Controlled‐Release Iron Therapy in Pregnancy Selective Use of Recombinant Human Erythropoietin in Pregnant Patients with Severe Anemia or Nonresponsive to Iron Sucrose Alone Intravenous Versus Oral Iron for Treatment of Anemia in Pregnancy: A Randomized Trial Comparative study--efficacy, safety and compliance of intravenous iron sucrose and intramuscular iron sorbitol in iron deficiency anemia of pregnancy. A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women. Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic Acid supplements. Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. Supplementation with iron and riboflavin enhances dark adaptation response to vitamin A-fortified rice in iron-deficient, pregnant, nightblind Nepali women. Etiopathogenesis of nutritional anemia in pregnancy: a therapeutic approach. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. 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. Anemia of pregnancy in Liberia, West Africa: a therapeutic trial. Mobilisation of iron in pregnancy. Oral versus high dose parenteral iron supplementation in pregnancy. [Ferro-folgamma--a good alternative in the treatment of iron deficiency anemia and depleted iron stores in pregnant women]. [Clinical experience with iron supplementation in pregnancy]. Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials. Comparison of effect of daily versus weekly iron supplementation during pregnancy on lipid peroxidation. Daily versus intermittent iron supplementation in pregnant women: hematological and pregnancy outcome. Iron absorption from Spatone (a natural mineral water) for prevention of iron deficiency in pregnancy. W.H.O. sponsored collaborative studies on nutritional anaemia in India. 1. The effects of supplemental oral iron administration to pregnant women. Side Effects of Oral Iron Prophylaxis in Pregnancy – Myth or Reality? Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route. Iron prophylaxis in pregnancy: intravenous route versus oral route. New schedule of intramuscular iron administration for pregnant women. The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose–response trial Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy 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 A comparison between intravenous iron polymaltose complex (Ferrum Hausmann®) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy [Treatment of anemia in pregnancy]. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. WHO sponsored collaborative studies on nutritional anaemia in India. The effect of parenteral iron administration in the control of anaemia of pregnancy. Pregnancy associated anemia and iron: a pilot study. Ethacrynic acid and packed-blood-cell transfusion in treatment of severe anaemia in pregnancy. Efficacy of Iron Therapy: A Comparative Evaluation of Four Iron Preparations Administered to Anaemic Pregnant Women Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Efficacy and safety of intravenously administered iron sucrose with and without adjuvant recombinant human erythropoietin for the treatment of resistant iron-deficiency anemia during pregnancy. Erythrocyte indices in pregnancy: effect of intermittent iron supplementation. Iron plus folate is more effective than iron alone in the treatment of iron deficiency anaemia in pregnancy: a randomised, double blind clinical trial Iron dextran in the treatment of iron-deficiency anaemia of pregnancy. Haematological response and incidence of side-effects. Folic acid -- has it a role in the treatment of severe iron deficiency anaemia in pregnancy? Relation between maternal haemoglobin concentration and birth weight in different ethnic groups Evaluation of tolerance of and response to iron dextran (Imferon) administered by total dose infusion to pregnant women with iron deficiency anemia. Routine iron supplementation in pregnancy has no effect on iron status of children at six months and four years of age. [Diagnosis and therapy of iron deficiency anemia in pregnancy]. The effect of iron and folic acid therapy on combined iron and folate deficiency anaemia: the results of a clinical trial. The Effectiveness of Weekly Iron Supplementation in Pregnant Women of Rural Northern Malawi Efficacy and tolerability of oral bovine lactoferrin compared to ferrous sulfate in pregnant women with iron deficiency anemia: A prospective controlled randomized study [The effectiveness of three regimens using ferrous sulfate to treat anemia in pregnant women].
One hundred and three antenatal patients with initial haemoglobin levels of 10.7 g./100 ml . or less at their first antenatal visit were treated with either ferrous gluconate , Ferrogradumet or intravenous Astrafer . A significant rise in haemoglobin level occurred in the first month in those groups receiving iron therapy compared with the control group . From the end of the first month until 36 weeks gestation , there was no significant difference between the treatment groups Objective : To evaluate the effectiveness of a stepwise use of recombinant human erythropoietin ( rhEPO ) in pregnant patients with severe anemia or nonresponsive to intravenously administered iron only . Methods : All subjects had iron deficiency anemia , i.e. , a hemoglobin ( Hb ) level < 10.0 g/dl and ferritin ≤15 μg/l . Patients with an Hb level ≥9.0 g/dl and < 10.0 g/dl received 200 mg iron sucrose intravenously twice weekly . If response to therapy was poor , patients additionally received 10,000 U rhEPO twice weekly . Patients with an Hb level < 9.0 g/dl primarily received iron sucrose and rhEPO likewise . Results : Of the 84 patients , 59 had a  baseline Hb level between 9.0 and 9.9 g/dl , of whom 32 responded poorly , thus receiving additional rhEPO . Twenty-five patients had a baseline Hb level < 9.0 g/dl . The overall Hb level after therapy was 11.0 g/dl ( ±0.5 , range 10.0–12.6 g/dl ) . Mean duration of therapy was 3.5 weeks ( 7 infusions ) . Conclusion : This study shows an effective treatment regimen for patients with various degrees of anemia in pregnancy . Iron sucrose is a safe and effective treatment option . In cases of severe iron deficiency anemia or poor response to parenteral iron therapy additional administration of rhEPO might be considered . However , the mechanism for not responding to  intravenous iron therapy despite iron deficiency anemia still remains unclear to a large extent OBJECTIVE : The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy . METHODS : In this r and omized open-label study , 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 & mgr;g/L received either oral iron polymaltose complex ( 300 mg elemental iron per day ) or intravenous iron sucrose . The iron sucrose dose was calculated from the following formula : weight before pregnancy ( kg ) × ( 110 g/L – actual hemoglobin [ g/L ] ) × 0.24 + 500 mg . Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery , and the hemoglobin on the first postpartum day . Adverse drug reactions , fetal weight , hospitalization time , and blood transfusions were also recorded . RESULTS : Hemoglobin values varied significantly with time between groups ( interaction effect , P < .001 ) . The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement ; the changes with respect to subsequent hemoglobin were significantly higher on the 14th ( P = .004 ) and 28th ( P = .031 ) days . Ferritin values were higher in patients receiving intravenous iron throughout pregnancy . No serious adverse drug reactions were observed . Fetal weight and hospitalization time were similar in the 2 groups . Blood transfusion was required for only one patient in the oral group . CONCLUSION : Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron , with no serious adverse reactions . LEVEL OF EVIDENCE : 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 BACKGROUND Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia . However , 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective . OBJECTIVE We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation . DESIGN In a prospect i ve , partially r and omized study , 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid , and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly .  One hundred women in each group completed the study .  Changes in hemoglobin , iron indicators , pregnancy outcomes , and birth weight were compared between the 2 groups . RESULTS Hemoglobin and iron indicators improved significantly with both treatments . The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment . No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed . Systemic side effects were more common in the parenteral iron group , whereas gastrointestinal side effects were more common in the oral iron group . CONCLUSIONS The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who can not tolerate oral administration of iron . However , intramuscular administration of iron is appropriate only in hospital setting s well equipped to treat anaphylactic crises 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 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 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 Nightblindness affects 16 - 52 % of pregnant women in areas of Nepal and in some cases persists after vitamin A treatment . Iron and riboflavin affect vitamin A utilization and photoreceptor function , respectively , and pilot data in the study population showed a high prevalence of iron and riboflavin deficiencies . OBJECTIVE The objective was to assess the effect of supplemental iron and riboflavin on pupillary threshold ( PT ) and plasma retinol in nightblind , pregnant Nepali women given vitamin A-fortified rice . DESIGN Nightblind pregnant women were r and omly assigned to receive , 6 d/wk under supervision for 6 wk , a vitamin A-fortified rice curry dish providing 850 microg retinal activity equivalents/d with either a 30-mg Fe and 6-mg riboflavin ( FeR + VA ) capsule or a placebo control ( VA only ) capsule . Hemoglobin , erythrocyte riboflavin , and plasma ferritin and retinol were measured before and after the intervention . Dark adaptation was assessed by PT score . RESULTS Women who were iron deficient at baseline ( n=38 ) had significantly greater improvement in PT score with  iron and riboflavin supplementation  than without ( P=0.05 ) . Iron and riboflavin supplements significantly reduced the prevalences of riboflavin deficiency ( from 60 % to 6 % ; P<0.0001 ) , iron deficiency anemia ( from 35 % to 15 % ; P<0.007 ) , and abnormal PT ( from 87 % to 30 % ; P<0.05 ) from baseline . Mean increases in erythrocyte riboflavin ( P<0.0001 ) and plasma ferritin ( P=0.01 ) were greater in the FeR + VA group than in the VA only group . CONCLUSIONS Iron deficiency may limit the efficacy of vitamin A to normalize dark adaptation in pregnant Nepali women . Further studies are needed to assess the effect of simultaneous delivery of iron and vitamin A for the treatment of nightblindness One hundred twelve pregnant women at 26 ± 2 weeks of gestation and with hemoglobin levels of less than 11 g/100 ml were investigated for level of hematocrit , serum iron , iron-binding capacity , serum vitamin B 12 , and serum folates . They were r and omly divided into eight groups receiving as follows : I , placebo ; II , iron ; III , vitamin B 12 ; IV , folic acid ; V , iron + vitamin B 12 ; VI , iron + folic acid ; VII , vitamin B 12 + folic acid ; and VIII , iron , vitamin B 12 , and folic acid . The treatment was given for a period of 4 weeks . The women receiving iron singly or in combination showed a significant rise in hemoglobin . Vitamin B 12 and /or folic acid did not enhance the effect of iron supplementation . The response to therapy was not related to initial level of serum iron , vitamin B 12 , or folic acid . The study clearly demonstrates that iron deficiency is the most important factor in causation of anemia in these women We studied the effect of iron supplementation on the iron status of mothers and on biochemical iron status and clinical and anthropometric measures in their infants . The subjects were 197 pregnant women selected at 28 wk + /- 21 d of gestation at a mother- and -child health center in Niamey , Niger . Ninety-nine women received 100 mg elemental Fe/d  throughout the remainder of their pregnancies and 98 received placebo . The prevalence of anemia and iron deficiency decreased markedly during the last trimester of pregnancy in the iron-supplemented group but remained constant in the placebo group . Three months after delivery , the prevalence of anemia was significantly higher in the placebo group . At delivery , there were no differences between the two groups in cord blood iron variables . Three months after delivery , serum ferritin concentrations were significantly higher in infants of women in the iron-supplemented group . Mean length and Apgar scores were significantly higher in infants with mothers in the iron group than in those with mothers in the placebo group BACKGROUND According to our current underst and ing , iron absorption with weekly iron supplements is not higher than that with daily supplements ( ie , there is no mucosal block ) . However , community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one . Furthermore , when differences in absorption are found , they are commonly smaller than would be expected on the basis of differences in the amount of iron provided . The possibility of differential compliance between the regimens needs to be evaluated to explain these findings . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d . Compliance was monitored by using a pill bottle equipped with an electronic counting device .  Hemoglobin concentrations were measured at baseline and after 4 , 8 , and 12 wk of supplementation . RESULTS There was no differential effect per iron tablet between weekly and daily regimens . A 12-wk daily regimen ( 68 % compliance ) produced a small but significantly greater hemoglobin response than did the weekly regimen ( 104 % compliance ) . The first 20 tablets consumed produced most of the effect ; after 40 tablets , there was no further response . CONCLUSIONS There was no evidence of a mucosal block in the daily regimen . Over 12 wk , 50 % of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect . The weekly regimen provided a large part of this amount , explaining the limited difference in effect . It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary 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 Research was conducted in Liberia , West Africa to ascertain which hematinics produce the best  Hb response in women during the 3rd trimester of pregnancy . After obtaining background information , each of the 621 subjects was r and omly assigned to one of four treatment groups . Group 1 was given 60 mg iron once daily , group 2 was given 60 mg iron 3 times daily , group 3 was given 60 mg iron 3 times daily plus a 5-mg folic acid tablet once daily , and group 4 was given the same treatment as group 3 but also a weekly antimalarial prophylactic . For comparison , 58 untreated women in their 3rd trimester were also studied . Before therapy the five groups were similar with respect to selected socioeconomic status , health , and dietary variables . Hb response to therapy was measured at 4-wk intervals from the 24th wk of gestation until term . The Hb rises in all four treatment groups were significantly ( p less than 0.001 ) higher than the base-line values at 4 , 8 , and 12 wk after the interventions . The percentage of anemic women was reduced from 78 to 45 % over the 12 wk of supplementation . Hb rises in groups 3 and 4 were not significantly different from those in groups receiving iron alone . It is concluded that iron deficiency is the main cause of anemia in this population Abstract Sternal bone-marrow aspirates from pregnant women were stained for storage iron . Haematological indicators of iron nutrition were examined throughout the remainder of pregnancy in three groups of women : those with latent or prelatent iron deficiency ( as judged by stainable marrow iron ) whose iron stores were replenished with parenteral iron  and who subsequently were given no supplementary haematinics ( A ) or oral folic acid ( B ) ; and those with satisfactory iron stores ( C ) . In group C , low levels of serum-iron developed during pregnancy , and iron-deficiency anaemia developed in some . Haematological indicators remained satisfactory in groups A and B , so iron re sources in these patients were much greater than the iron content of the bone-marrow indicated . It is suggested that storage iron in the marrow is mobilised early in pregnancy to provide a source of immediately available iron ; this mobilisation is achieved , perhaps , by an increase in serum total iron-binding capacity 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 To study the effect of different therapeutical regimens of Ferro-Folgamma , in pregnant patients with iron deficiency anemia . MATERIAL S AND METHODS 22 pregnant patients between 20 and 35 week of gestation ( mean 29 gestational week ) with hemoglobin levels between 83.1 - 106 g/l were included . They were divided in two groups : group 1 included patients with hemoglobin levels up to 100g/l and group 2 - -with hemoglobin levels between 100 and 110 . The dosage of the preparation in group 1 was 1 tablet Ferro-Folgamma tid for 40 days , and 1 tablet Ferro-Folgamma bid for the same period . Blood sample s were taken four times during the study on day 0 , 10th day , 20th day and in the week after the 40th completed day of therapy . The sample s were tested for CBC , iron , transferine , feritine , folic acid . All patients were given complete information about the possible risks of iron deficiency anemia during pregnancy and parturition . DISCUSSION AND RESULTS The mean hemoglobin level at initiation of treatment was 91.22 g/l ( day 0 ) . After initiation of treatment the the following rise in hemoglobin levels was detected 10th day - 103.8 g/l , 20th day - 112.6 g/l , after the 40th completed day - 136.0 g/l . The mean levels of the rest of hematological parameters were , day 0 - Er - 3.25 mln/microl , Fe - 7.53 micromol/l , transferine - 3.65 gr/l , feritine - 15.02 ngr/ml , folic acid - 14.08 ng/ml , vit . B12 - 219.68 pg/ml ; 10th day - Er- 3.5 mln/microl , Fe - 14 . 12 micromol/l ; 20th day - Er - 4.10 mln/microl , Fe - 20.46 micromol/l ; 40th completed day - Er- 4.69 mln/microl , Fe - 13.12 micromol/l , transferine - 3.82 gr/l , feritine - 27.42 ngr/ml , folic acid - 15.67 ng/ml , vit . B12 - 484.52 pg/ml respectively . CONCLUSIONS Oral treatment with Ferro-Folgamma , according the described dosage regimen , demonstrates its fast and stable effect in treatment of moderate iron deficiency and recovery of depleted iron pool in pregnant patients as well . It could be administered as a prophylactic preparation for borderline anemic states 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 The objective of this study was to analyze adherence and side effects of three iron supplement regimens ( ferrous sulfate ) on anemic pregnant women . The clinical trial involved 150 women between the 16th and 20th gestational weeks , at low obstetric risk and with hemoglobin concentration of between 8.0 and 11.0 g/dL. Treatment was provided by ferrous sulfate with 60 mg of elemental iron during 16 ( + /- 1 ) weeks , in three regimens : single tablet a week ( n = 48 ) ; single tablet twice a week ( n = 53 ) or single tablet a day ( n = 49 ) . The outcomes were adherence , assessed through interviews and by counting tablets , and side effects , according to patient information . The adherence showed a declining trend ( 92 % , 83 % and 71 % ; p = 0.010 ) and the side effects revealed a growing trend ( 40 % , 45 % and 71 % ; p = 0.002 ) as the dosage increased . Diarrhea and epigastric pain were significantly associated with the dose administered ( p = 0.002 ) . These results suggest that in anemic pregnant women , complaints are directly proportional and the compliance is inversely proportional to the amount of medicinal iron 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 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 The absorption of iron  from Spatone Iron-Plus has been investigated in pregnant women with iron deficiency anaemia . A total of 25 mg Fe was taken and absorption determined from the increase in serum iron concentration during a period of 3 h. Mean absorption was 28 % , significantly higher than in nonpregnant , nonanaemic women ( 14 % ) . These studies demonstrate that Spatone provides an alternative to the st and ard ferrous sulphate tablet  for prevention of iron deficiency in pregnancy . As only lower doses of iron are required , the unpleasant side-effects of iron therapy are largely avoided A W.H.O. sponsored collaborative study of the effects of iron supplementation to pregnant women was carried out in Delhi ( northern India ) and Vellore ( southern India ) . Supplementation was given under supervision from the 26th to the 36th or 38th week of pregnancy . A control group received only placebo ; one group received vitamin B12 and folic acid alone ; four groups received vitamin B12 , folate and a daily iron supplement ranging from 30 to 240 mg of elemental iron as ferrous fumerate , and one further group received 120 mg of iron without B12 or folate . Groups receiving no iron showed a fall in mean stet concentration . Those receiving iron showed a rise in haemoglobin , the best results being in the groups receiving 120 and 240 mg of iron together with vitamin B12 and folate . Even in these groups however there was still a high prevalence of anaemia and iron deficiency at the end of the trial period . Iron alone did not produce as good results as iron plus vitamin B12 and folate . The supplementation had no detectable effect on the birth weight of the children , nor on the haemoglobin concentration of the infants at three months of age . The daily absorption of iron in the pregnant women , as judged from the increase in haemoglobin mass , was not as satisfactory as expected . Possible reasons for this are discussed . It is concluded that to provide these women with adequate iron a daily oral supplementation of 120 mg of elemental iron or more is needed . This can only be achieved by medicinal means . Before supplementation can be recommended on a public health scale , further information regarding the cost and expected benefits of such measures must be obtained 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 OBJECTIVE The aim of this study was to compare intravenous iron sucrose versus oral iron sulfate in anemia at 6 months of pregnancy . STUDY DESIGN A r and om , prospect i ve , open study with individual benefit was performed involving 50 patients with hemoglobin levels between 8 and 10 g/dL and a ferritin value of < 50 microg/L. In the intravenous group ( IV group ) , the iron dose was calculated from the following formula : Weight before pregnancy ( kg ) x ( 120 g/L - Actual hemoglobin [ g/L ] ) x 0.24 + 500 mg . The oral group ( PO group ) received 240 mg of iron sulfate per day for 4 weeks . Treatment efficacy was assessed by measurement of hemoglobin and reticulocytes on days 8 , 15 , 21 , and 30 and at delivery and of ferritin on day 30 and at delivery . The baby 's birth weight and iron stores were noted . Results were expressed as median + /- interquartile range . Mann-Whitney and Wilcoxon tests were used for the analysis , with P < .05 considered significant . RESULTS An increase in hemoglobin was observed , rising from 9.6 + /- 0.79 g/dL to 11.11 + /- 1.3 g/dL on day 30 in the IV group and from 9.7 + /- 0.5 g/dL to 11 + /- 1.25 g/dL on day 30 in the PO group ( not significant ) . On day 30 ( P < .0001 ) and at delivery ( P = .01 ) ferritin was higher in the IV group . A mean higher birth weight of 250 g was noted in the IV group ( not significant ) . CONCLUSION Iron sucrose appears to be a treatment without serious side effects indicated in correction of pregnancy anemia or iron stores depletion 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 Pregnant women between 14 and 20 weeks were r and omly recruited in 2 groups , 50 to each . One group received iron with folic acid orally , other group was given 5 injections of iron dextran spaced 4 weekly . Mean haemoglobin was same for both the groups at the beginning ( p > 0.05 ) . At 36 weeks intramuscular group has shown statistically more haemoglobin rise than oral group ( p < 0.001 ) . This new intramuscular schedule is found to be convenient , cheap and acceptable to pregnant women . It also assures at least 5 antenatal checkups to a pregnant woman 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 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 BACKGROUND Anticonvulsants are used for pre-eclampsia in the belief they prevent eclamptic convulsions , and so improve outcome . Evidence supported magnesium sulphate as the drug to evaluate . METHODS Eligible women ( n=10141 ) had not given birth or were 24 h or less postpartum ; blood pressure of 140/90 mm Hg or more , and proteinuria of 1 + ( 30 mg/dL ) or more ; and there was clinical uncertainty about  magnesium sulphate .  Women were r and omised in 33 countries to either magnesium sulphate  ( n=5071 ) or placebo ( n=5070 ) . Primary outcomes were eclampsia and , for women r and omised before delivery , death of the baby . Follow up was until discharge from hospital after delivery . Analyses were by intention to treat . FINDINGS Follow-up data were available for 10,110 ( 99.7 % ) women , 9992 ( 99 % ) of whom received the allocated treatment . 1201 of 4999 ( 24 % ) women given magnesium sulphate reported side-effects versus 228 of 4993 ( 5 % ) given placebo . Women allocated magnesium sulphate had a 58 % lower risk of eclampsia ( 95 % CI 40 - 71 ) than those allocated placebo ( 40 , 0.8 % , vs 96 , 1.9 % ; 11 fewer women with eclampsia per 1000 women ) . Maternal mortality was also lower among women allocated magnesium sulphate ( relative risk 0.55 , 0.26 - 1.14 ) . For women r and omised before delivery , there was no clear difference in the risk of the baby dying ( 576 , 12.7 % , vs 558 , 12.4 % ; relative risk 1.02 , 99 % CI 0.92 - 1.14 ) . The only notable difference in maternal or neonatal morbidity was for placental abruption ( relative risk 0.67 , 99 % CI 0.45 - 0.89 ) . INTERPRETATION Magnesium sulphate halves the risk of eclampsia , and probably reduces the risk of maternal death . There do not appear to be substantive harmful effects to mother or baby in the short term A comparative study was conducted to demonstrate the difference , if any , in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate .  Sixty pregnant women with iron deficiency anaemia were assigned r and omly to either group and treated for 6 weeks . The age and parity distributions with mean packed cell volumes ( PCVs ) and gestational age at onset of treatment in the two groups were comparable . Comparing the mean PCVs at week 2 , week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs ( P < 0.001 ) . Thirty-six per cent of patients in the iron dextran group compared to 3.3 % in the oral iron group ( P = 0.004 ) had their anaemia corrected by the sixth week . No significant side effects accompanied the use of intramuscular iron dextran . It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate . Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks ; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients 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 Abstract : Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases . Over 90 % of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake . The two main modalities of treating iron deficiency anaemia are oral or parenteral iron . Ferrous Hausmann ® ( iron dextrin ) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion . This study compares the efficacy of Ferrum Hausmann ® with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy . Our study shows that treatment with intravenous Ferrum Hausmann ® ( iron dextrin ) result ed in a significantly better level and rate of increase of haemoglobin ( p<0.001 ) . Serum ferritin , which is the best indicator of iron stores , was significantly higher ( p<0.001 ) in the intravenous group . Other indices of iron status such as serum iron , serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron . The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently , completely and at a faster rate than oral iron therapy , thus providing the fuel for stimulation of full erythopoiesis compared to oral iron . There were also no reports of any adverse reactions with intravenous iron dextrin , whereas there were a considerable proportion of women on oral iron therapy who reported side effects . In conclusion , intravenous iron therapy with Ferrous Hausmann ® ( iron dextrin ) is a suitable , effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy In a therapeutic comparative study two trial-groups ( 1 and 2 ) of 30 pregnant women each suffering from iron deficiency anemia of light degree received r and omly selected a combination of ferrous succinate and multivitamins ( Multibionta-Eisen ) or a combination of ferrous sulfate and folic acid ( preparations ES ) . By both medications the decrease of hemoglobin , red blood count and hematocrit could be stopped and a re-increase of these values was seen afterwards . There was no significant differences in response between Multibionta-Eisen and ES . A significant increase of Hb , RBC and Hc as compared prior to treatment was limited to group 2 . Possible causes for the non-significant results of group 1 are discussed . The results of the study are demonstrating a certain superiority of preparation ME . This combination showed at least equal efficiency as preparation ES in spite of a smaller iron dosage and was well tolerated without exception . Subjective complaints may be better improved by Multibionta-Eisen MRC CRASH is a r and omised controlled trial ( IS RCT N74459797 ) of the effect of corticosteroids on death and disability  after head injury . We r and omly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less , within 8 h of injury , to a 48-h infusion of corticosteroid ( methylprednisolone ) or placebo . Data at 6 months were obtained for 9673 ( 96.7 % ) patients . The risk of death was higher in the corticosteroid group than in the placebo group ( 1248 [ 25.7 % ] vs 1075 [ 22.3 % ] deaths ; relative risk 1.15 , 95 % CI 1.07 - 1.24 ; p=0.0001 ) , as was the risk of death or severe disability ( 1828 [ 38.1 % ] vs 1728 [ 36.3 % ] dead or severely disabled ; 1.05 , 0.99 - 1.10 ; p=0.079 ) . There was no evidence that the effect of corticosteroids  differed by injury severity or time since injury . These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury 1 . The relative efficacy of oral and parenteral iron administration in the prophylaxis and treatment of Fe-deficiency anaemia of pregnancy has been studied . 2 . Intravenous administration of Fe by total dose infusion of Fe dextran was not superior to oral Fe 120 mg/d , 6 d/week for 10 - 12 weeks . 3 . Intramuscular Fe dextran , 100 mg twice per week for 10 - 12 weeks , produced a significantly greater rise in mean haemoglobin concentration than oral Fe therapy . 4 . The superiority of intramuscular Fe as compared with intravenous Fe is probably related to the different h and ling of the Fe dextran by the reticulo-endothelial system . 5 . In spite of the better response to intramuscular Fe dextran , it is not recommended for public health practice because of the risks associated with its use and the much higher cost of the preparation and its delivery Iron deficiency occurs when the rate of loss of utilization exceeds its assimilation . Treatment is based on iron supplementation but due to side effects compliance to iron therapy is poor . A double blind comparative study was done using a novel time release preparation of ferrous sulphate ( Code A ) v.s. sustained release ferrous sulphate preparation ( Code B ) on 60 pregnant women in mid or late pregnancy with anaemia . The amount of ferrous sulphate in Code A was less than half of Code B. The patients were sequentially r and omised as Code A or Code B recipient . The non compliance rate was 33 % , and for both Code A & Code B. The mean improvement in hemoglobin after 4 weeks of therapy was 2.01 gm% for Code A and 2.3 gm% for Code B. Iron absorption as evidence d by improvement in S. Iron , TIBC and ferritin levels was better with Code A. The improvement in subjective symptoms of anaemia was better than average in Code B preparation . Code A group had comparatively more side effects both major and minor , this may have been the reason for a slightly higher drop out rate in this group . In conclusion the timed release preparation has a comparable haematological response and better absorption with significantly lower doses as compared to the sustained release preparation Summary An investigation was planned to establish whether direct transfusion of packed cells with added ethacrynic acid was as safe and effective as exchange transfusion in the management of severe an˦mia in pregnancy , when cardiac failure caused by an˦mia is either present or imminent . 93 pregnant Nigerian women with h˦matocrit readings between 5 % and 13 % were allocated at r and om to two treatment groups . One group received exchange transfusion and the other was managed by direct transfusion of packed cells to which ethacrynic acid had been added . Subsequent treatment was the same for both groups . Analysis of maternal and fetal outcome showed that the results achieved by the two methods of treatment was similar . In the 46 patients treated by exchange transfusion 1 mother and 12 fetuses were lost , compared with no maternal death and the loss of 11 fetuses in the 47 treated by direct transfusion and ethacrynic acid . Apart from its simplicity , the ethacrynic acid technique has the advantage that less donor blood is required . Direct blood-transfusion combined with ethacrynic acid is , therefore , recommended for the initial treatment of very severe an˦mia in pregnancy , except for patients who require emergency surgery and those in advanced labour , for whom exchange transfusion is still preferred The authors conducted a clinical investigation on sixty-nine pregnant women , anaemic and non-anaemic , the purpose being to assess the effect of 50 days treatment with four different medicinal iron preparations , namely , ferrous sulphate , iron chondroitinsulfuric acid complex , and ferritin alone or associated with folinic acid and cobamamide , on various haematological parameters ( Hb , RCC , Ht , CV , Iron , and Transferrin IBC ) . The four products demonstrated a similar efficacy in maintaining anaemic conditions under control ; moreover , the results confirmed our hypothesis of the absorption of iron ferritin . While three products were well tolerated , ferrous sulphate induced , in some cases , side-effects OBJECTIVE To determine the efficacy and safety of Total Dose Infusion ( TDI ) of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin ( Hb ) after intervention . STUDY DESIGN Non-r and omized control trial . PLACE AND DURATION OF STUDY Section of Gynaecology and Obstetrics , Shifa International Hospital and Shifa Community Health Centre , Islamabad during January 2005 to January 2006 . PATIENTS AND METHODS A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study . Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit , in a monitored in-patient setting . Control comprised of a second group of 50 pregnant females matched for age , parity and baseline hemoglobin , tolerant to oral iron supplementation ( ferrous sulphate 200 mg three times a day ) attending the antenatal clinics during the same period . Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks . RESULTS In the intervention group , mean pre-infusion hemoglobin level was 8.57 + /- 0.9 gm/dl ( range 5 - 10.5 gm/dl ) and mean post-infusion Hb was 11.0 + /- 1.1 ( range 8.4 - 14.3 gm/dl ) . In control group , mean pre-oral intake Hb level was 9.5 + /- 0.9 gm/dl ( range 7 - 10.5 gm/dl ) and mean post-oral intake Hb was 10.2 + /- 1.2 gm/dl ( range 6.4 - 12.8 gm/dl ) . Mean increase of Hb in intervention group was 2.43 gm/dl ( 95 % CI 2.4 - 3.8 ) and for controls it was 0.7 gm/dl ( 95 % CI 0.6 - 2.3 ) . Flushing and palpitations were observed in 4 % of interventional group patients and none in the control group . No significant adverse reactions were observed in either group . CONCLUSION We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women OBJECTIVE To evaluate the safety and efficacy of intravenous iron sucrose complex ( ISC ) as compared with oral ferrous sulfate in the treatment of iron deficiency anemia during pregnancy . STUDY DESIGN prospect i ve , open , controlled study in which pregnant women with iron deficiency anemia were sequentially selected from the antenatal clinic and assigned either to ISC ( study group ) or to ferrous sulfate ( control group ) . METHODS Each study patient was given the total calculated amount of ICS ( Hb deficit ( g/l ) x body weight ( kg ) x 0.3 ) in divided doses ( 200 mg ( elemental iron ) in 100 ml normal saline intravenously over 1 h daily ) followed by 10 mg/kg to replenish iron stores . Each patient of the control group was given ferrous sulfate 300 mg ( 60 mg elemental iron ) orally three times a day . All patients were monitored for adverse effects , clinical and laboratory response . RESULTS There were 52 patients and 59 controls . ISC group achieved a significantly higher Hb level ( 128.5 + /- 6.6 g/l vs. 111.4 + /- 12.4 g/l in the control group P < or = 0.001 ) in a shorter period ( 6.9 + /- 1.8 weeks vs. 14.9 + /- 3.1 weeks in the control group , P < or = 0.001 ) . ISC complex group showed no major side effects while 4 ( 6 % ) of the control group could not tolerate ferrous sulfate , 18 ( 30 % ) complained of disturbing gastrointestinal symptoms and 18 ( 30 % ) had poor compliance . CONCLUSION We conclude that ISC is safe and effective in the treatment of iron deficiency anemia during pregnancy OBJECTIVE This study was undertaken to determine the efficacy and safety of intravenously administered iron sucrose with versus without adjuvant recombinant human erythropoietin in the treatment of gestational iron-deficiency anemia resistant to therapy with orally administered iron alone . STUDY DESIGN Forty patients with gestational iron-deficiency anemia were r and omly assigned to receive intravenously iron sucrose plus recombinant human erythropoietin or iron sucrose alone twice weekly . Target hemoglobin value was 11.0 g/dL. Efficacy measures were reticulocyte count , increase in hematocrit , and time to target hemoglobin level ( treatment duration in weeks and need for continued therapy after 4 weeks ) . RESULTS Both regimens were effective , but with adjuvant recombinant human erythropoietin the reticulocyte counts were higher from day 4 ( P<.01 ) , increases in hematocrit were greater from day 11 ( P < .01 ) , and the median duration of therapy was shorter ( 18 vs 25 days ) , with more patients reaching the target hemoglobin level by 4 weeks of treatment ( n = 19 vs. n = 15 ) . The groups did not differ with respect to maternal-fetal safety parameters . CONCLUSION Adjuvant recombinant human erythropoietin safely enhanced the efficacy of iron sucrose in the treatment of gestational iron-deficiency anemia resistant to orally administered iron alone 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 Objective To evaluate whether folate supplementation to iron is able to accelerate solving of iron deficiency anaemia in pregnancy Sixty pregnant patients with a haemoglobin ( Hb ) less than 8 g/dl and proven iron-deficiency anaemia were r and omly allocated to two treatment groups . Group A received the usual recommended dose of iron dextran ( Imferon ; Fisons ) and group B received two-thirds of the recommended dose . A further 30 patients received oral iron ( group C ) . There was no difference in Hb value between the three groups 4 weeks after treatment or 3 months after delivery . At 6 months after delivery , a higher mean Hb value was found in the patients in group A than those in groups B and C. Significantly higher serum ferritin levels were found in group A and this difference was still present 6 months postnatally . There was no significant difference in the incidence of delayed reactions between the two groups who received iron dextran Forty-one pregnant patients with severe iron deficiency anaemia were treated with either intravenous iron-dextran ( Imferon ; Fisons ) or intravenous iron plus folic acid . There was no difference in the rate of response or the eventual total response in the two groups , suggesting that iron therapy does not unmask or produce a relative folic acid deficiency Abstract Objective : To assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups . Design : Retrospective analysis of 153602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy data base during 1988 - 91 . The haemoglobin measurement used was the lowest recorded during pregnancy . Setting : North West Thames region . Subjects : 115262 white women , 22206 Indo-Pakistanis , 4570 Afro-Caribbeans , 2642 mediterraneans , 3905 black Africans , 2351 orientals , and 2666 others . Main outcome measures : Birth weight and rates of low birth weight ( < 2500 g ) and preterm delivery ( < 37 completed weeks ) . Results : Maximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85 - 95 g/l ; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95 - 105 g/l . A similar pattern occurred in all ethnic groups . Conclusions : The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight ; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery . This phenomenon is seen in all ethnic groups . Some ethnic groups have higher rates of low birth weight and preterm delivery than white women , and they also have higher rates of low haemoglobin concentrations . This increased rate of “ anaemia , ” however , does not account for their higher rates of low birth weight , which occurs at all haemoglobin concentrations . Key messages Key messages Failure of the haemoglobin concentration to fall during pregnancy was associated with a five to sevenfold increase in the incidence of low birth weight and preterm birth Routine haematinic administration in pregnancy is unnecessary on fetal grounds for most pregnancies The mean corpuscular volume may be a better indicator of maternal iron deficiency , but this needs prospect i ve Six hundred twenty-three pregnant women with iron deficiency anemia received iron dextran Imferon by total dose infusion ( TDI ) . Two dose levels were compared in respect of tolerance and hemoglobin response . The incidence of delayed reactions was significantly higher in the high dose group ( P less than 0.01 ) but there was no significant difference in the incidence of reactions occurring during the infusion . These findings are discussed in relation to the hemoglobin response 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 . 39 pregnant women , hemoglobin in serum less than or equal to 6,80 mmol/l were treated with Vitaferro , Folicombin and additional vitamins . Test groups were formed by means of r and omisation . Hematological and clinicochemical parameters were measured before , as well as 2 and 6 weeks after starting treatment and the results were evaluated .-- In the diagnosis of iron deficiency anemia in pregnancy serum iron concentration and iron-binding capacity are sufficient . The diagnosis is proved by an increase of the serum hemoglobin 2 weeks after starting therapy . For the total number of patients an increase of hemoglobin could be proved 2- and 6 weeks after starting therapy . However , the 3 chosen therapeutic methods did not show any differences in statistically proved values in form of therapeutic results . This is , in our view , due to given deviation and the specific character of the test group . During pregnancy iron deficiency anemia should be treated by doses more than 100 mg iron per day . Normalization of the hemoglobin under iron substitution is no indication for immediate interruption of the treatment Pregnant women with anaemia due to combined iron and folate deficiencies were r and omly divided into 3 groups receiving either combination therapy with iron and pteroylglutamic acid , or treatment with iron or pteroylglutamic acid olone .  A fourth group of pregnant women with levels of Hb above 10 g/100 ml received  placebo . Combined iron and folate administration result ed in a marked therapeutic response , while mild or insignificant improvement was associated with either iron or folic acid teratment alone . The Hb concentration of the women receiving placebo dropped gradually in most instances . The results reported here suggest that in population s with a high prevalence of iron and folate deficiencies both these compounds should be supplied in order to prevent anaemia . The possible causal relationship between iron and folate deficiencies are discussed in the light of the present results and relevant literature 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 Objective . To compare the effects of bovine lactoferrin with ferrous sulfate on iron nutritional status and to evaluate their tolerability in 100 pregnant women with iron deficiency anemia . Design . Prospect i ve , r and omized , controlled , double blind trial . Setting . Obstetrics clinic of a University Department of Obstetrics and Gynecology . Population . One‐hundred pregnant , healthy women to be treated either with one capsule of 100 mg bovine lactoferrin twice a day ( Group A ; n = 49 ) and 520 mg ferrous sulfate once a day ( Group B ; n = 48 ) . Methods . After 30 days , we evaluated hemoglobin ( Hb ) , serum ferritin , serum iron and total iron‐ binding capacity ( TIBC ) values . All women were asked to keep a diary of five potential gastrointestinal side effects ( abdominal pain , nausea , vomiting , diarrhea and constipation ) . For each symptom , patients had to rate its severity according to a scale ranging from 0 ( absent ) to 3 ( severe ) . Main outcome measures . Hb level before and after treatment . Secondary outcomes were serum ferritin , serum iron and TIBC levels and the difference in symptom scores between groups . Results . In Groups A and B , Hb , serum ferritin and iron were significantly increased while TIBC was significantly reduced in comparison with basal values . No significant differences were observed between Groups A and B. The median scores of abdominal pain and constipation were significantly higher in patients treated with ferrous sulfate in comparison with those treated with bovine lactoferrin . Conclusions . The results show that bovine lactoferrin has the same efficacy as ferrous sulfate in restoring iron deposits with significantly fewer gastrointestinal side effects OBJECTIVE To evaluate the effectiveness of three regimens employing ferrous sulfate to treat pregnant women with anemia . METHODS The study was carried out at the Women 's Health Center of the Pernambuco Institute of Maternal and Child Health in the city of Recife , Pernambuco , Brazil , from May 2000 to December 2001 . A r and omized clinical trial with blinded laboratory analysis was conducted . Iron ( 60 mg ) was administered as 300-mg ferrous sulfate tablets . The women were allocated to three treatment groups , according to the frequency of ingesting the tablets : once a week ( 48 women ) , twice a week ( 53 women ) , and once a day ( 49 women ) . The groups were compared for the values for hemoglobin ( Hb ) concentration , mean corpuscular volume , and ferritin before and after the treatment . RESULTS Before the intervention , the groups were homogeneous . They had the following mean ( + /- st and ard deviation ) concentrations of hemoglobin : 10.2 + /- 0.5 g/dL for the group receiving iron once a week , 10.2 + /- 0.6 g/dL for the group receiving iron twice a week , and 10.1 + /- 0.6 g/dL for the group receiving iron once a day . The means of corpuscular volume were , respectively : 88.5 + /- 5.0 fL , 87.6 + /- 5.9 fL , and 88.7 + /- 5.1 fL. The respective medians for ferritin were 30.2 ng/mL , 37.1 ng/mL , and 52.9 ng/mL. The cure rate ( Hb > 11 g/dL ) was 27 % in the patients treated once a week , 34 % in those treated twice a week , and 47 % in the women treated daily . Treatment failure ( hemoglobin < 10 g/dL ) was seen in 41.6 % , 13.2 % , and 2.0 % of the patients in the respective groups . Interruption of treatment due to diarrhea or epigastric pain occurred only among the patients treated daily . CONCLUSION The regimen with iron administered daily is still the best option for treating anemia . However , treatment with ferrous sulfate administered twice a week is an alternative for patients who are unable to adhere to daily treatment
BACKGROUND Iron deficiency , the most common cause of anaemia in pregnancy worldwide , can be mild , moderate or severe .
Severe anaemia can have very serious consequences for mothers and babies , but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm .
OBJECTIVES To assess the effects of different treatments for iron-deficiency anaemia in pregnancy ( defined as haemoglobin less than 11 g/dl ) on maternal and neonatal morbidity and mortality .