Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia. Periconceptional iron supplementation does not reduce anemia or improve iron status among pregnant women in rural Bangladesh. Changes in iron status during pregnancy in peruvian women receiving prenatal iron and folic acid supplements with or without zinc. Micronutrient supplementation and pregnancy outcomes: double-blind randomized controlled trial in China. A Comparative Evaluation of Multiple Micronutrient and Iron–Folic Acid Supplementation during Pregnancy in Pakistan: Impact on Pregnancy Outcomes W.H.O. sponsored collaborative studies on nutritional anaemia in India. 1. The effects of supplemental oral iron administration to pregnant women. Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Iron Supplementation in Iron-Replete and Nonanemic Pregnant Women in Tanzania: A Randomized Clinical Trial. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China Antenatal iron supplements consumed daily produce oxidative stress in contrast to weekly supplementation in Mexican non-anemic women. Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Further Observations on the Relation between Iron and Folate Status in Pregnancy Daily multivitamins with iron to prevent anemia in high-risk infants: a randomized clinical trial. Impact of daily versus weekly hematinic supplementation on anemia in pregnant women.
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 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 Iron deficiency anemia is the most prevalent nutrient deficiency during pregnancy , yet there are few data on the effect of prenatal iron supplementation in women in developing countries . OBJECTIVE Our objective was to describe the effect of iron supplementation on hematologic changes during pregnancy , and the effect on those changes of adding zinc to the supplements . DESIGN Pregnant women were enrolled in a r and omized , double-masked study conducted at a hospital in a shantytown in Lima , Peru . Women were supplemented daily from 10 - 24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 microg folic acid with or without 15 mg Zn .  Hemoglobin and ferritin concentrations were measured in 645 and 613 women , respectively , at enrollment , at 28 - 30 and 37 - 38 wk gestation , and in the cord blood of 545 neonates . RESULTS No differences in iron status were detected by supplement type , but hematologic changes were related to initial hemoglobin status . Women with anemia ( hemoglobin < 110 g/L ) showed steady increases in hemoglobin concentration throughout pregnancy whereas women with relatively higher initial hemoglobin concentrations had declining values during mid pregnancy , then rising values by 37 - 38 wk gestation . Women with an initial hemoglobin concentration > 95 g/L showed increases in serum ferritin by the end of the pregnancy . Despite supplementation , women with poorer hematologic status ; who were younger , single , and multiparous ; and who consumed fewer supplements were more likely to have anemia at the end of pregnancy . CONCLUSIONS These hematologic changes are congruent with the effects of iron supplementation reported in placebo-controlled trials and the addition of zinc did not significantly affect them 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 Background Maternal micronutrient deficiencies are widespread in Pakistan and are potentially associated with maternal undernutrition and intrauterine growth retardation . Intervention strategies largely consist of administration of iron – folic acid supplements during pregnancy . Objective We evaluated the acceptability of multiple micronutrient supplementation and its potential benefits on pregnancy outcomes and maternal micronutrient status in a cohort of pregnant women in rural and urban Sindh through a cluster-r and omized design . Methods We r and omly assigned 2,378 pregnant women to receive either iron – folic acid or multiple micronutrient supplements . The supplements were administered fortnightly by community health workers who performed home visits to assess tolerance and observe the mothers . Results The women in both groups consumed about 75 % of the supplements provided , and few reported adverse effects such as vomiting , abdominal pain , etc . There was a small ( 70 g ) but significant increase in birthweight among infants of mothers receiving multiple micronutrients as compared with infants of mothers receiving iron – folic acid supplements ( 2.95 ± 0.6 vs. 2.88 ± 0.5 kg , p = .01 ) . This translated into a 10 % reduction ( p < 0.17 ) in the proportion of low-birthweight infants among infants of mothers receiving multiple micronutrients . Although stillbirth rates were comparable in the two groups , the early neonatal mortality rate in the group receiving multiple micronutrients was higher , although not significantly , than that in the group receiving iron– folic acid ( 43.2 vs. 23.5 deaths per 1,000 live births ; RR = 1.64 ; 95 % CI , 0.94 to 2.87 ) . Comparable reductions in anemia ( hemoglobin < 11 g/dL ) were observed , although the proportion with low iron stores ( assessed by serum ferritin ) was lower in the iron – folic acid group in the postnatal period . Although the proportion of women with sub clinical vitamin A deficiency after supplementation did not differ between the two groups , the iron – folic acid group had a higher proportion with lower serum zinc levels in the immediate postpartum period . Conclusions These data suggest that multiple micronutrient supplements are well tolerated during pregnancy , but the effect on birthweight is modest . The observed effect on early neonatal mortality suggests the need for further studies and careful assessment of the intervention in health system setting 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 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 IMPORTANCE Anemia is common in pregnancy and increases the risk of adverse outcomes . Iron deficiency is a leading cause of anemia in sub-Saharan Africa , and iron supplementation is the st and ard of care during pregnancy ; however , recent trials among children have raised concerns regarding the safety of iron supplementation in malaria-endemic regions . There is limited evidence on the safety of iron supplementation during pregnancy in these areas . OBJECTIVE To evaluate the safety and efficacy of iron supplementation during pregnancy in a malaria-endemic region . DESIGN , SETTING , AND PARTICIPANTS We conducted a r and omized , double-blind , placebo-controlled clinical trial among pregnant women presenting for antenatal care in Dar es Salaam , Tanzania , from September 28 , 2010 , through October 4 , 2012 . Iron-replete , nonanemic women were eligible if they were uninfected with human immunodeficiency virus , primigravidae or secundigravidae , and at or before 27 weeks of gestation . Screening of 21,316 women continued until the target enrollment of 1500 was reached . Analyses followed the intent-to-treat principle and included all r and omized participants . INTERVENTIONS Participants were r and omized to receive 60 mg of iron or placebo , returning every 4 weeks for st and ard prenatal care , including malaria screening , prophylaxis with the combination of sulfadoxine and pyrimethamine , and treatment , as needed . MAIN OUTCOMES AND MEASURES The primary outcomes were placental malaria , maternal hemoglobin level at delivery , and birth weight . RESULTS Among 1500 study participants ( 750 r and omized for each group ) , 731 in iron group and 738 in placebo group had known birth outcomes and 493 in iron group and 510 in placebo group had placental sample s included in the analysis . Maternal characteristics were similar at baseline in the iron and placebo groups , and 1354 ( 91.7 % ) used malaria control measures . The risk of placental malaria was not increased by maternal iron supplementation ( relative risk [ RR ] , 1.03 ; 95 % CI , 0.65 - 1.65 ) , and iron supplementation did not significantly affect birth weight ( 3155 vs 3137 g , P = .89 ) . Compared with placebo , iron supplementation significantly improved the mean increase from baseline to delivery for hemoglobin ( 0.1 vs -0.7 g/dL , P < .001 ) and serum ferritin ( 41.3 vs 11.3 µg/L , P < .001 ) . Iron supplementation significantly decreased the risk of anemia at delivery by 40 % ( RR , 0.60 ; 95 % CI , 0.51 - 0.71 ) but not severe anemia ( RR , 0.68 ; 95 % CI , 0.41 - 1.14 ) . Iron supplementation significantly reduced the risk of maternal iron deficiency at delivery by 52 % ( RR , 0.48 ; 95 % CI , 0.32 - 0.70 ) and the risk of iron deficiency anemia by 66 % ( RR , 0.34 ; 95 % CI , 0.19 - 0.62 ) . CONCLUSIONS AND RELEVANCE Prenatal iron supplementation among iron-replete , nonanemic women was not associated with an increased risk of placental malaria or other adverse events in the context of good malaria control . Participants receiving supplementation had improved hematologic and iron status at delivery compared with the placebo group . These findings provide support for continued administration of iron during pregnancy in malaria-endemic regions . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01119612 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 Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies 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 UNLABELLED Universal prenatal daily supplementation with iron ( 60 - 120 mg iron ) plus folic acid ( 0.4 mg ) , as recommended by INACG/WHO/UNICEF , prevents anemia where iron deficiency is prevalent but may be excessive for non-anemic women . Weekly supplementation with 120 mg iron plus various amounts of folic acid similarly prevents significant anemia . OBJECTIVE Determine , in non-anemic pregnant women , if oxidative stress is produced by recommended daily or weekly supplementation schemes . PROCEDURE 100 non-anemic pregnant women , 30 % iron-deficient at week 20 , were r and omly supplemented daily followed by weekly , each for 8 weeks , or in reversed order . RESULTS With daily supplementation thio-barbituric-acid-reacting-substances ( TBARS ) increased significantly and high serum ferritin , iron , and excessively elevated hemoglobin occurred near term . During weekly supplementation significant anemia and high iron parameters were prevented , and elevated TBARS declined . CONCLUSION In non-anemic pregnant women both schemes prevented significant anemia . Oxidative stress occurred only during daily supplementation periods . Weekly supplementation appears safer 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 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 OBJECTIVE The goal of this study was to assess the effectiveness of multivitamins with iron as prophylaxis against  iron deficiency and anemia in infancy . METHODS The study was a double-blinded , r and omized , pragmatic , clinical trial conducted at 3 urban primary care clinics . Subjects included healthy , full-term infants who were enrolled at their 6-month well-child visit . Infants were r and omly assigned to receive st and ard-dose multivitamins with or without iron ( 10 mg/day ) . Parents administered multivitamins by mouth daily for 3 months . Laboratory results at 9 months of age were analyzed for the presence of anemia and /or iron deficiency . Anemia was defined as hemoglobin level < 11.0 g/dL. Iron deficiency was initially defined as any abnormal laboratory value of the following : mean corpuscular volume combined with red cell distribution width or zinc protoporphyrin ( with blood lead level < 10 microg/dL ) for most subjects and ferritin , transferrin saturation , or reticulocyte hemoglobin content for a subset . Subsequent analyses defined iron deficiency as any 2 abnormalities of the above laboratory outcomes , except hemoglobin . RESULTS The control ( n = 138 ) and intervention ( n = 146 ) groups were equivalent with respect to all important sociodemographic and nutritional variables . At 9 months of age , anemia was found in 21 % of infants ( n = 58 ) . A total of 229 ( 81 % ) had iron deficiency on the basis of 1 abnormal laboratory indicator and 139 ( 49 % ) on the basis of 2 abnormal laboratory indicators . No difference existed in the occurrence of anemia and iron deficiency between the intervention and control groups . In the intervention group , 22 % and 78 % of 138 , respectively , were anemic or had 1 abnormal laboratory outcome indicative of iron deficiency . In the control group , 19 % and 84 % of 144 were anemic or iron deficient . When stratified by adherence , no differences in hematologic outcomes between groups were noted . However , in multivariate logistic regression , infants whose mothers were anemic during pregnancy were 2.15 times more likely than others to have any laboratory abnormality ( 95 % confidence interval : 1.14 - 4.07 ) . Increasing adherence , regardless of group assignment , was associated with a 0.56 times reduced risk of any abnormality ( 95 % confidence interval : 0.41 - 0.76 ) . CONCLUSION On the basis of intention-to-treat analysis , multivitamins with iron was not effective in preventing iron deficiency or anemia in 9-month-old infants . However , effective prevention and treatment of maternal anemia during pregnancy and giving multivitamins with or without additional iron during infancy may prove to be important approaches to the prevention of iron deficiency among high-risk children . Because of the consequences of iron deficiency and its high prevalence among low-income infants , additional investigation in these areas is warranted 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
Conclusion Applying the CHERG rules , we recommend a 73 % reduction in anemia at term with daily iron ( alone ) supplementation or iron/folate ( combined ) vs. no intervention or placebo ; for inclusion in the LiST model .
Introduction Iron deficiency is the most prevalent nutrient deficiency in the world , particularly during pregnancy .
According to the literature , anemia , particularly severe anemia , is associated with increased risk of maternal mortality .
It also puts mothers at risk of multiple perinatal complications .
Numerous studies in the past have evaluated the impact of supplementation with iron and iron-folate but data regarding the efficacy and quality of evidence of these interventions are lacking .
This article aims to address the impact of iron with and without folate supplementation on maternal anemia and provides outcome specific quality according to the Child Health Epidemiology Reference Group ( CHERG ) guidelines .