more prevalent in the groups receiving additional retinol and /or riboflavin than in the IF group ( P < 0.05 ) . Thus , a combination of iron , folic acid , retinol , and riboflavin was more effective than iron plus folic acid alone . Multimicronutrient supplementation may be worthwhile for pregnant women in rural China 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 United States , the prevalence of third trimester anemia among low-income pregnant women is 29 % and has not improved since the 1980s . Although low adherence has been linked to the ineffectiveness of iron supplementation programs , data regarding adherence to supplementation in low-income women are currently lacking . Hence this study was conducted to better underst and the factors associated with adherence to the use of iron-containing prenatal multivitamin/mineral supplements among low-income pregnant women . Adherence to supplement use was assessed by pill counts among 244 pregnant women of 867 women who were initially r and omized to receive 1 of 3 prenatal supplements . All women received care at a public prenatal clinic . Maternal characteristics associated with adherence were identified using predictive modeling . Women took 74 % of supplements as prescribed . Adherence was higher among non-Hispanic white women than among non-Hispanic black women ( 79 % vs. 72 % , P < /= 0.01 ) . Interactions of ethnicity with age group , smoking status , and prior supplement use were significant . Multivariate regression analysis stratified by ethnicity revealed that among the white women education beyond high school , unmarried status , nulligravidity , and smoking were positively associated with adherence . In contrast , among the black women , supplement use 3 mo prior to current pregnancy and no loss of appetite were positively associated with adherence . Further research investigating the influence of cultural factors is necessary to better underst and adherence to supplement use and the differences in adherence among ethnic groups 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 BACKGROUND In Korea , it is customary to prescribe iron and folic acid supplements to pregnant women after the 20th wk of gestation ; however , little evidence exists to support this practice . OBJECTIVE The objective was to determine the effects of time of initiation and dose of prenatal iron and folic acid supplementation on the iron and folate nutriture of Korean women during pregnancy . DESIGN A total of 131 pregnant women were placed into 1 of 5 experimental groups , either the control group or 1 of 4 supplemented groups . The supplemented groups varied by time of initiation , which was either during the first trimester or at week 20 of gestation , and by dose of iron and folic acid supplements provided , which consisted of either 30 mg Fe plus 175 microg folic acid or 60 mg Fe plus 350 microg folic acid . All supplemented groups continued supplementation until delivery . RESULTS Improvements in iron and folate nutriture were highly dependent on when the supplement program was initiated , but both supplement doses were equally effective . In contrast , the influence of folic acid supplementation on maternal folate status was not as pronounced as was the influence of iron supplementation on iron status . CONCLUSION In pregnant Korean women , initiating iron and folic acid supplementation earlier during pregnancy may prevent the deterioration of iron and folate nutriture more than does increasing supplement doses in later stages of pregnancy 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 We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by approximately 15 % . OBJECTIVE We examined the effect of daily maternal micronutrient supplementation on  fetal loss and infant mortality .  DESIGN The study was a double-blind , cluster-r and omized , controlled trial among 4926 pregnant women and their 4130 infants in rural Nepal . In addition to vitamin A ( 1000 microg retinol equivalents ) , the intervention groups received either folic acid ( FA ; 400 microg ) , FA + iron ( 60 mg ) , FA + iron + zinc ( 30 mg ) , or multiple micronutrients ( MNs ; the foregoing plus 10 microg vitamin D , 10 mg vitamin E , 1.6 mg thiamine , 1.8 mg riboflavin , 2.2 mg vitamin B-6 , 2.6 microg vitamin B-12 , 100 mg vitamin C , 64 microg vitamin K , 20 mg niacin , 2 mg Cu , and 100 mg Mg ) . The control group received vitamin A only . RESULTS None of the supplements reduced fetal loss . Compared with control infants , infants whose mothers received FA alone or with iron or iron + zinc had a consistent pattern of 15 - 20 % lower 3-mo mortality ; this pattern was not observed with MNs . The effect on mortality was restricted to preterm infants , among whom the relative risks ( RRs ) were 0.36 ( 95 % CI : 0.18 , 0.75 ) for FA , 0.53 ( 0.30 , 0.92 ) for FA + iron , 0.77 ( 0.45 , 1.32 ) for FA + iron + zinc , and 0.70 ( 0.41 , 1.17 ) for MNs . Among term infants , the RR for mortality was close to 1 for all supplements except MNs ( RR : 1.74 ; 95 % CI : 1.00 , 3.04 ) . CONCLUSIONS Maternal micronutrient supplementation failed to reduce overall fetal loss or early infant mortality .  Among preterm infants , FA alone or with iron reduced mortality in the first 3 mo of life . MNs may increase mortality risk among term infants , but this effect needs further evaluation 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 BACKGROUND Iron supplements are often prescribed during pregnancy despite the lack of intervention trials that have assessed the effects of supplementation in pregnancy on childhood development . OBJECTIVE The objective was to determine whether iron supplementation during pregnancy influences  childhood intelligence quotient ( IQ )  in an industrialized country . DESIGN Pregnant women ( n = 430 ) were r and omly allocated to receive iron ( 20 mg/d ) or placebo from 20 wk gestation until delivery , and the women and their children were followed up over the long term ( 4 y ) . Seventy percent of these families participated in the follow-up . The proportion of women with iron deficiency anemia at the end of pregnancy was 1 % ( 2 of 146 ) in the iron group and 11 % ( 15 of 141 ) in the placebo group . The primary outcome was the IQ of the children at 4 y of age , as assessed by the Stanford-Binet Intelligence Scale . Secondary outcomes included child behavior and the general health of the mothers . RESULTS The mean IQ was not significantly different ( P = 0.980 ) between the children of the iron-supplemented mothers ( 109 + /- 11 ; n = 153 ) and the children of the mothers in the placebo group ( 109 + /- 11 ; n = 149 ) . However , the percentage of children with an abnormal behavior score was higher in the iron group ( 24 of 151 , or 16 % ) than in the placebo group ( 12 of 149 , or 8 % ) ; the relative risk was 1.97 ( 95 % CI : 1.03 , 3.80 ; P = 0.037 ) . There was no significant difference in the health of the mothers between groups , as assessed by the SF-36 Health Survey . CONCLUSIONS Prenatal iron supplementation that reduces the incidence of iron deficiency anemia from 11 % to 1 % has no effect on the IQ of the offspring at 4 y of age 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 Previously we showed that women in rural Nepal experience multiple micronutrient deficiencies in early pregnancy . OBJECTIVE This study examined the effects of daily antenatal micronutrient supplementation on changes in the biochemical status of several micronutrients during pregnancy . DESIGN In Nepal , we conducted a r and omized controlled trial in which 4 combinations of micronutrients ( folic acid , folic acid + iron , folic acid + iron + zinc , and a multiple micronutrient supplement containing folic acid , iron , zinc , and 11 other nutrients ) plus vitamin A , or vitamin A alone as a control , were given daily during pregnancy . In a sub sample of subjects ( n = 740 ) , blood was collected both before supplementation and at approximately 32 wk of gestation . RESULTS In the control group , serum concentrations of zinc , riboflavin , and vitamins B-12 and B-6 decreased , whereas those of copper and alpha-tocopherol increased , from the first to the third trimester . Concentrations of serum folate , 25-hydroxyvitamin D , and undercarboxylated prothrombin remained unchanged . Supplementation with folic acid alone or folic acid + iron decreased folate deficiency . However , the addition of zinc failed to increase serum folate , which suggests a negative inhibition ; multiple micronutrient supplementation increased serum folate .  Folic acid + iron + zinc failed to improve zinc status but reduced sub clinical infection .  Multiple micronutrient supplementation decreased the prevalence of serum riboflavin , vitamin B-6 , vitamin B-12 , folate , and vitamin D deficiencies but had no effect on infection . CONCLUSIONS In rural Nepal , antenatal supplementation with multiple micronutrients can ameliorate , to some extent , the burden of deficiency . The implication s of such biochemical improvements in the absence of functional and health benefits remain unclear BACKGROUND The need for prophylactic iron during pregnancy is uncertain . OBJECTIVE We tested the hypothesis that administration of a daily iron supplement from enrollment to 28 wk of gestation to initially iron-replete , nonanemic pregnant women would reduce the prevalence of anemia at 28 wk and increase birth weight . DESIGN Between June 1995 and September 1998 , 513 low-income pregnant women in Clevel and were enrolled in the study before 20 wk of gestation . Of these , 275 had a hemoglobin concentration > /= 110 g/L and a ferritin concentration > /= 20 micro g/L and were r and omly assigned to receive a monthly supply of capsules containing either 30 mg Fe as ferrous sulfate or placebo until 28 wk of gestation . At 28 and 38 wk of gestation , women with a ferritin concentration of 12 to < 20 micro g/L or < 12 micro g/L received 30 and 60 mg Fe/d , respectively , regardless of initial assignment . Almost all the women received some supplemental iron during pregnancy . We obtained infant birth weight and gestational age at delivery for 117 and 96 of the 146 and 129 women r and omly assigned to receive iron and placebo , respectively . RESULTS Compared with placebo , iron supplementation from enrollment to 28 wk of gestation did not significantly affect the overall prevalence of anemia or the incidence of preterm births but led to a significantly higher mean ( + /- SD ) birth weight ( 206 + /- 565 g ; P = 0.010 ) , a significantly lower incidence of low-birth-weight infants ( 4 % compared with 17 % ; P = 0.003 ) , and a significantly lower incidence of preterm low-birth-weight infants ( 3 % compared with 10 % ; P = 0.017 ) . CONCLUSION Prenatal prophylactic iron supplementation deserves further examination as a measure to improve birth weight and potentially reduce health care costs BACKGROUND Iron deficiency anemia ( IDA ) is common in pregnant women , but previous trials aim ed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects . OBJECTIVE The objective was to assess the effect on  maternal IDA and iron deficiency ( ID , without anemia ) of supplementing pregnant women with a low dosage ( 20 mg/d ) of iron . Effects on iron status were assessed at the time of delivery and at 6 mo postpartum . Gastrointestinal side effects were assessed at 24 and 36 wk of gestation . DESIGN This was a r and omized , double-blind , placebo-controlled trial of a 20-mg daily iron supplement ( ferrous sulfate ) given from 20 wk of gestation until delivery . RESULTS A total of 430 women were enrolled , and 386 ( 89.7 % ) completed the follow-up to 6 mo postpartum . At delivery , fewer women from the iron-supplemented group than from the placebo group had IDA [ 6/198 , or 3 % , compared with 20/185 , or 11 % ; relative risk ( RR ) : 0.28 ; 95 % CI : 0.12 , 0.68 ; P < 0.005 ] , and fewer women from the iron-supplemented group had ID ( 65/186 , or 35 % , compared with 102/176 , or 58 % ; RR : 0.60 ; 95 % CI : 0.48 , 0.76 ; P < 0.001 ) . There was no significant difference in gastrointestinal side effects between groups . At 6 mo postpartum , fewer women from the iron-supplemented group had ID ( 31/190 , or 16 % , compared with 51/177 , or 29 % ; RR : 0.57 ; 95 % CI : 0.38 , 0.84 ; P < 0.005 ) . The rate of IDA between the groups did not differ significantly at 6 mo postpartum . CONCLUSION Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects BACKGROUND There is a growing interest in periconceptional iron supplementation in developing countries by research ers and policy makers ; however , there are no r and omized controlled trials that examine the effectiveness of this strategy in decreasing  anemia during pregnancy . OBJECTIVE The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy . DESIGN A r and omized , double-blind , controlled trial was conducted in rural Bangladesh . Married , nulliparous women were r and omly assigned to receive daily iron and folic acid ( IFA ; 60 mg ferrous fumarate and 400 microg folic acid ) ( n = 134 ) or folic acid ( FA ; 400 microg ) ( n = 138 ) in the form of a powdered supplement added to food . Women were followed until pregnancy or the end of 9 mo . Primary outcomes included hemoglobin , plasma ferritin , and plasma transferrin receptor concentrations . RESULTS Among 88 pregnant women , periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation . However , each 1 % increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline ( P = 0.03 ) , and those who initiated supplementation at a mean ( + /-SD ) time of 72.9 + /- 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 + /- 12.3 d after conception ( P = 0.01 ) . Among 146 nonpregnant women , IFA decreased anemia ( odds ratio : 0.19 ; 95 % CI : 0.04 , 0.95 ) and improved iron stores ( P = 0.001 ) more than did FA . CONCLUSION Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy . This trial was registered at www . clinical trials.gov as NCT00953134 Background The data comparing daily versus intermittent iron supplementation during pregnancy remain controversial . This study was undertaken to compare the efficacy of daily versus two different intermittent iron supplementation regimes on hematologic markers and birth outcomes in nonanemic pregnant women . Methods Two hundred and ten women with singleton pregnancies , no known disease , and hemoglobin levels > 11.0 g/dL were r and omly assigned to one of three groups , ie , Group A consuming two iron supplementation tablets once weekly ( 100 mg iron per week , n = 70 ) , Group B consuming one tablet twice weekly ( 100 mg iron per week , n = 70 ) and Group C , consuming one tablet daily ( 50 mg iron per day , n = 70 ) . No additional micronutrients were supplied . Hemoglobin and serum ferritin levels were measured at 20 , 28 , and 38 weeks . Pregnancy and birth outcomes ( pregnancy termination , method of delivery , birth weight , stillbirth ) were analyzed . Results In total , 201 women completed the protocol . There was a significant difference in mean hemoglobin and ferritin levels in Group B at 38 weeks ( P = 0.018 and P = 0.035 , respectively ) but this difference was not clinical ly significant ( hemoglobin > 12 g/dL , ferritin > 19 μg/L ) . There was a significant increase in ferritin in Group C ( P = 0.03 ) at 28 weeks . No significant difference was observed with respect to pregnancy or birth outcome across the groups . All regimens prevented the occurrence of hemoglobin < 10.5 g/dL , but weekly supplementation was associated with development of a hemoglobin level < 11.0 g/dL ( risk ratio 0.044 ) . Conclusion Twice-weekly supplementation is as effective as daily supplementation , and may represent an acceptable compromise in iron supplementation regimens for nonanemic pregnant women Background In spite of the beneficial effect of iron supplementation in iron-deficient pregnant women , iron supplementation may not be needed for women who are iron replete or not anemic . Moreover , the theoretical possibility of adverse effects , such as oxidative damage , from administration of iron supplements during pregnancy has been raised . Objective To determine the effect of prophylactic iron supplementation on iron status and birth outcomes among nonanemic pregnant women . Methods A r and omized , triple-blind clinical trial was conducted . One hundred forty-eight nonanemic pregnant women with hemoglobin > 110 g/L , serum ferritin > 12 μg/L , and gestational age < 20 weeks were r and omly assigned to receive either ferrous sulfate ( 60 mg elemental iron ) ( n = 70 ) or placebo ( n = 78 ) until delivery . Hemoglobin concentration and serum ferritin were measured by electronic counter and radioimmunoassay , respectively . Data were analyzed by independent t-tests , ANCOVA , and repeated measures . Results At delivery , the incidence of iron deficiency was significantly lower in the iron than in the placebo group . There were no significant differences between the two groups in maternal hemoglobin and ferritin concentrations at delivery or in the infant 's birthweight , birth length , or length of gestation . Conclusions Iron supplementation during pregnancy in nonanemic women with low serum ferritin may have benefits beyond the prevention of iron-deficiency anemia Higher folate needs are present during pregnancy , which may lead to tissular deficiency in the mother and to depleted newborn folate reserves . The aim of this work was to assess the prevalence of folate deficiency and to establish the rates of serum and red cell folate in two groups of mothers and newborn infants , one receiving only iron and the other iron and folate during pregnancy .  The rates of serum and red cell folate found at the end of pregnancy were significantly higher in the group which received folate ; however , the percentage of cases with tissular folate deficiency was low in both groups , with no significant difference ( 3.8 % and 1.3 % , respectively ) . These findings , along with the lack of effect of supplemental folate on erythropoiesis , pose some questions on the usefulness of supplemental folate during pregnancy in our country OBJECTIVE To reduce prevalence of anaemia in low-income postpartum women . DESIGN A r and omised , non-blind clinical trial was conducted among 959 low-income , postpartum women in eleven clinics in Mississippi . The clinics were r and omised to one of three treatment groups : ( i ) selective anaemia screening of high-risk women as recommended currently ( control ) ; ( ii ) universal anaemia screening and treatment of anaemic women ( group I ) ; and ( iii ) universal Fe supplementation of 65 mg/d for two months to all low-income women ( group II ) . All study participants within each clinic received the same treatment . Women were followed up at 6 months after delivery . Hb was measured at baseline and at follow-up . The primary outcome variable was the proportion of women with anaemia after treatment . SETTING Eleven health clinics in Mississippi . SUBJECTS Low-income , postpartum women . RESULTS Baseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for continuous variables and the χ2 test for categorical variables . Fifty-two per cent of postpartum women were anaemic ( Hb < 12·0 g/dl ) and the rate decreased to 33 % at 6 months after the intervention . Group II women , who received universal Fe supplementation , improved their Hb status significantly ( P < 0·001 ) at 6 months postpartum compared with the other groups . Prevalence of anaemia was also significantly lower among group II women ( 22·5 % ) compared with controls ( 34 % ) and group I women ( 43 % ; P < 0·001 ) . CONCLUSIONS A universal Fe supplementation strategy was effective in reducing the prevalence of anaemia among low-income postpartum women Summary . Serum iron , serum iron‐binding capacity , serum ferritin and erythrocyte protoporphyrin were determined during uncomplicated pregnancy in 45 healthy women ; 22 were given oral iron  while the others were given a placebo . When iron was not given , 15 out of 23 women had exhausted iron stores and iron deficiency at term , as judged from low serum ferritin , low serum transferrin saturation and high erythrocyte protoporphyrin values . Only seven of them had a haemoglobin concentration between 10 and 11 g/dl at term but none had values < 10 g/dl . In the iron‐treated group ( n=22 ) none of the women developed iron deficiency . Serum ferritin was the most sensitive and specific test of iron deficiency . A practical procedure to detect iron deficiency and to control iron supplementation in pregnancy is suggested Eighty-one pregnant or lactating women living in a village in The Gambia were allocated to treatment groups to receive a daily placebo , riboflavin , ferrous sulphate or ferrous sulphate plus riboflavin . At the beginning of the study and at 3 and 6 weeks thereafter women were examined clinical ly and blood sample s collected for haematological and biochemical measurements . Pregnant women showed a wide range of response to supplement but among the lactating women an interesting pattern emerged : whereas the haematological status of the placebo group declined over 6 weeks , in the group receiving iron supplements this deterioration was reduced although not significantly . Riboflavin given in addition to iron result ed in a significant increase in circulating plasma iron and in iron stores , relative to the placebo Objective To present the pregnancy results and interim birth results of a pragmatic r and omised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV . Design A pragmatic r and omised controlled trial . Setting Two health centres ( 1 ° de Maio and Machava ) in Maputo , Mozambique , a setting of endemic malaria and high prevalence of HIV . Participants Pregnant women ( ≥18-year-olds ; non-high-risk pregnancy , n=4326 ) attending prenatal care consultation at the two health centres were recruited to the trial . Interventions The women were r and omly allocated to either Routine iron ( n=2184 ; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy ) or Selective iron ( n=2142 ; screening and treatment for anaemia and daily intake of 1 mg of folic acid ) . Outcome measures The primary outcomes were preterm delivery ( delivery < 37 weeks of gestation ) and low birth weight ( < 2500 g ) . The secondary outcomes were symptoms suggestive of malaria and self-reported malaria during pregnancy ; birth length ; caesarean section ; maternal and child health status after delivery . Results The number of follow-up visits was similar in the two groups . Between the first and fifth visits , the two groups were similar regarding the occurrence of fever , headache , cold/chills , nausea/vomiting and body aches . There was a suggestion of increased incidence of self-reported malaria during pregnancy ( OR 1.37 , 95 % CI 0.98 to1.92 ) in the Routine iron group . Birth data were available for 1109 ( 51 % ) in the Routine iron group and for 1149 ( 54 % ) in the Selective iron group . The birth outcomes were relatively similar in the two groups . However , there was a suggestion ( statistically non-significant ) of poorer outcomes in the Routine iron group with regard to long hospital stay after birth ( relative risk ( RR ) 1.43 , 95 % CI 0.97 to 1.26 ; risk difference ( RD ) 0.02 , 95 % CI −0.00 to 0.03 ) and unavailability of delivery data ( RR 1.06 , 95 % CI 1.00 to 1.13 ; RD 0.03 , 95 % CI −0.01 to 0.07 ) . Conclusions These interim results suggest that routine iron prophylaxis during pregnancy did not confer advantage over screening and treatment for anaemia regarding maternal and child health . Complete data on birth outcomes are being collected for firmer conclusions . Trial registration The trial is registered at Clinical Trials.gov , number NCT00488579 ( June 2007 ) . The first women were r and omised to the trial proper April 2007–March 2008 . The pilot was November 2006–March 2008 . The 3-month lag was due to technical difficulties in completing trial registration Beverley-Anne Biggs and colleagues conduct a community-based cluster r and omized trial in rural Viet Nam to compare the effect of antenatal iron-folic acid supplementation taken daily or twice weekly on  maternal and infant outcomes . Please see later in the article for the Editors ' 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 A gastric delivery system ( GDS ) for iron supplementation was evaluated . Radioisotopic studies in 9 volunteers demonstrated a three-fold higher absorption of GDS iron compared with ferrous sulphate elixir . A double-blind placebo controlled trial was done in 200 women to compare the gastrointestinal side-effects associated with 50 mg iron daily given either as GDS or conventional ferrous sulphate . The conventional preparation was associated with a significantly higher frequency of nausea and anorexia , whereas there were no significant differences in reported side-effects between subjects receiving GDS or placebo . A single GDS capsule daily provides the same amount of absorbed iron as conventional ferrous sulphate given three times daily , and does not produce gastrointestinal side-effects 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 Abstract Objective : Iron supplementation was found to be a cause of oxidative stress . The aim of this study was to compare oxidative stress in pregnancies with and without iron supplementation in the first trimester pregnancies . Methods : One hundred and eight women in the first trimester of normal pregnancies were r and omly assigned to three groups . Patients were grouped as following : Group 1 received placebo ( n = 36 ) , group 2 received folate supplementation ( n = 36 ) and group 3 was directed to the iron supplementation ( n = 36 ) . Oxidative stress was assessed at 14th week of gestation by the utilization of serum γ-glutamyl transferase level . Pregnancies were followed until delivery . Relationship between the oxidative stress and pregnancy outcome was assessed among groups . Results : Mean age was similar among groups , mean gravidity and parity were significantly lower in group with Fe supplementation ( p < 0.05 ) . Maternal weight and weight gain during pregnancy were also significantly lower in group 3 ( p < 0.05 ) . Mean serum albumin levels were similar among groups while serum γ-glutamyl transferase ( GGT ) levels were significantly higher in group 3 . There were 10 cases of oligohydramnios in group 3 , two cases in group 2 and no cases in group 1 ( p < 0.001 ) . Conclusion : Iron supplementation during first trimester pregnancy was found to be associated with an increased oxidative stress 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 Rationale : Because the characteristics of all body fluids depends on patient ’s health status , is it possible that disadvantaged and socially vulnerable mothers may have lower amounts of iron in their breast milk , and that their babies receive lower content of the mineral for their normal growth and development . Assuring a preventive treatment of the mother might solve this problem . Objective : to demonstrate breast milk iron content from disadvantaged mothers and impact of personalized iron supplementation program . Material s and Methods : cross-sectional study . Breast milk sample s were obtained for ferritin analysis . Health ’s services usually provides free folic acid and iron treatment however , treatment compliance is low . Patients were r and om in two groups : “ A : Controls ” that had  free iron tablets available from Health Centre  ; and “ B : Intervention ” group where patients accepted to be periodically contacted at home by health ’s team for personalized iron dispensation . Results : 360 patients were included .  Profilaxis and treatment compliance were 100 % and 97,6 % for B group while for “ Control ” one was 63 % and 34%(p0.0001 ) . Higher breast milk iron levels were detected in Intervention ’s mothers compared with control ’s patients ( p0.007 ) . Conclusion : Personalized iron prophylaxis and treatment increased breast milk iron levels . Public health policy must ensure iron dispensation for each underserved mother in order to reduce children problems associate to iron deficiency during the first year of their life Background . The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component , prescribed for women in the second half of pregnancy Pregnancy is a condition exhibiting increased susceptibility to oxidative stress , and Fe plays a central role in generating harmful oxygen species . The objective of the present study is to investigate the changes in haematological status , oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins .  The study was a 2 months double-blind , r and omised trial . Pregnant women ( n 164 ) were allocated to four groups : group C was the placebo control group ; group I was supplemented daily with 60 mg Fe ( ferrous sulphate ) daily ; group IF was supplemented daily with Fe plus 400 μg folic acid ; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin , respectively . After the 2-month trial , Hb significantly increased by 15.8 , 17.3 and 21.8 g/l , and ferritin by 2.8 , 3.6 and 11.0 μg/l , in the I , IF and IM groups compared with placebo . Polarisation ( ρ ) and microviscosity ( η ) decreased significantly in other groups compared with placebo , indicating an increase in membrane fluidity . Significant decreases of ρ and η values compared with group C were 0.033 and 0.959 for group I , 0.037 and 1.074 for group IF and 0.064 and 1.865 for group IM , respectively . In addition , significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups , as well as increases of plasma retinol and urine riboflavin in group IM . The findings show that supplementation with Fe and particularly in combination with vitamins  could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity 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 Pregnancy during adolescence is associated with adverse birth outcomes , including preterm delivery and low birthweight . The nutrient availability to the fetus may be limited if the mother is still growing . This research aims to study the effects of pregnancy during adolescence in a nutritionally poor environment in rural Nepal . This study utilized data from a r and omized controlled trial of micronutrient supplementation during pregnancy in south-eastern Nepal . Women of parity 0 or 1 and of age < or= 25 years who gave birth to a singleton liveborn infant who was measured within 72 h of delivery were included ( n = 1393 ) . There was no difference in the risk of low birthweight ( OR = 0.96 ; 95 % CI = 0.90 - 1.02 ) or small for gestational age ( OR = 1.01 ; 95 % CI = 0.94 - 1.08 ) per year of increasing maternal age among primiparae . Young maternal age did not affect the anthropometry or gestational age of the offspring of parity 1 women . Each year of increasing maternal age among primiparae was associated with increases in birth length ( 0.07 cm ; 95 % CI = -0.01 to 0.16 ) , head ( 0.05 cm ; 95 % CI = 0.01 - 0.09 ) and chest circumference ( 0.07 cm ; 95 % CI = 0.01 - 0.12 ) , but not weight ( 9.0 g ; 95 % CI = -2.1 to 21.8 ) of their offspring . Young maternal age was associated with an increased risk of preterm delivery among primiparae ( OR = 2.07 ; 95 % CI = 1.26 - 3.38 ) that occurred at an age cut-off of < or=18 years relative to those 19 - 25 years . Thus , we conclude that young maternal age ( < or=18 years ) increased the risk of preterm delivery , but not intrauterine growth retardation , for the first but not second liveborn infant OBJECTIVE To examine the effect of supplemental prenatal folic acid , folic acid-iron , folic acid-iron-zinc , and multiple micronutrients on  maternal morbidity in rural Nepal . METHODS A cluster-r and omized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation . Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity . RESULTS A total of 3986 ( 97.3 % ) women completed an interview regarding labor and delivery ; morbidity history was available for 3564 ( 87.0 % ) women .  Folic acid-iron reduced the risk of postpartum hemorrhage ( relative risk [ RR ] 0.59 ; 95 % confidence interval [ CI ] 0.35 - 0.98 ) . Risk of dysfunctional labor increased with multiple micronutrient supplementation ( RR 1.28 ; 95 % CI , 1.01 - 1.60 ) , although preterm premature rupture of membrane decreased ( RR 0.40 ; 95 % CI , 0.21 - 0.79 ) . Puerperal sepsis was lower in those receiving folic acid-iron , folic acid-iron-zinc , and multiple micronutrients compared with controls ( P<0.05 ) . CONCLUSION Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting Although routine Fe supplementation in pregnancy is a common practice , its clinical benefits or risks are uncertain . Children born to mothers in the Fe group in a trial of Fe supplementation in pregnancy have been found to have a significantly higher risk of abnormal behaviour at 4 years of age than those born to mothers in the placebo group . The objective of the present study therefore was to determine whether Fe supplementation in pregnancy influences child behaviour at early school age . The study was a follow-up of children at 6 - 8 years of age after women ( n 430 ) were r and omly allocated to receive a daily Fe supplement ( 20 mg ) or placebo from 20 weeks gestation until delivery . The supplement reduced the incidence of Fe-deficiency anaemia at delivery from 9 % to 1 % . Child behaviour and temperament were assessed using the Strengths and Difficulties Question naire and the Short Temperament Scale for Children . Of the children , 264 ( 61 % ) participated in the follow-up . Mean behaviour and temperament scores and the proportion of parent-rated and teacher-rated abnormal total difficulties scores did not differ between the Fe and placebo groups . However , the incidence of children with an abnormal teacher-rated peer problems subscale score was higher in the Fe group ( eleven of 112 subjects ; 8 % ) than in the placebo group ( three of 113 subjects ; 2 % ) ; the relative risk was 3.70 ( 95 % CI 1.06 , 12.91 ; P = 0.026 ) . We conclude that prenatal Fe supplementation had no consistent effect on child behaviour at early school age in this study population . Further investigation regarding the long-term effects of this common practice is warranted 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 CONTEXT Iron and zinc are important for the development of both intellectual and motor skills . Few studies have examined whether iron and zinc supplementation during gestation , a critical period of central nervous system development , affects children 's later functioning . OBJECTIVE To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy . DESIGN , SETTING , AND PARTICIPANTS Cohort follow-up of 676 children aged 7 to 9 years in June 2007-April 2009 who had been born to women in 4 of 5 groups of a community-based , double-blind , r and omized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal . Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial . INTERVENTIONS Women whose children were followed up had been r and omly assigned to receive daily iron/folic acid , iron/folic acid/zinc , or multiple micronutrients containing these plus 11 other micronutrients , all with vitamin A , vs a control group of vitamin A alone from early pregnancy through 3 months postpartum . These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation . MAIN OUTCOME MEASURES Children 's intellectual functioning , assessed using the Universal Nonverbal Intelligence Test ( UNIT ) ; tests of executive function , including go/no-go , the Stroop test , and backward digit span ; and motor function , assessed using the Movement Assessment Battery for Children ( MABC ) and finger-tapping test . RESULTS The difference across outcomes was significant ( Bonferroni-adjusted P < .001 ) for iron/folic acid vs control but not for other supplement groups . The mean UNIT T score in the iron/folic acid group was 51.7 ( SD , 8.5 ) and in the control group was 48.2 ( SD , 10.2 ) , with an adjusted mean difference of 2.38 ( 95 % confidence interval [ CI ] , 0.06 - 4.70 ; P = .04 ) . Differences were not significant between the control group and either the iron/folic acid/zinc ( 0.73 ; 95 % CI , -0.95 to 2.42 ) or multiple micronutrient ( 1.00 ; 95 % CI , -0.55 to 2.56 ) groups . In tests of executive function , scores were better in the iron/folic acid group relative to the control group for the Stroop test ( adjusted mean difference in proportion who failed , -0.14 ; 95 % CI , -0.23 to -0.04 ) and backward digit span ( adjusted mean difference , 0.36 ; 95 % CI , 0.01 - 0.71 ) but not for the go/no-go test . The MABC score was lower ( better ) in the iron/folic acid group compared with the control group but not after adjustment for confounders ( mean difference , -1.47 ; 95 % CI , -3.06 to 0.12 ; P = .07 ) . Finger-tapping test scores were higher ( mean difference , 2.05 ; 95 % CI , 0.87 - 3.24 ; P = .001 ) in the iron/folic acid group . CONCLUSION Aspects of intellectual functioning including working memory , inhibitory control , and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00115271 The long-term benefits of antenatal iron supplementation in child survival are not known . In 1999 - 2001 , 4,926 pregnant women in rural Nepal participated in a cluster-r and omized , double-masked , controlled trial involving 4 alternative combinations of micronutrient supplements , each containing vitamin A. The authors examined the impact on birth weight and early infant mortality in comparison with controls , who received vitamin A only . They followed the surviving offspring of these women at approximately age 7 years to study effects of in utero supplementation on survival . Of 4,130 livebirths , 209 infants died in the first 3 months and 8 were lost to follow-up . Of those remaining , 3,761 were followed , 150 died between ages 3 months and 7 years , and 152 were lost to follow-up . Mortality rates per 1,000 child-years from birth to age 7 years differed by maternal supplementation group , as follows : folic acid , 13.4 ; folic acid-iron , 10.3 ; folic acid-iron-zinc , 12.0 ; multiple micronutrients ; 14.0 ; and controls , 15.2 . Hazard ratios were 0.90 ( 95 % confidence interval ( CI ) : 0.65 , 1.22 ) , 0.69 ( 95 % CI : 0.49 , 0.99 ) , 0.80 ( 95 % CI : 0.58 , 1.11 ) , and 0.93 ( 95 % CI : 0.66 , 1.31 ) , respectively , in the 4 supplementation groups . Maternal iron-folic acid supplementation  reduced mortality among these children by 31 % between birth and age 7 years . These results provide additional motivation for strengthening antenatal iron-folic acid programs 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 OBJECTIVES To compare the effect of daily versus weekly iron supplementation on lipid peroxidation , hemoglobin levels and maternal and perinatal outcome in non-anemic pregnant women . METHODS Of 109 women r and omly allocated into three groups , 90 completed the study . Group I ( n = 30 ) received daily iron folic acid ; Group II ( n = 30 ) received weekly iron folic acid ; Group III ( n = 30 ) received daily iron (III)-hydroxide polymaltose complex .  Hemoglobin levels , hematological indices , thiobarbituric acid reactive substances ( TBARS ) and glutathione levels were measured at baseline ( 14 - 16 weeks ) and at 30 - 34 weeks . Statistical analysis was done using the anova test . RESULTS Group I had a highly significant increase in TBARS level ( 0.61 + /- 0.26 micromol/L , P = 0.000 ) compared to groups II and III in which the change in TBARS was not significant ( 0.02 + /- 0.06 and 0.007 + /- 0.06 micromol/L , respectively ) . There was an insignificant fall in glutathione levels in all groups . There was no significant difference in the mean period of gestation , pregnancy complications and neonatal outcome between the three groups . Among 22.2 % of women who were non-compliant , Group I had significantly higher incidence of non-compliance ( P = 0.016 ) and side-effects ( P = 0.001 ) . Final hemoglobin was higher in Group I than II ( 11.9 + /- 1.2 , 11.3 + /- 0.9 , respectively , P = 0.041 ) . The TBARS level was not statistically different between preterm and term deliveries . Nine out of 11 patients who developed hypertension during pregnancy had preeclampsia . The final TBARS level was significantly higher in these women ( P = 0.000 ) . CONCLUSIONS Daily supplementation with ferrous sulphate results in greater lipid peroxidation than weekly supplementation , the latter is comparable with daily iron (III)-hydroxide polymaltose complex . Lipid peroxidation levels are significantly higher in preeclampsia 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 Objectives : To assess the effects of daily prenatal multimicronutrient supplementation on  birth weight ( BW ) and perinatal mortality . Design : R and omised , controlled , double masked trial . Setting : Urban Guinea-Bissau , West Africa . Subjects : A total of 2100 pregnant women ( 22±7 weeks pregnant at entry ) were recruited through antenatal clinics , of which 1670 ( 79.5 % ) completed the trial . BW was available for 1100 live born babies . Interventions : Identical-looking supplements containing one ( MN-1 ) or two ( MN-2 ) Recommended Dietary Allowances ( RDA ) of 15 micronutrients , or iron and folic acid ( control ) . Results : Mean BW among 1100 live born infants was 3050±498 g with 11.9 % being low birth weight ( LBW , BW<2500 g ) . Perinatal mortality was 82 per 1000 deliveries ( N=1670 ) , and neonatal mortality 45 per 1000 live births ( N=1599 ) . Mean BW in MN-1 ( n=360 ) and MN-2 ( n=374 ) groups were 53 [ −19 ; 125 ] and 95 [ 24 ; 166 ] g higher than controls ( n=366 ) . Proportion of LBW was 13.6 % in control , and 12.0 and 10.1 % in the MN-1 and MN-2 groups , respectively ( P=0.33 ) . Among anaemic women ( 30 % ) , MN-2 increased BW with 218 [ 81 ; 354 ] g compared to controls , with a decreased risk of LBW of 69 [ 27 ; 87]% . There were apparently no differences in perinatal mortality between groups . Conclusions : Prenatal micronutrient supplementation  increased BW but did not reduce perinatal mortality in this study . Multimicronutrient supplementation with two RDA should be considered in future programmes to reduce the proportion of LBW BACKGROUND Policies for timing of cord clamping vary , with early cord clamping generally carried out in the first 60 seconds after birth , whereas later cord clamping usually involves clamping the umbilical cord more than one minute after the birth or when cord pulsation has ceased . The benefits and potential harms of each policy are debated . OBJECTIVES To determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomes SEARCH METHODS We search ed the Cochrane Pregnancy and Childbirth Group 's Trials Register ( 13 February 2013 ) . SELECTION CRITERIA R and omised controlled trials comparing early and late cord clamping . DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and quality and extracted data . MAIN RESULTS We included 15 trials involving a total of 3911 women and infant pairs . We judged the trials to have an overall moderate risk of bias . MATERNAL OUTCOMES : No studies in this review reported on maternal death or on severe maternal morbidity . There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage ( risk ratio ( RR ) 1.04 , 95 % confidence interval ( CI ) 0.65 to 1.65 ; five trials with data for 2066 women with a late clamping event rate ( LCER ) of ~3.5 % , I(2 ) 0 % ) or for postpartum haemorrhage of 500 mL or more ( RR 1.17 95 % CI 0.94 to 1.44 ; five trials , 2260 women with a LCER of ~12 % , I(2 ) 0 % ) . There were no significant differences between subgroups depending on the use of uterotonic drugs . Mean blood loss was reported in only two trials with data for 1345 women , with no significant differences seen between groups ; or for maternal haemoglobin values ( mean difference ( MD ) -0.12 g/dL ; 95 % CI -0.30 to 0.06 , I(2 ) 0 % ) at 24 to 72 hours after the birth in three trials . NEONATAL OUTCOMES : There were no significant differences between early and late clamping for the primary outcome of neonatal mortality ( RR 0.37 , 95 % CI 0.04 to 3.41 , two trials , 381 infants with a LCER of ~1 % ) , or for most other neonatal morbidity outcomes , such as Apgar score less than seven at five minutes or admission to the special care nursery or neonatal intensive care unit . Mean birthweight was significantly higher in the late , compared with early , cord clamping ( 101 g increase 95 % CI 45 to 157 , r and om-effects model , 12 trials , 3139 infants , I(2 ) 62 % ) . Fewer infants in the early cord clamping group required  phototherapy for jaundice than in the late cord clamping group ( RR 0.62 , 95 % CI 0.41 to 0.96 , data from seven trials , 2324 infants with a LCER of 4.36 % , I(2 ) 0 % ) . Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group ( MD -1.49 g/dL , 95 % CI -1.78 to -1.21 ; 884 infants , I(2 ) 59 % ) . This difference in haemoglobin concentration was not seen at subsequent assessment s. However , improvement in iron stores appeared to persist , with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed ( RR 2.65 95 % CI 1.04 to 6.73 , five trials , 1152 infants , I(2 ) 82 % ) . In the only trial to report longer-term neurodevelopmental outcomes so far , no overall differences between early and late clamping were seen for Ages and Stages Question naire scores . AUTHORS ' CONCLUSIONS A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted , particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants . Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available 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 Background : It is a common belief among women that iron compounds have unpleasant gastrointestinal side effects . Objective : To assess the gastrointestinal side effects of iron prophylaxis in pregnancy . Methods : A r and omized , double-blind study comprising 404 healthy pregnant women allocated to four groups taking ferrous iron supplement ( as fumarate ) in doses of 20 ( n = 99 ) , 40 ( n = 100 ) , 60 ( n = 102 ) and 80 mg ( n = 103 ) daily from 18 weeks of gestation to delivery . Iron supplement was predominantly taken at bedtime . Gastrointestinal symptoms ( nausea , vomiting , epigastric pain , eructation , pyrosis , meteorism , borborygmi , colic pain , flatulence , constipation , thin feces , diarrhea ) , black feces , and use of laxatives were recorded by interview at 18 , 32 and 39 weeks of gestation . Results : The frequencies of gastrointestinal symptoms were not significantly different in the four iron supplement groups either at inclusion or at 32 and 39 weeks of gestation and thus not related to the iron dose . Conclusion : This study shows that a supplement of 20–80 mg ferrous iron ( as fumarate ) , taken between meals , has no clinical ly significant gastrointestinal side effects . The implementation of iron prophylaxis to pregnant women should not be compromised by undue concern of non-existing side effects Background / Objectives : Little is known about the long-term effects of maternal multi-micronutrient supplementation on the growth of children during early childhood . In this follow-up study , the effects of maternal supplementation with multi-micronutrients in pregnancy on postnatal child growth are examined . Subjects/ Methods : A longitudinal follow-up of a subset of newborns ( n=1388 ) whose mothers were r and omly assigned to receive the supplements of folic acid , iron – folic acid or multi-micronutrients daily during pregnancy in the original trial was conducted . Children ’s weight and length were measured and assessed during monthly home visits from birth to 30 months of age . Results : The pooled prevalence rate of stunting over different time points during the first 30 months was 13.5 , 14.9 and 12.1 % for the folic acid group , iron – folic acid group and multi-micronutrient group , respectively . However , there were no significant differences in the pooled odds of stunting in children between the multi-micronutrient group and the folic acid ( odds ratio ( OR ) 0.97 , 95 % confidence interval ( CI ) : 0.74–1.26 ) , and between the multi-micronutrient group and the iron – folic acid group ( OR 0.82 , 95 % CI : 0.63–1.07 ) . Similar results for the three groups were found for the occurrences of underweight and wasting in children . Furthermore , no significant differences were observed in length , weight , length-for-age , weight-for-age and weight-for-length Z-scores among the three treatment groups . Conclusions : Currently , available evidence is insufficient to support a greater advantage of the effect of maternal multi-micronutrient supplementation on child growth over iron – folic acid or folic acid only supplementation during the first 30 months BACKGROUND Delayed clamping of the umbilical cord increases the infant 's iron endowment at birth and haemoglobin concentration at 2 months of age . We aim ed to assess whether a 2-minute delay in the clamping of the umbilical cord of normal-weight , full-term infants improved iron and haematological status up to 6 months of age . METHODS 476 mother-infant pairs were recruited at a large obstetrics hospital in Mexico City , Mexico , r and omly assigned to delayed clamping ( 2 min after delivery of the infant 's shoulders ) or early clamping ( around 10 s after delivery ) , and followed up until 6 months postpartum . Primary outcomes were infant haematological status and iron status at 6 months of age , and analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00298051 . FINDINGS 358 ( 75 % ) mother-infant pairs completed the trial . At 6 months of age , infants who had delayed clamping had significantly higher mean corpuscular volume ( 81.0 fL vs 79.5 fL 95 % CI -2.5 to -0.6 , p=0.001 ) , ferritin ( 50.7 mug/L vs 34.4 mug/L 95 % CI -30.7 to -1.9 , p=0.0002 ) , and total body iron . The effect of delayed clamping was significantly greater for infants born to mothers with low ferritin at delivery , breastfed infants not receiving iron-fortified milk or formula , and infants born with birthweight between 2500 g and 3000 g. A cord clamping delay of 2 minutes increased 6-month iron stores by about 27 - 47 mg . INTERPRETATION Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before 6 months of age , when iron-fortified complementary foods could be introduced OBJECTIVE Our purpose was to study the effect of hematinic supplementation on the maternal erythropoietin response during singleton pregnancy . STUDY DESIGN In a r and omized , double-blind trial 97 patients with a first-trimester hemoglobin level > or = 14.0 gm/dl received either  iron and folic acid ( hematinic group , n = 53 ) or a placebo ( n = 44 ) .  Serial hemoglobin , hematocrit , and serum erythropoietin were recorded from maternal blood and from cord blood on delivery . Serum ferritin was measured in the first trimester , at 36 weeks ' gestation , and in cord blood . RESULTS In both groups ( 1 ) the mean hemoglobin was lower ( p < 0.01 ) at 40 weeks ' gestation than when first examined and ( 2 ) the mean serum erythropoietin was higher ( p < 0.01 ) . The mean serum ferritin was lower ( p < 0.001 ) in both groups at 36 weeks ' gestation than at presentation but higher ( p = 0.04 ) in the hematinic group than in the placebo group . The mean hemoglobin and hematocrit were similar in the two groups until the third trimester but thereafter were higher ( p < 0.05 ) in the hematinic group . The mean maternal serum erythropoietin was higher ( p < 0.05 ) in the placebo group than in the hematinic group after 24 weeks ' gestation . The mean cord blood hematologic values were similar in the two groups . CONCLUSION Maternal serum erythropoietin increased during pregnancy , but this response was reduced in the third trimester in the hematinic-supplemented group OBJECTIVE To assess and compare the efficacy and safety of two and three doses of intravenous iron sucrose with daily oral ferrous sulphate in the prophylaxis of iron deficiency anaemia in pregnant women . STUDY DESIGN 260 women with singleton pregnancy who met inclusion criteria and who gave informed consent were r and omised between the 21st and 24th week into either the intravenous iron group or the oral iron group . Of 130 women in the intravenous iron group , 75 women received two doses of 200 mg iron sucrose and 55 three doses of 200 mg iron sucrose . The first dose was administered between the 21st and 24th gestational weeks , the second between the 28th and 32nd and the third between the 35th and 37th . The women of the oral group were given oral tablets of 80 mg ferrous sulphate daily , beginning on the day of study enrolment and stopping on the day of delivery . RESULTS There was a non-significant trend to a higher frequency of responders ( haemoglobin > or = 11 g/dl ) in the intravenous iron group ( 75 vs. 80 % ) . There was a significant difference of repleted iron stores before delivery ( ferritin>50 microg/l ) in the group with three intravenous iron doses in comparison to the oral iron group ( 49 vs. 14 % ; p<0.001 ) . No differences were observed in regard to maternal and perinatal outcomes . CONCLUSIONS There was no clinical ly significant difference in the haematological , maternal and foetal outcomes in the parenteral route of iron prophylaxis in pregnant women OBJECTIVE We examined factors affecting compliance to  antenatal micronutrient supplementation  and women 's perceptions of supplement use . DESIGN R and omized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum . Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers . At 6 weeks postpartum women with live births ( n 4096 ) were interviewed regarding their perceptions of the supplement . Median compliance calculated as percentage of total eligible doses received by women was high ( 84 % ) . SETTING Rural southern Nepal . SUBJECTS Pregnant women . RESULTS Women with high compliance ( above the median of 84 % ) were likely to be older , less educated , poorer , undernourished , belong to lower caste and of Pahadi ( hill ) ethnicity compared with women with low compliance ( at or below the median of 84 % ) . Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance . The major reason for irregular intake was forgetting to take supplements . A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future . A large proportion of women ( 91 % ) perceived a benefit from taking the supplement such as improved strength and health , whereas only about 10 % perceived any side-effects which were not a major barrier to compliance . CONCLUSIONS The present analysis highlights that poor , undernourished , uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly , and counselled about side-effects 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 Universal prenatal daily iron-folic acid ( IFA ) and multiple micronutrient ( MM ) supplements are recommended to reduce the risk of low birth weight , maternal anemia , and iron deficiency ( ID ) during pregnancy , but the evidence of their effect on iron status among women with mild or no anemia is limited . The aim of this study was to describe the iron status [ serum ferritin ( SF ) , serum soluble transferrin receptor ( sTfR ) , and body iron ( BI ) ] before and after micronutrient supplementation during pregnancy . We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a r and omized , double-blind trial in China . Women were r and omly assigned to take daily 400 μg of folic acid ( FA ) ( control ) , FA plus 30 mg of iron , or FA , iron , plus 13 additional MMs provided before 20 wk of gestation to delivery . Venous blood was collected in this subset during study enrollment ( before 20 wk of gestation ) and 28 - 32 wk of gestation . We found that , at 28 - 32 wk of gestation , compared with the FA group , both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator ( SF , sTfR , or BI ) was used for defining ID . The prevalence of ID at 28 - 32 wk of gestation for IFA , MM , and FA were 35.3 % , 42.7 % , and 59.6 % by using low SF , 53.6 % , 59.9 % , and 69.9 % by using high sTfR , and 34.5 % , 41.2 % , and 59.6 % by using low BI , respectively . However , there was no difference in anemia prevalence ( hemoglobin < 110 g/L ) between FA and IFA or MM groups . We concluded that , compared with FA alone , prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia . This trial was registered at clinical trials.gov as NCT00137744 BACKGROUND We previously reported that a r and omized controlled trial of antenatal micronutrient supplements in rural Nepal decreased the risk of low birth weight by approximately 15 % . OBJECTIVE The objective was to examine the effects of micronutrient supplementation on growth and body composition in children of supplemented mothers through school age . DESIGN Mothers received 1 of 5 micronutrient supplements daily : folic acid , folic acid + iron , folic acid + iron + zinc , multiple micronutrients , or a control . All of the supplements contained vitamin A.  Children born during this trial were revisited at age 6 - 8 y to measure height , weight , midupper arm circumference , waist circumference , and triceps and subscapular skinfold thicknesses . Arm fat and muscle area were estimated by using st and ard formulas , and height-for-age , weight-for-age , and body mass index-for-age z scores were calculated by using the World Health Organization growth st and ard . RESULTS Of the 3771 surviving children , 3324 were revisited and consented to anthropometric measurements . Maternal supplementation with folic acid + iron + zinc result ed in an increase in mean height ( 0.64 cm ; 95 % CI : 0.04 , 1.25 ) and a reduction in mean triceps skinfold thickness ( -0.25 mm ; 95 % CI : -0.44 , -0.06 ) , subscapular skinfold thickness ( -0.20 mm ; 95 % CI : -0.33 , -0.06 ) , and arm fat area ( -0.18 cm(2 ) ; -0.34 , -0.01 ) . No significant differences were found between groups in mean weight or body mass index-for-age z scores , waist circumference , or arm muscle area . Other micronutrient combinations including a multiple micronutrient formulation failed to show a growth benefit . CONCLUSION Antenatal supplementation with zinc may benefit child growth , particularly in areas where a deficiency of this nutrient is common 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 BACKGROUND Beyond perinatal folic acid supplementation , the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear . We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia . METHODS In this r and omized double-blind controlled trial , 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009 . Women were r and omly assigned to daily folic acid ( 400 μg ) ( control ) , folic acid-iron ( 30 mg ) , or folic acid , iron , and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery . Primary outcome was perinatal mortality . Secondary outcomes included neonatal and infant mortality , preterm delivery , birth weight , birth length , gestational duration , and maternal hemoglobin concentration and anemia . RESULTS A total of 92.7 % of women consumed 80 % to 100 % of supplements as instructed . On average , women consumed 177 supplements . Compared with daily prenatal folic acid , supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality ( 8.8 , 8.7 , and 8.3 , respectively ) per 1000 births , and relative risks ( RRs ) were 1.00 ( 95 % CI , 0.68 - 1.46 ; P = .99 ) and 0.94 ( 95 % CI , 0.64 - 1.39 ; P = .76 ) , respectively . Risk of other adverse maternal and infant outcomes also did not differ , except that RRs for third-trimester maternal anemia were 0.72 ( 95 % CI , 0.63 - 0.83 ; P < .001 ) and 0.71 ( 95 % CI , 0.62 - 0.82 ; P < .001 ) , respectively . CONCLUSION Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia  prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00133744 OBJECTIVE The hypothesis that daily use of a prenatal supplement with iron from enrollment to third trimester to initially iron-replete , nonanemic pregnant women would reduce third-trimester anemia and improve birth outcomes was tested . STUDY DESIGN Eight hundred sixty-seven women in Raleigh , North Carolina , who were at < 20 weeks of gestation were enrolled ; 429 of these women had hemoglobin levels of > or = 110 g/L and ferritin levels of > or = 40 microg/L and were assigned r and omly to receive prenatal supplements with 30 mg of iron as ferrous sulfate ( n = 218 women ) or 0 mg of iron ( n = 211 women ) until 26 to 29 weeks of gestation . Intent-to-treat analysis was used for the outcomes of third-trimester iron status , birth weight , preterm birth , and small-for-gestational age . RESULTS Mean birth weight was higher by 108 g ( P = .03 ) , and the incidence of preterm delivery was lower ( 8 % vs 14 % ; P = .05 ) in the 30-mg group compared with the control group , respectively . Iron supplementation did not affect the prevalence of small-for-gestational age infants or third-trimester iron status . CONCLUSION Prophylactic iron supplementation that is begun early in pregnancy among low income women in the United States may have benefits beyond the reduction of iron deficiency anemia during pregnancy AIM To determine the effect of an education program and /or pill count on the change in hemoglobin levels and the prevalence of  anemia in pregnant women . METHODS A r and omized , factorial design controlled trial was conducted at the Tribhuvan University Teaching Hospital , Nepal . A total of 320 eligible pregnant women receiving prenatal care were r and omized into four groups ( control , education , pill count and education with pill count ) by block r and omization with allocation concealment . All recruited women received conventional routine prenatal care with a daily dose of 60 mg iron supplementation . In addition , the education group received an education program . Pill counting was done for the pill count group at their routine prenatal visits . The education with pill count group received both the education program plus pill counting .  Baseline hemoglobin at the recruitment phase and follow-up hemoglobin after three months of recruitment were measured . Changes in hemoglobin levels and anemia prevalence were analyzed and compared between groups . RESULTS The education only and education with pill count groups had significantly higher hemoglobin changes ( 0.23 and 0.26 g/dL , respectively ) than the control group ( P < 0.01 ) . Anemia was reduced by 59 % in the education group and by 65 % in the education with pill count group , compared to the control group ( P < 0.05 ) . Pill count alone significantly improved neither the hemoglobin level nor anemia prevalence compared to the control group . CONCLUSION An education program along with routine iron supplementation can improve hemoglobin levels and reduce anemia prevalence in pregnant women . Pill count as a measure of compliance has no additional effect on improving hemoglobin status 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 OBJECTIVE We evaluated the effect of iron supplementation on biochemical indicators of iron status , namely hemoglobin ( Hb ) , serum ferritin ( SF ) , and serum transferrin receptor ( sTfR ) , during pregnancy . METHODS A prospect i ve study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 microg of folic acid for 100 d from 19 wk of gestation . The indicators of  iron status ( Hb , SF , and sTfR ) at 19 , 27 , and 35 wk of gestation were analyzed . The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic ( n = 35 ) and non-anemic ( n = 38 ) at 19 wk . RESULTS All three indicators of iron status during supplementation ( 27 and 35 wk ) were similar to the presupplementation status . The sTfR as an indicator correlated negatively with presupplementation Hb levels ( r = -0.417 ) . Based on sTfR level in iron-adequate pregnant women , a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy . When the response was tested in anemic pregnant women , iron supplementation improved mean Hb ( P < 0.05 ) at the end of 35 wk ( 96 + /- 8.8 to 110 + /- 20.2 g/L ) of gestation , with no change in SF . Conversely , non-anemic pregnant women showed a significant increase in SF and a decrease in Hb ( 122 + /- 11.6 to 112 + /- 15.2 g/L ) at 35 wk of gestation . A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women . CONCLUSIONS These observations suggest that , during pregnancy , sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator It has been shown that the incidence of megaloblastic anaemia in a group of 463 r and omly selected pregnant women receiving iron  was 12 times as high as in a control group of 235 pregnant women receiving iron and folic acid .  The incidence of all types of anaemia in the women receiving iron alone was more than three times the incidence in those having iron and folic acid . Some women who were not anaemic or who had normoblastic anaemia had serum folate levels in the same range as the women with megaloblastic anaemia , but none of the women with megaloblastic anaemia had high serum folate levels . The labile fraction of the serum folate was no more reliable than the total serum folate as a diagnostic criterion of megaloblastic erythropoiesis in the individual case . The blood group distribution in the women with megaloblastic anaemia was the same as in the general population . Babies born to mothers with megaloblastic anaemia tended to be smaller than the rest , although there was no difference in the placental weights . The significance of these findings is discussed OBJECTIVE . We investigated the benefits of maternal multimicronutrient supplementation during gestation on the mental and psychomotor development  of infants . METHODS . In a double-blind , r and omized , controlled trial , pregnant women ( N = 5828 ) in 2 rural counties in western China were assigned r and omly to receive multimicronutrient ( 5 minerals and 10 vitamins at levels approximating the recommended daily allowance ) , folic acid plus iron , or folic acid supplementation daily from ∼14 weeks of gestation until delivery . We assessed a subset of the newborns ( N = 1305 ) from the 3 supplementation groups by measuring their mental and psychomotor development with the Bayley Scales of Infant Development , at 3 , 6 , and 12 months of age . Multilevel analyses were used to compare the mental development and psychomotor development raw scores at 3 , 6 , and 12 months . RESULTS . Multimicronutrient supplementation was associated with mean increases in mental development raw scores for infants at 1 year of age of 1.00 and 1.22 points , compared with folic acid only and folic acid plus iron supplementation , respectively . However , supplementation did not increase significantly the psychomotor development raw scores up to 1 year of age . CONCLUSION . Compared with iron and folic acid supplementation , the administration of multimicronutrients to pregnant women  improved the mental development of their children at 1 year of age Background / Objectives : To compare the efficacy and side effects of low-dose vs high-dose iron supplements to correct anaemia in pregnancy . Subjects/ Methods : One hundred and eighty women with anaemia ( haemoglobin < 110 g l−1 ) in mid-pregnancy . The women were r and omly allocated to 20 ; 40 or 80 mg of iron daily for 8 weeks from mid-pregnancy . Results : One hundred and seventy-nine ( 99 % ) women completed the trial . At the end of treatment , there was a clear dose – response of increasing mean haemoglobin concentration with iron dose ( 111±13 g l−1 at 20 mg per day , 114±11 g l−1 at 40 mg per day and 119±12 g l−1 at 80 mg per day , P=0.006 ) . However , the incidence of anaemia did not differ statistically between groups . Compared with women in the 80 mg iron group , the odds ratio of anaemia was 1.9 ( 95 % CI : 0.8 , 4.3 , P=0.130 ) and 1.1 ( 95 % CI : 0.5 , 2.6 , P=0.827 ) , respectively , for women in the 20 mg iron group and the 40 mg iron group . The incidence of gastrointestinal side effects was significantly lower for women in the 20 mg iron group compared with women in the 80 mg iron group ; the odds ratio was 0.4 ( 95 % CI : 0.2 , 0.8 , P=0.014 ) for nausea , 0.3 ( 95 % CI : 0.2 , 0.7 , P=0.005 ) for stomach pain and 0.4 ( 95 % CI : 0.2 , 0.9 , P=0.023 ) for vomiting . Conclusions : Low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with high-dose supplements A r and omized , double-blind , placebo-controlled community-based trial of oral iron supplementation ( 200 mg ferrous sulphate daily ) administered to multigravid pregnant women by traditional birth attendants ( TBAs ) was carried out in a rural area of The Gambia .  Iron supplementation led to a significant reduction in the prevalence of anaemia and of iron deficiency .  Iron supplementation was not accompanied by increased susceptibility to malaria infection ; there was no difference in the prevalence and severity of peripheral blood or placental malaria infection between the 2 groups of women . The birth weight of children born to women who received iron prophylaxis was increased by an average of 56 g. It is concluded that oral iron prophylaxis can be successfully delivered through TBAs integrated into a primary health care programme . This simple intervention can produce significant beneficial effects on the health of the mother without inducing increased susceptibility to malaria and has the potential for reducing perinatal mortality by increasing birth weight BACKGROUND The efficacy of iron polymaltose complex ( IPC ) in the treatment of iron deficiency anemia ( IDA ) during pregnancy has not been well established , and the evidence is inconclusive . AIMS The aim of the study was to compare efficacy , safety , compliance , and cost-effectiveness of IPC with ferrous sulphate ( FS ) in pregnant patients . SETTING S AND DESIGN S The r and omized , double-blind , parallel-group study was conducted in the Department of Pharmacology in collaboration with the Department of Obstetrics and Gynaecology Postgraduate Institute of Medical Education and Research , Ch and igarh , India . METHODS One hundred pregnant women aged 20 - 40 years at 14 to 27 weeks ' gestation , with hemoglobin ( Hb ) < 9 g/dL , and serum ferritin < 12 mcg/L , were classified into 2 groups . One group received IPC ( 100 mg elemental iron ) , and the other group received FS ( 120 mg elemental iron ) daily for 8 weeks . At Week 0 and Week 8 , Hb , packed cell volume ( PCV ) , mean corpuscular volume ( MCV ) , mean corpuscular hemoglobin ( MCH ) , mean corpuscular hemoglobin concentration ( MCHC ) , serum iron , and serum ferritin were measured . Compliance with study medication was determined by pill counting at each visit . Cost minimization analysis was done to compare the costs of the 2 treatments . STATISTICAL ANALYSIS Data are expressed as mean -/+ SD . Paired and unpaired ' t ' test were used to analyze differences within groups and between groups . Chi-square ( x2 ) test was used to analyze primary efficacy parameters and adverse drug reactions ( ADR ) . RESULTS Statistically significant increases in Hb , PCV , MCV , MCH , MCHC , serum iron , and serum ferritin levels were seen at the end of 8 weeks of treatment in both groups . The overall adverse effects were more common in the FS group compared with the IPC group [ 41 ( 78 % ) vs 15 ( 31 % ) , P < .001 ] . The compliance rate was significantly ( P < .05 ) higher for the IPC ( 91 % ) group than for the FS ( 87 % ) group . The average total cost ( direct + indirect ) of treatment of anemia was comparable between the 2 groups . CONCLUSION The results of the present study suggest that IPC can be considered as a useful alternative formulation for the treatment of IDA during pregnancy for those patients who can not tolerate other iron preparations ( ferrous form ) ; this is an important finding , as compliance is a significant concern during pregnancy 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 BACKGROUND Community iron supplementation programmes for pregnant women have lacked effectiveness , partly because of low compliance . OBJECTIVE To determine factors that influence compliance among pregnant women in Senegal . DESIGN Two hundred and twenty-one pregnant women , recruited from six health centres in Dakar during their first prenatal visit , were r and omly assigned to receive either a prescription to purchase iron/folic acid tablets ( control , n = 112 ) to be taken daily , according to official policy , or to receive free tablets ( treatment , n = 109 ) . Compliance was assessed 20 weeks after enrollment through interviews and pill count . Women with low or high compliance ( < 70 % or > or=70 % ) were asked to explain what influenced their adherence to supplementation . RESULTS Overall compliance was 69 % ; it was significantly higher in the treatment than in the control group ( 86 % vs. 48 % ; P < 0.0001 ) . Women with high compliance ( 58 % ) were motivated by : ( 1 ) the perception of improved health upon taking the tablets ( treatment = 24 % , control = 10 % ) ; ( 2 ) the insistence by midwives that they take the tablets ; and ( 3 ) the mention that the tablets would improve health . Women with low compliance ( 42 % ) reported : ( 1 ) the experience of side-effects that they associated with the tablets ( treatment = 13 % , control = 14 % ) ; ( 2 ) misunderst and ing that they needed to continue taking the tablets throughout pregnancy ( treatment = 0 % , control = 18 % ) ; and ( 3 ) forgetfulness . CONCLUSION Compliance with iron/folic acid supplementation in Senegal can be increased by providing women with clear instructions about tablet intake and educating them on the health benefits of the tablets The iron-rich bread ( 2.2 mg iron per 50 g slice ) used in the study was developed using Eragrostis tef flour , naturally rich in iron . Iron deficiency is prevalent in pregnancy and compliance with supplements can be low . In this double-blind , r and omized trial 34 Caucasian , primiparous antenatal patients were r and omized to receive intervention bread or a placebo for 6 weeks . Women consumed on an average of 2.3 slices per day , providing a total of 5.0 mg iron . Using haemoglobin cut-offs , 12 % of participants eating the iron-rich bread were iron deficient by the end of the study compared with 27 % in the control group . For other markers of iron status , these were improved in the placebo versus the treatment group . For example , a significant decline in serum iron and transferrin saturation was not observed in this group . Findings demonstrate that other modes of delivery , i.e. food fortification , may be needed to generate ‘ physiological effects ’ , or further measures are taken to improve intervention compliance Folic acid is frequently given to pregnant women at the same time as intermittent preventive treatment ( IPTp ) with sulfadoxine/pyrimethamine ( SP ) , but it is not known if it interferes with the anti-malarial activity of SP . To investigate this concern , 1,035 Gambian primigravidae were r and omized to receive either folic acid ( 500 - 1,500 microg/day ) together with oral iron ( 522 ) or oral iron alone ( 513 ) for 14 days at the same time as they received IPTp with SP . On presentation , 261 women ( 25 % ) had Plasmodium falciparum asexual parasitemia . Prevalences of parasitemia on day 14 after treatment were similar in both groups : 5.7 % ( 26 of 458 ) in the iron plus folic acid group and 4.9 % ( 22 of 446 ) in the iron alone group ( risk difference = 0.74 % , 95 % confidence interval [ CI ] = -2.2 % to 3.7 % ) . Parasitologic cure was observed in 116 ( 91 % ) of 128 of women who were parasitemic on presentation and who received iron and folic acid and in 122 ( 92 % ) of 133 women who received iron alone ( difference = 1.1 % , 95 % CI = -5.6 % to 8.0 % ) . Women who received folic acid and iron had a slightly higher mean hemoglobin concentration at day 14 than women who had received iron alone ( difference = 0.14 g/dL , 95 % CI = 0.01 - 0.27 g/dL ) . The results of this study suggest that in an area of low SP resistance , administration of folic acid to pregnant women in a dose of 500 - 1,500 mug/day will not interfere with the protective effect of SP when used for IPTp 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 BACKGROUND Iron and vitamin A deficiencies impact anemia and the immune system . OBJECTIVE to investigate the effect of iron combined with retinol supplementation on iron status , IL-2 level and lymphocyte proliferation . METHODS a double-blind r and omized trial conducted over 2 months . We r and omly allocated 186 anemic pregnant women with 80 ≤ Hb 0 < 110 g/L into four groups . Group I ( n=47 ) was supplemented daily with 60 mg iron as ferrous sulfate , IF ( n=46 ) with 60 mg iron and 0.4 mg folic acid , IR ( n=46 ) with 60 mg iron , 2.0 mg retinol and 0.4 mg folic acid and C ( n=47 ) was the placebo group , . RESULTS after the 2 months trial , there were considerable increases of iron status in Hb , plasma iron and ferritin in the I , IF and IR groups compared with Group C. Increases in plasma iron and ferritin in the IR group were also significantly greater than in Groups I and IF . Compared with group C , increases of IL-2 levels were 119 , 184 and 206 ng/L ; and lymphocyte proliferation increased by 0.095 , 0.112 and 0.219 in Groups I , IF and IR , respectively . Increases of IL-2 were 65.3 ng/L and 87.5 ng/L in Groups IF and IR , greater than in Group I ( both p values < 0.01 ) ; and lymphocyte proliferation in Group IR were 0.124 and 0.107 , also greater than in Groups I and IF , respectively . CONCLUSION iron combined retinol supplementation was more beneficial to improving iron status and lymphocyte proliferation during pregnancy than iron alone The efficacy of prophylactic treatment with ferrous sulfate ( 80 mg Fe++ ) and the combination of ferrous sulfate with folic acid ( 80 mg Fe++ and 350 microgram folic acid ) were studied in a double blind trial in the 20th , and again in the 30th and 36th week of pregnancy ( 29 patients ) . At the beginning of the treatment ( 20th week ) 29 % of the patients showed a pathologically reduced serum folic acid level . Combined therapy has a favorable effect on the folic acid levels in the serum and red blood cells ; this was confirmed statistically . At the end of pregnancy , 69 % of the patients of the control group ( ferrous sulfate ) showed a pathologically reduced serum level and 23 % a subnormal level in erythrocytes . These results un question ably justify the prophylactic prescription of folic acid during pregnancy 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 aims to evaluate iron prophylaxis in pregnant women from the individual aspect , i.e. according to serum ferritin levels at the beginning of pregnancy , and to assess which dose of iron would be adequate to prevent iron deficiency ( ID ) and iron deficiency anaemia ( IDA ) during pregnancy and postpartum . A r and omised , double-blind study comprising 301 healthy Danish pregnant women allocated into four groups taking ferrous iron ( as fumarate ) in doses of 20 mg ( n=74 ) , 40 mg ( n=76 ) , 60 mg ( n=77 ) and 80 mg ( n=75 ) from 18 weeks gestation ( inclusion ) to 8 weeks postpartum . Iron status markers [ serum ferritin , serum soluble transferrin receptor ( sTfR ) , haemoglobin ] were recorded at 18 , 32 and 39 weeks gestation and 8 weeks postpartum . Body iron was calculated using the serum sTfR/serum ferritin ratio . ID was defined by serum ferritin < 12 μg/l in pregnancy and < 15 μg/l postpartum ; IDA as serum ferritin < 12 μg/l and haemoglobin < 5th percentile in iron-replete pregnant women . Women in the iron supplement groups were stratified according to serum ferritin levels at inclusion ; 50.7 % had ferritin ≤30 μg/l , 37.7 % ferritin 30–70 μg/l and 11.6 % ferritin > 70 μg/l . At 32 weeks , women with ferritin ≤30 μg/l had an ID frequency of : 20-mg group 54.1 % , 40 mg 29.7 % , 60 mg 24.4 % , 80 mg 20.6 % ( p<0.001 ) ; women with ferritin > 30 μg/l had an ID frequency of : 20-mg group 20.0 % , 40 mg 13.9 % , 60 mg 5.7 % , 80 mg 5.1 % ( p<0.001 ) . Women with ferritin > 70 μg/l had no ID . Postpartum , ID was found in 4.7 % in 20-mg group , 2.9 % in group 40 mg and 0 % in group 60 and 80 mg . IDA : At 32 weeks , women with ferritin ≤30 μg/l had an IDA frequency of : 20-mg group 2.7 % , 40 mg 2.7 % , 60 and 80 mg 0 % ; none of the women with ferritin > 30 μg/l displayed IDA . Body iron at 18 weeks was 10.4 mg/kg , similar in the four iron groups . Later in pregnancy body iron declined significantly , being lower the 20 mg group , and similar in the 40 , 60 and 80-mg groups . Postpartum body iron rose to inclusion levels being 9.3 mg/kg in the 20-mg group and 10.5 mg/kg in the 40- , 60- and 80-mg groups . This study gives an estimate of iron dosage in individual iron prophylaxis adjusted to serum ferritin levels in early pregnancy . In the prevention of ID , we suggest 80–100 mg ferrous iron/day to women having ferritin ≤30 μg/l and 40 mg ferrous iron/day to women having ferritin 31–70 μg/l . In the prevention of IDA , we suggest 40 mg ferrous iron/day to women having ferritin ≤70 μg/l . Women with ferritin > 70 μg/l have no need for iron supplement 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 In a prospect i ve , r and omized trial , a single dose of PGE2 gel , 0.5 mg ( 2.5 ml ) , was given to 416 low Bishop Score patients 12 h prior to indicated oxytocin induction and compared with 404 non‐gel controls .  Successful initial induction was achieved in 83 % of the treated and 58 % of the non‐treated subjects . In addition the induction — delivery interval was shortened ( median times 9.0 h vs. 11.3 h ) and fewer cesarean sections were performed ( 16 % vs. 21 % ) in the PGE2 gel series . The endocervical administration of PGE2 was well tolerated and , provided care is taken to avoid excess extra‐amniotic placement , systemic PGE2 effects are minimal 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 Folic acid administered to pregnant Bantu , whose diet is low in folate , was associated with a significant reduction in the incidence of prematurity . No such effect could be demonstrated in White patients subsisting on an average Western diet . This suggests that folate deficiency may contribute to the “ pregnancy wastage ” in population s whose dietary folate intake is low , and is a further indication for folic acid supplementation during pregnancy in these groups 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 Iron is important general well being , to prevent or treat anemia , and is a cofactor of many enzymes in the anti-oxidant process . Effect of sodium iron ethylenediaminetetraacetate ( NaFeEDTA ) and ferrous sulfate on iron bioavailability and oxidative stress in anemic pregnant women was evaluated . A 2-month r and omized controlled trial was conducted on 153 anemic pregnant women , with 80 < = Hb < 110 g/L. They were r and omly allocated to three groups : group C ( n=51 ) was the placebo control group , group I ( n=51 ) was supplemented daily with 60 mg iron as ferrous sulfate , and group IE ( n=51 ) with 60 mg iron as NaFeEDTA .  Blood sample s were collected before and at the end of the intervention for measurements of hematological indices and oxidative stress parameters . Considerable increases of hematologic indicators were observed : 20.5 and 21.8 g/L for Hb ( both p values < 0.001 ) ; 4.81 and 7.19 μmol/L for plasma iron ( both p values < 0.001 ) , 2.63 and 8.99 μg /L for ferritin ( both p values < 0.05 ) in I and IE groups , respectively , compared with the control group . Glutathione peroxidase ( GSH-Px ) activities increased by 32.6 and 75.3 IU/ml , and malondialdehyde ( MDA ) levels decreased by 0.70 and 1.12 μmol/L in I and IE groups , compared with the C group ( p values < 0.05 ) . Moreover , differences of plasma iron , ferritin and GSH-Px activity were 2.38 μmol/L , 6.36 μg /L and 42.7 IU/ml were also significantly greater in the IE group than in the I group . Moderate iron supplementation may be beneficial to improving iron deficiency and oxidative stress , and NaFeEDTA is better than ferrous sulfate 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 In a r and omized double-blind study the new effervescent iron tablet Loesferron was tested in 57 postpartum patients .  Hgb and red blood count rose significantly with this treatment . It was found that on effervescent tablet daily was sufficient for a satisfactory result of the treatment . No side effects were noted to this well tasting iron beverage . The reason is probably the prior dilution of the iron compound which delivers lower local iron potentials to the gastric mucosa 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 Objective : Micronutrient deficiencies during pregnancy may be linked to poor newborn health and poor host defences against infection . We assessed newborn morbidity to determine the effect of four combinations of antenatal micronutrient supplements . Design : Cluster-r and omised , double-masked , controlled trial . Setting : Rural community in Nepal . Interventions : Women received daily supplements from early pregnancy through to 3 months postpartum of vitamin A alone ( control ) or vitamin A with folic acid , folic acid plus iron , folic acid plus iron plus zinc or a multiple micronutrient supplement containing these and 11 other nutrients . Main outcome measures : Infants were visited in their home at birth ( n = 3927 ) and for each of 9 days thereafter to elicit a 24-h history of nine infant morbidity symptoms , measure infant respiratory rate and axial temperature , and assess the infant for chest indrawing . At 6 weeks of age , infants were visited again in their homes to elicit a 30-day and 7-day history of 10 morbidity symptoms using parental recall . Results : Maternal micronutrient supplementation had no effect on 10-day morbidity or morbidity 30-day and 7-day morbidity assessed at 6 weeks of age all relative risks were close to 1 . Symptoms of birth asphyxia increased by about 60 % ( p<0.05 ) in infants of women who received the multiple micronutrient supplement compared with the control . Symptoms of combinations of sepsis , preterm and birth asphyxia were associated with 8- to 14-fold increased odds of 6-month infant mortality . Conclusions : None of the combinations of antenatal micronutrient supplements tested improved symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age . Further research is needed to eluci date the association and mechanism of increased risk of birth asphyxia following maternal multiple micronutrient supplementation . Trial registration numbers : NCT00115271 The iron status at 6 months and 4 years of children born to women who were r and omly allocated to receive 20 mg of iron daily in the second half of pregnancy did not differ from children of mothers in the control group . OBJECTIVE The objective of the study was to determine whether vitamin D ( vitD ) supplementation during pregnancy affects obstetric and neonatal outcomes . SETTING The study was conducted at a university hospital in Karachi , Pakistan . METHODS The study was a single-center , open-label , r and omized , controlled trial of routine care ( group A , 200 mg ferrous sulfate and 600 mg calcium daily ) vs vitD supplementation ( group B , 4000 IU vitamin D3 daily ) , started at 20 weeks and continued till delivery . Maternal serum sample s of 25-hydroxyvitamin D ( 25OHD ) were collected at baseline and delivery . Neonatal vitD status was assessed in cord blood or in neonatal serum sample s within 48 hours of birth . Obstetric outcomes included gestational hypertension , gestational diabetes , and preterm labor , and neonatal well-being included small for gestational age , birth weight , length , head circumference , and 1- and 5-minute Apgar scores . RESULTS Of 207 gravidae enrolled , 193 completed the trial .  Maternal age , vitD status , and gestational age at enrollment were comparable between the two groups . At delivery , maternal 25OHD was increased in group B ( 18.3 ± 11 ng/dL vs 8.82 ± 11.84 ng/dL ( P = .001 ) compared with group A ( 6.9 ± 7.0 ng/dL vs 6.32 ± 3.97 ng/dL , P = .06 ) . The obstetric outcomes were comparable between the two groups ( P > .05 ) . Neonatal 25OHD levels were significantly higher in group B compared with group A ( 19.22 ± 12.19 ng/dL vs 6.27 ± 5.2 ng/dL ) . There was positive correlation between maternal and neonatal 25OHD levels ( r = 0.83 , P = .001 ) . One- and 5-minute Apgar scores were significantly higher in group B ( 7.10 ± 0.66 vs 6.90 ± 0.50 , P = .026 , and 8.53 ± 0.68 vs 8.33 ± 0.81 , P = .051 , respectively ) . Neonatal anthropometric parameters were comparable between the two groups ( P > .05 ) . CONCLUSION Maternal vitD supplementation improved maternal and neonatal vitD status OBJECTIVE To evaluate the effect of iron supplementation on serum copper and zinc levels . METHOD In a r and omized , double-blind , placebo-controlled trial , 66 pregnant women with hemoglobin 13.2 g/dL or greater between the 13th and 18th week of pregnancy were r and omized into case and control groups . From the 20th week until the end of pregnancy the case group received one ferrous sulfate tablet containing 50 mg elemental iron daily , while the control group received placebo .  Hemoglobin , ferritin , copper , and zinc levels at 24 - 28 and 32 - 36 weeks of pregnancy were measured and compared . RESULTS In the case group , serum copper levels in the second and third trimester were significantly lower than the control group ( P<0.01 and P<0.001 , respectively ) . Serum zinc levels in the case group in the second and third trimester were also significantly lower than the control group ( P<0.001 ) . CONCLUSION Iron supplementation in pregnant women with hemoglobin greater than 13.2 g/dL reduces serum levels of copper and zinc Hemoglobin ( Hb ) concentration , serum iron level , iron binding capacity and blood folate ( Lactobacillus casei ) activity were determined in 310 unselected pregnant Burmese women .  Hb concentration was less than 11 g/dl in 72 % of the women ; the serum iron level was less than 50 mug/dl in 33 % ; serum folate activity was less than 3ng/ml in 13 % ; and red cell folate activity was less than 100 ng/ml in 17 % of the women . Ninety-six of the women in our study were r and omly divided into four groups , treated from the 22nd to the 25th week of pregnancy until full term with either ferrous sulfate containing 60 mg elemental iron twice daily , 5 mg folic acid twice daily , a combination of both , or a placebo only . At full term , Hb concentration fell in the groups given placebo or folic acid . On the other h and , in the groups given iron alone or iron plus folic acid there was an increase in Hb of 0.4 and 0.7 g/dl , respectively ( intergroup difference not statistically significant ) . Serum iron and blood folate levels fell in the groups not receiving the appropriate hematinic . In spite of deficient serum and red cell folate levels in 30 and 40 % , respectively , of the group on iron alone , the mean Hb concentration increased at full term and none of the women had a Hb concentration lower than 10 g/dl . Blood folate levels were lower in the iron-supplemented group than in the placebo group , indicating that iron deficiency does not aggravate the folate nutritional status 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 OBJECTIVE To measure levels of markers of anemia before and after delivery in women who had high hemoglobin levels during the early stage of the second trimester of pregnancy and did not receive iron supplementation during their pregnancies . METHODS In a r and omized , double-blind , placebo-controlled trial 244 women who had a hemoglobin concentration of 13.2 g/dL or greater and a serum ferritin level higher than 15 microg/L between the 13th and 18th week of pregnancy took either one 150-mg tablet of ferrous sulfate daily or placebo during their pregnancies . Markers of anemia were measured at the time of delivery and 6 weeks postpartum . RESULTS There were statistically significant differences between the 2 groups in hematocrit as well as hemoglobin and ferritin levels both at the time of delivery and 6 weeks postpartum ( P<0.05 ) , but these differences were not clinical ly significant . CONCLUSION Not using iron supplementation did not cause a considerable decrease in markers of anemia in women with a hemoglobin concentration of 13.2 g/dL or greater in the second trimester of pregnancy 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 Anemia is still the major nutritional problem among pregnant women in Southeast Asia . The objective of this study was to measure hemoglobin status and reduction of underweight in a group of pregnant women who received iron-fortified or nonfortified milk  , and another group who received iron supplements ( tablets ) or placebo . The 44 women in the iron-fortified milk group received 15 mg of iron per day per 400 ml of milk , and 41 women received placebo . The 40 women in the iron supplement group received 60 mg of iron per day , and 43 women received nonfortified milk . During this intervention trial , all women were supervised from the 14th to the 18th week of gestation until delivery . Blood was sample d at 0 , 5 , 10 , and 16 weeks of intervention . After the 16th week of intervention , the changes in hemoglobin ( ΔHb ) concentrations in both treatment groups ( the iron-fortified milk and the iron tablet groups ) were not significantly different ( ΔHb : −0.5 ± 0.9 and −0.3 ± 0.9 g/L , respectively ) , but the changes were significantly greater in the nonfortified milk and placebo groups ( ΔHb : −1.2 ± 0.9 and −1.1 ± 0.8 g/L , respectively ; p < .01 ) . The change in transferrin saturation ( ΔTS ) in the iron-fortified milk group ( ΔTS : 3.4 ± 12.9 % ) was greater than that in the placebo and nonfortified milk groups ( ΔTS : −10.1 ± 9.8 % and −11.6 ± 10.7 % , respectively ) ( p < .01 ) . The weight gain of the subjects during intervention did not differ significantly in the fortified and nonfortified milk groups ( Δweight : 5.0 ± 2.0 and 5.8 ± 2.1 kg , respectively ) , but was higher than in the iron tablet group ( Δweight : 4.6 ± 3.1 kg p < .05 ) and the placebo group ( Δweight : 3.8 ± 2.5 kg ; p < .001 ) . Iron supplementation and fortification were seen to be effective in promoting weight gain in pregnant Vietnamese women . For women who are underweight , the administration of iron-fortified milk has additional benefits to those of supplementation , most likely due to additional energy and nutrient inputs 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 Summary Prenatal multivitamin supplements ( PMS ) are recommended during pregnancy . Suboptimal adherence in women experiencing gastrointestinal ( GI ) conditions is thought to be attributed to the high elemental iron content in PMS . This study sought to quantify adherence and tolerability of iron-containing PMS in women with pre-existing GI conditions by recruiting women who called the Motherisk Helpline . Women with ( n = 36 ) and without ( n = 166 ) pre-existing GI conditions were r and omised to either PregVit ® ( n = 106 ) or Orifer F ® ( n = 96 ) . Monthly follow-up interviews were conducted to assess pill intake and GI adverse effects associated with PMS . The results of our study suggest that with the use of small size and low dose iron PMS , women with pre-existing GI conditions do not experience ( 1 ) more GI adverse effects , ( 2 ) lower adherence than women with no such conditions , and ( 3 ) may experience less severe nausea and vomiting of pregnancy . Supplementing with small tablets of low dose iron PMS should be considered Questions have been raised about potentially negative effects of antenatal folic acid use in population s with a high prevalence of vitamin B-12 deficiency . Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance  and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and /or vitamin B-12 status . Pregnant women were cluster r and omized to receive daily supplements containing vitamin A alone or with folic acid , folic acid+iron , folic acid+iron+zinc , or a multiple micronutrient .  In a sub sample ( n = 1132 ) , micronutrient status biomarkers were analyzed at baseline and late pregnancy . Children born to the women who participated in the trial were visited at 6 - 8 y of age . Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment ( HOMA-IR ) . Children whose mothers were deficient in vitamin B-12 ( < 148 pmol/L , 27 % ) during early pregnancy had a 26.7 % increase in HOMA-IR ( P = 0.02 ) , but there was no association with maternal folate status . Among children born to women who were vitamin B-12 deficient at baseline , the percent difference in HOMA-IR compared to the control group was 15.1 % ( 95 % CI : -35.9 , 106.4 ) , 4.9 % ( -41.6 , 88.5 ) , 3.3 % ( -38.4 , 73.5 ) , and 18.1 % ( -29.0 , 96.7 ) in the folic acid , folic acid-iron , folic acid-iron-zinc , and multiple micronutrient supplementation groups , respectively , none of which were significant . Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance , but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring IMPORTANCE Maternal micronutrient deficiencies may adversely affect fetal and infant health , yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia . OBJECTIVE To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month  infant mortality and adverse birth outcomes . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized , double-masked trial in Bangladesh , with pregnancy surveillance starting December 4 , 2007 , and recruitment on January 11 , 2008 . Six-month infant follow-up ended August 30 , 2012 . Surveillance included 127,282 women ; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants . Median gestation at enrollment was 9 weeks ( interquartile range , 7 - 12 ) . INTERVENTIONS Women were provided supplements containing 15 micronutrients or iron-folic acid alone , taken daily from early pregnancy to 12 weeks postpartum . MAIN OUTCOMES AND MEASURES The primary outcome was all-cause infant mortality through 6 months ( 180 days ) . Prespecified secondary outcomes in this analysis included stillbirth , preterm birth ( < 37 weeks ) , and low birth weight ( < 2500 g ) . To maintain overall significance of α = .05 , a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes ( .05/5 ) . RESULTS Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group , there were 14,374 and 14,142 live-born infants , respectively , included in the analysis . At 6 months , multiple micronutrients did not significantly reduce infant mortality ; there were 764 deaths ( 54.0 per 1000 live births ) in the iron-folic acid group and 741 deaths ( 51.6 per 1000 live births ) in the multiple micronutrient group ( relative risk [ RR ] , 0.95 ; 95 % CI , 0.86 - 1.06 ) . Multiple micronutrient supplementation result ed in a non-statistically significant reduction in stillbirths ( 43.1 vs 48.2 per 1000 births ; RR , 0.89 ; 95 % CI , 0.81 - 0.99 ; P = .02 ) and significant reductions in preterm births ( 18.6 vs 21.8 per 100 live births ; RR , 0.85 ; 95 % CI , 0.80 - 0.91 ; P < .001 ) and low birth weight ( 40.2 vs 45.7 per 100 live births ; RR , 0.88 ; 95 % CI , 0.85 - 0.91 ; P < .001 ) . CONCLUSIONS AND RELEVANCE In Bangladesh , antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but result ed in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00860470 Iron ( Fe ) deficiency and anemia during pregnancy remain highly prevalent in Senegal because of low compliance with Fe supplementation . Improving women 's access to supplements may increase compliance . Six prenatal centers in Dakar were r and omly assigned to either a control group in which women received routine prenatal visits , including prescriptions to purchase iron/folic acid tablets ( IFA ) according to the guidelines of the current Senegalese supplementation program ( n=112 ) , or to an intervention group in which women received free IFA ( n=109 ) in addition to routine prenatal care . Compliance was assessed 20 weeks after enrollment by pill count and interviews . Hemoglobin , erythrocyte protoporphyrin and serum ferritin were measured at baseline and follow-up . Compliance was 48 % and 86 % in the control and intervention groups , respectively ( P<0.001 ) . After adjustment for confounding , prevalence of anemia was 62 % in the control group versus 31 % in the intervention group ( P<0.001 ) ; prevalence of Fe deficiency was 49 % and 21 % in the control and intervention groups , respectively ( P<0.001 ) . Improving access to IFA for pregnant women visiting health centers could dramatically increase their compliance , improve Fe status and decrease the incidence of anemia Abstract Objective : To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) in pregnant women . Design : R and omized , double-blind , intention-to-treat study . Setting : Antenatal care clinic . Sample : 80 healthy ethnic Danish pregnant women . Methods : Women were allocated to ferrous bisglycinate 25 mg elemental iron ( Aminojern ® ) ( n=40 ) or ferrous sulfate 50 mg elemental iron ( n=40 ) from 15 to 19 weeks of gestation to delivery . Hematological status ( hemoglobin , red blood cell indices ) and iron status ( plasma iron , plasma transferrin , plasma transferrin saturation , plasma ferritin ) were measured at 15–19 weeks ( baseline ) , 27–28 weeks and 36–37 weeks of gestation . Main outcome measures : Occurrence of ID ( ferritin < 15 μg/L ) and IDA ( ferritin < 12 μg/L and hemoglobin < 110 g/L ) . Results : At inclusion , there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status . The frequencies of ID and IDA were low and not significantly different in the two iron groups . The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group ( P=0.001 ) . Newborns weight was slightly higher in the bisglycinate vs. the sulfate group ( 3601±517 g vs. 3395±426 g , P=0.09 ) . Conclusions : In the prevention of ID and IDA , ferrous bisglycinate was not inferior to ferrous sulfate . Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95 % of Danish women during pregnancy and postpartum
BACKGROUND Iron and folic acid supplementation has been the preferred intervention to improve iron stores and prevent anaemia among pregnant women , and it is thought to improve other maternal and birth outcomes .
OBJECTIVES To assess the effects of daily oral iron supplements for pregnant women , either alone or in conjunction with folic acid , or with other vitamins and minerals as a public health intervention in antenatal care .