Oral administration of lactoferrin increases hemoglobin and total serum iron in pregnant women. Lactoferrin Efficacy versus Ferrous Sulfate in Curing Iron Disorders in Pregnant and Non-Pregnant Women Safety and efficacy of lactoferrin versus ferrous sulphate in curing iron deficiency and iron deficiency anaemia in hereditary thrombophilia pregnant women: an interventional study Lactoferrin versus ferrous sulphate for the treatment of iron deficiency anemia during pregnancy: a randomized clinical trial Efficacy and tolerability of oral bovine lactoferrin compared to ferrous sulfate in pregnant women with iron deficiency anemia: A prospective controlled randomized study Iron Sucrose Versus Oral Iron Therapy in Pregnancy Anemia Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial A prospective, partially randomized study of pregnancy outcomes and hematologic responses to oral and intramuscular iron treatment in moderately anemic pregnant women. Efficacy and safety of oral lactoferrin supplementation in combination with rHuEPO-beta for the treatment of anemia in advanced cancer patients undergoing chemotherapy: open-label, randomized controlled study. Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy. A comparison between intravenous iron polymaltose complex (Ferrum Hausmann®) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. Evaluation of a gastric delivery system for iron supplementation in pregnancy. Phase III, randomized study of the effects of parenteral iron, oral iron, or no iron supplementation on the erythropoietic response to darbepoetin alfa for patients with chemotherapy-associated anemia. Prevention of iron deficiency anemia in adolescent and adult pregnancies.
Iron deficiency anemia ( IDA ) during pregnancy continues to be of world-wide concern . IDA is a risk factor for preterm delivery and subsequent low birth weight , and possibly for poor neonatal health . Iron supplementation in pregnancy is a widely recommended practice , yet intervention programs have met with many controversies . In our study , 300 women at different trimesters of pregnancy were enrolled in a trial of oral administration of ferrous sulfate ( 520 mg once a day ) or 30 % iron-saturated bovine lactoferrin ( bLf ) ( 100 mg twice a day ) . Pregnant women refusing treatment represented the control group . In this group hemoglobin and total serum iron values measured after 30 d without treatment decreased significantly , especially in women at 18 - 31 weeks of pregnancy . In contrast , after 30 d of oral administration of bLf , hemoglobin and total serum iron values increased and to a greater extent than those observed in women treated orally for 30 d with ferrous sulfate , independently of the trimester of pregnancy . Unlike ferrous sulfate , bLf did not result in any side effects . These findings lead us to hypothesize that lactoferrin could influence iron homeostasis directly or through other proteins involved in iron transport out of the intestinal cells into the blood Iron homeostasis in pregnancy compensates for increased iron requirements and in women of child-bearing age for iron loss in menses . Oral administration of ferrous sulfate , prescribed to cure iron deficiency ( ID ) and ID anemia ( IDA ) , often fails to increase hematological parameters and causes adverse effects . Recently , we demonstrated safety and efficacy of bovine lactoferrin ( bLf ) in pregnant women suffering from ID/IDA . Two clinical trials were conducted on pregnant and non-pregnant women of child-bearing age suffering from ID/IDA . In both trials , women received oral administration of bLf 100 mg/twice/day ( Arm A ) , or ferrous sulfate 520 mg/day ( Arm B ) . Hematological parameters , serum IL-6 and prohepcidin were assayed before and after therapy . Unlike ferrous sulfate , bLf  increased hematological parameters ( P<0.0001 ) . In pregnant women , bLf  decreased serum IL-6 ( P<0.0001 ) , and increased prohepcidin ( P=0.0007 ) . In non-pregnant women bLf did not change the low IL-6 levels while it increased prohepcidin ( P<0.0001 ) . Ferrous sulfate increased IL-6 ( P<0.0001 ) and decreased prohepcidin ( P=0.093 ) . bLf established iron homeostasis by modulating serum IL-6 and prohepcidin synthesis , whereas ferrous sulfate increased IL-6 and failed to increase hematological parameters and prohepcidin .  bLf is a more effective and safer alternative than ferrous sulfate for treating ID and IDA Objective Evaluate the safety and efficacy of bovine lactoferrin ( bLf ) versus the ferrous sulphate st and ard intervention in curing iron deficiency ( ID ) and ID anaemia ( IDA ) in pregnant women affected by hereditary thrombophilia ( HT ) . Design Interventional study . Setting Secondary -level hospital for complicated pregnancies in Rome , Italy . Population 295 HT pregnant women ( ≥18 years ) suffering from ID/IDA . Methods Women were enrolled in Arm A or B in accordance with their personal choice . In Arm A , 156 women received oral administration of 100 mg of bLf twice a day ; in Arm B , 139 women received 520 mg of ferrous sulphate once a day . Therapies lasted until delivery . Main outcome measures Red blood cells , haemoglobin , total serum iron , serum ferritin ( haematological parameters ) were assayed before and every 30 days during therapy until delivery . Serum IL-6 , key factor in inflammatory and iron homeostasis disorders , was detected at enrolment and after therapy at delivery . Possible maternal , foetal , and neonatal adverse effects were assessed . Results Haematological parameters were significantly higher in Arm A than in Arm B pregnant women ( P ≤ 0.0001 ) . Serum IL-6 significantly decreased in bLf-treated women and increased in ferrous sulphate-treated women . BLf did not exert any adverse effect . Adverse effects in 16.5 % of ferrous sulphate-treated women were recorded . Arm A women experienced no miscarriage compared to five miscarriages in Arm B women . Conclusions Differently from ferrous sulphate , bLf is safe and effective in curing ID/IDA associated with a consistent decrease of serum IL-6 . The absence of miscarriage  among bLf-treated women provided an unexpected benefit . Trial registration : Clinical Trials.gov Identifier NCT01221844 Abstract Objective : This study was conducted to evaluate the efficacy and safety of lactoferrin in comparison to ferrous sulphate for the treatment of iron deficiency anemia ( IDA ) during pregnancy . Material s and methods : This prospect i ve , r and omized , parallel-group , single-center study was conducted in the Department of Obstetrics and Gynecology at Menoufia University Hospital , Egypt and included a total of 200 pregnant women in the second trimester with IDA who were enrolled and r and omly assigned either to receive 150 mg of dried ferrous sulphate capsules or lactoferrin 250 mg capsules once daily for eight consecutive weeks . The primary efficacy parameter was the amount of increase in hemoglobin concentration by 4 and 8 weeks , the adverse effects related to iron therapy and the patient compliance to the treatment . Results : Total increase in Hb after 2 months with lactoferrin was higher ( 2.26 ± 0.51 g/dL ) compared to ferrous sulfate ( 1.11 ± 0.22 g/dL ) ( p < 0.001 ) . Gastrointestinal adverse events occurred more frequently with ferrous sulphate than the lactoferrin group ( p < 0.001 ) . The number of women requesting change the drug was higher in the ferrous sulphate group ( p < 0.001 ) . Conclusion : Lactoferrin was more effective than ferrous sulfate over a two-month period in pregnant women with IDA , with fewer gastrointestinal adverse events and better treatment acceptability 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 Background : Iron deficiency anemia ( IDA ) is the most common medical problem in pregnancy .  Parenteral iron is a useful treatment , although iron dextran use decreased due to anaphylaxis . Iron sucrose is a newer agent that has overcome the shortcomings of iron dextran . Objective : The aim of this study was to compare the efficacy and tolerance of intravenous iron sucrose ( IVIS ) therapy with oral iron ( OI ) therapy in pregnant women with IDA and to study the factors influencing treatment . Material s and Methods : This prospect i ve , r and omized clinical trial included pregnant women between 14 and 36 weeks with established IDA who were treated with IVIS or OI ( ferrous fumarate ) .  All patients were monitored for laboratory response and adverse effects . Independent sample -t test , Chi square test and ANOVA were used for statistical analysis . P < 0.05 was considered significant . Results : Although hemoglobin increased in both the groups , increase in the reticulocyte count and percentage increase in hemoglobin was significantly higher in the IVIS group than in the OI group ( 23.62 % vs. 14.11 % ) . Serum ferritin was significantly higher in the IVIS group than in the OI group ( P = 0.000 ) . The IVIS group had no major side-effects . Compliance was good with OI , although 23 % had gastrointestinal side-effects . Patient weight , gestation at diagnosis , initial hemoglobin and ferritin levels did not influence the response to treatment . Conclusion : IVIS is safe and effective in the treatment of IDA during pregnancy . Iron stores increased better with IVIS compared with OI Abstract Objective : To compare oral iron to intravenous iron administration to women in late pregnancy and /or after labor to correct iron deficiency . Methods : 271 anemic women ( 148 pregnant women and 123 women post lower segment caesarean section ) with hemoglobin ( Hb ) levels below 110 g/L were enrolled over a two-year period and r and omized to receive either two tablets FGF ( ferrous sulfate with folic acid ) or 400 mg of intravenous iron sucrose plus folic acid 600 µg . Treatment effectiveness was assessed by measuring Hb and ferritin postpartum on day 1 , day 14 and day 42 . Transfusions of red blood cells and adverse drug reactions were recorded . Results : Data of 214 women were available for analysis . Both forms of iron replacement therapy led to increased hemoglobin and ferritin levels over the testing period . Ferritin was significantly higher in the i.v . iron treatment group compared to the oral iron treatment group ( p = 0.004 ) two weeks after delivery , while Hb values did not differ between the groups . No serious adverse drug reactions were observed . Red blood cell transfusion rate was low ( 1.9 % ) , with equal rates observed in both treatment groups . Conclusion : Intravenous and oral irons were both effective in correcting peripartum anemia , although intravenous iron restored stores faster than oral iron 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 Advanced-stage cancer patients often suffer from anemia that closely resembles the anemia of chronic inflammatory diseases characterized by specific changes in iron homeostasis and absorption . i.v . iron improves the efficacy of recombinant human erythropoietin ( rHuEPO ) in anemic cancer patients undergoing chemotherapy . We report the results of an open-label , r and omized , prospect i ve trial aim ed at testing the efficacy and safety of treatment with oral lactoferrin versus i.v . iron , both combined with rHuEPO , for the treatment of anemia in a population of 148 advanced cancer patients undergoing chemotherapy . All patients received s.c . rHuEPO-beta , 30,000 UI once weekly for 12 weeks , and were r and omly assigned to ferric gluconate ( 125 mg i.v . weekly ) or lactoferrin ( 200 mg/day ) . Both arms showed a significant hemoglobin increase . No difference in the mean hemoglobin increase or the hematopoietic response , time to hematopoietic response , or mean change in serum iron , C-reactive protein , or erythrocyte sedimentation rate were observed between arms . In contrast , ferritin decreased in the lactoferrin arm whereas it increased in the i.v . iron arm . In conclusion , these results show similar efficacy for oral lactoferrin and for i.v . iron , combined with rHuEPO , for the treatment of  anemia  in advanced cancer patients undergoing chemotherapy Abstract Objective : To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) in pregnant women . Design : R and omized , double-blind , intention-to-treat study . Setting : Antenatal care clinic . Sample : 80 healthy ethnic Danish pregnant women . Methods : Women were allocated to ferrous bisglycinate 25 mg elemental iron ( Aminojern ® ) ( n=40 ) or ferrous sulfate 50 mg elemental iron ( n=40 ) from 15 to 19 weeks of gestation to delivery . Hematological status ( hemoglobin , red blood cell indices ) and iron status ( plasma iron , plasma transferrin , plasma transferrin saturation , plasma ferritin ) were measured at 15–19 weeks ( baseline ) , 27–28 weeks and 36–37 weeks of gestation . Main outcome measures : Occurrence of ID ( ferritin < 15 μg/L ) and IDA ( ferritin < 12 μg/L and hemoglobin < 110 g/L ) . Results : At inclusion , there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status . The frequencies of ID and IDA were low and not significantly different in the two iron groups . The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group ( P=0.001 ) . Newborns weight was slightly higher in the bisglycinate vs. the sulfate group ( 3601±517 g vs. 3395±426 g , P=0.09 ) . Conclusions : In the prevention of ID and IDA , ferrous bisglycinate was not inferior to ferrous sulfate . Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95 % of Danish women during pregnancy and postpartum Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects BACKGROUND Iron deficiency anaemia is the most common deficiency disorder in the world , affecting more than one billion people , with pregnant women at particular risk . OBJECTIVES AND DESIGN We conducted a single site , prospect i ve , nonblinded r and omized-controlled trial to compare the efficacy , safety , tolerability and compliance of st and ard oral daily iron versus intravenous iron . SUBJECTS We prospect ively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies , of which 461 ( 18 % ) had moderate IDA . Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited . INTERVENTIONS Patients were r and omized to daily oral ferrous sulphate 250 mg ( elemental iron 80 mg ) with or without a single intravenous iron polymaltose infusion . RESULTS Prior to delivery , the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level ( mean of 19.5 g/L vs. 12 g/L ; P < 0.001 ) ; the increase in mean serum ferritin level ( 222 microg/L vs. 18 ug/L ; P < 0.001 ) ; and the percentage of mothers with ferritin levels below 30 microg/L ( 4.5 % vs. 79 % ; P < 0.001 ) . A single dose of intravenous iron polymaltose was well tolerated without significant side effects . CONCLUSIONS Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA 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 AIM Iron deficiency is a leading cause of anemia in pregnancy . The present study aim ed to compare the efficacy of oral and intravenous iron therapy in improving iron deficiency anemia in pregnancy and restoring iron stores , compare the obstetric outcome in the two groups and evaluate the safety of intravenous iron sucrose . MATERIAL AND METHODS This was a prospect i ve study , where 100 anemic antenatal women with hemoglobin 7 - 9 g/dL , mean corpuscular volume < 85 fL and serum ferritin < 15 ng/mL , were r and omized into two groups . In group A ( n=50 ) , the women received 200 mg tablets of ferrous sulphate , each containing 60 mg elemental iron , three times a day for 4 weeks . In group B ( n=50 ) , iron sucrose was given in divided doses of 200 mg each on alternate days by slow intravenous infusion . Primary outcome measure was treatment efficacy , assessed by measurement of hemoglobin , red blood cell indices and reticulocytes on days 7 , 14 , 21 , and 30 and at delivery , and of ferritin on day 30 and at delivery . Any side-effects of treatment and the neonatal outcome were studied as secondary outcome measures . RESULTS There was a statistically significant difference in increase of hemoglobin levels ( 3.1g/dL in group A vs 5.1 g/dL in group B ; P=0.002 ) and ferritin levels between the two groups on day 30 ( P=0.005 ) . The adverse effects from iron treatment were mild but more prominent in group A. Neonatal outcome was comparable in the two groups . CONCLUSION Intravenous administration of iron sucrose is a safe treatment for correction of anemia in pregnancy , without serious side-effects The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system ( GDS ) . Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present ( hemoglobin concentration 80 - 110 g/L ) . The participants were r and omly assigned to one of three study groups given no iron , two FeSO4 tablets ( 100 mg Fe ) daily , or one GDS capsule ( 50 mg Fe ) daily . Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes , including serum transferrin receptor . There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement . We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily , a GDS offers significant advantages for iron supplementation of pregnant women PURPOSE Functional iron deficiency may impair response to erythropoiesis-stimulating agents ( ESAs ) in iron-replete patients with chemotherapy-associated anemia ( CAA ) . This study evaluated whether coadministration of parenteral iron improves ESA efficacy in patients with CAA . PATIENTS AND METHODS This prospect i ve , multicenter , r and omized trial enrolled 502 patients with hemoglobin ( Hb ) less than 11 g/dL who were undergoing chemotherapy for nonmyeloid malignancies . All patients received darbepoetin alfa once every 3 weeks and were r and omly assigned to receive either ferric gluconate 187.5 mg intravenously ( IV ) every 3 weeks , oral daily ferrous sulfate 325 mg , or oral placebo for 16 weeks . RESULTS There was no difference in the erythropoietic response rate ( ie , proportion of patients achieving Hb ≥ 12 g/dL or Hb increase ≥ 2 g/dL from baseline ) : 69.5 % ( 95 % CI , 61.9 % to 76.5 % ) of IV iron-treated patients achieved an erythropoietic response compared with 66.9 % ( 95 % CI , 59.1 % to 74.0 % ) who received oral iron and 65.0 % ( 95 % CI , 57.2 % to 72.3 % ) who received oral placebo ( P = .75 ) . There were also no differences in the proportion of patients requiring red cell transfusions , changes in quality of life , or the dose of darbepoetin administered . Adverse events ( AEs ) tended to be more common in the IV iron arm : grade 3 or higher AEs occurred in 54 % ( 95 % CI , 46 % to 61 % ) of patients receiving IV iron compared with 44 % ( 95 % CI , 36 % to 52 % ) who received oral iron and 46 % ( 95 % CI , 38 % to 54 % ) who received oral placebo ( P = .16 ) . CONCLUSION In patients with CAA , addition of IV ferric gluconate to darbepoetin failed to provide additional benefit compared with oral iron or oral placebo OBJECTIVE Worldwide attention over iron deficiency anemia ( IDA ) in pregnancy has shifted recently from providing supplements during pregnancy to attempting to ensure that women , especially adolescents , have adequate iron stores prior to conception . We sought to determine whether adolescent and /or adult women still need supplements during pregnancy to avoid IDA , even if iron stores are adequate , and whether the IDA translates into maternal and /or infant morbidity and mortality . DESIGN R and omized , double-blind clinical trial with placebo control . SETTING Multicenter clinic setting in central Wisconsin . PARTICIPANTS Adolescent women 18 years or less in their first pregnancy , and adult women 19 years or older , who were found to be healthy and iron sufficient at their first prenatal visit . METHODS Participants were r and omized to receive iron supplementation ( 60 mg/day elemental iron ) or placebo .  Serum ferritin of 12 ng/mL or less with simultaneous hemoglobin of 11 g/dL or less defined IDA . When IDA occurred at the second trimester , a therapeutic supplement of 180 mg of elemental iron per day was initiated . RESULTS Forty-seven percent of all placebo-supplemented and 16 % of all iron-supplemented patients exhibited IDA ( p<0.001 ) ; 59 % of adolescent placebo-supplemented and 20 % of adolescent iron-supplemented patients exhibited IDA ( p=0.021 ) . Nausea , vomiting , diarrhea , and constipation were not significantly different in the iron supplemented group compared to the placebo group , and no significant differences were seen in maternal or neonatal health , but the number of women studied was limiting for analysis of these adverse events . CONCLUSION IDA is common in healthy , iron-sufficient adolescent pregnant women during the second trimester , and body stores of iron decline in both adolescent and adult pregnancies . The incidence of IDA during adolescent and adult pregnancies is substantially reduced with 60 mg of elemental iron per day . However , there remains no clear evidence that maternal or neonatal health will benefit from correcting these deficits
Significantly less gastrointestinal side effects were reported with lactoferrin treatment .
No significant differences existed with regard to other outcomes .
In conclusion , for pregnant women with IDA , daily oral bovine lactoferrin is just as good as ferrous sulfate in improving hematological parameters with fewer gastrointestinal side effects .
This systematic review and meta- analysis aim ed to evaluate the efficacy of daily oral bovine lactoferrin versus daily oral ferrous iron preparations for treatment of iron deficiency anemia ( IDA ) during pregnancy .