TABLE 7.

Antenatal Iron Supplementation

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Preziosi et al156Niger; periurban setting; DBRCTWomen (n = 197) were given 100 mg/d elemental iron (n = 99) or placebo (n = 98).Supplementation had a significant effect in decreasing the prevalence of anemia (a 6% decrease in anemia prevalence was observed at delivery compared to 6 mo of gestation).Of 8 fetal or neonatal deaths, 7 were in the placebo group, and 1 was in the iron group; Apgar scores were significantly better in the supplemented group than the controls; the supplement also was associated with increased birth length of infants but not birth weight (P < .05).
Menendez et al154The Gambia; rural setting; DBRCTMultigravida women (n = 550) were given 60 mg/d elemental iron (n = 273) or placebo (n = 277); all women received 5 mg of folic acid weekly.Supplementation increased Hb level by 0.5 g/dL (P < .01) and improved plasma iron level by 2.7 μmol/L (P = .001) in the pregnant women.Supplementation was not found to have any significant influence on birth weight and prevalence of LBW except in women who had taken the supplement for >80 d; this subgroup of women delivered significantly heavier babies (mean difference: 9.2 g; P = .04) compared to the controls.
Atukorala et al167Sri Lanka; rural setting; prospective cohort study (PCS)Pregnant women (n = 195) were given a fortified food supplement (thriposha), iron supplements (60 mg/d), and 0.25 mg of folate.Iron supplementation improved maternal Hb parameters irrespective of how many tablets were taken (P < .01); supplementation for >17 wk was more effective than <17 wk.No effect of the supplementation on birth weight was noted.
Agarwal et al141India; rural setting; RCTPregnant women between 16 and 24 wk of gestation (n = 418) were selected from 6 subcenters of a rural block of Varanasi district; women from 3 subcenters who chose to participate in the study group (n = 137) received 60 mg of elemental iron combined with 500 μg of folic acid daily for 100 d; women from another 3 subcenters who were unsupplemented served as controls (n = 123).Compared to baseline, iron-folate supplementation increased Hb level (mean difference: 1.8 g/dL; P < .001) as well as serum ferritin level (mean difference: 20.57 g/dL; P < .001) in the pregnant women.Supplemented women delivered significantly heavier babies compared to controls (2.88 ± 0.41 vs 2.59 ± 0.34 kg; P < .001); there was a 46% decrease in LBW rates in the supplemented group compared to controls; the percentage of LBW babies was 20.4% in the study group compared to 37.9% in the control group (P < .05); the mean birth weight of infants born to women given supplements starting between 16 and 19 wk of gestation was greater than the mean birth weight of infants born to women supplemented after the 20th week of gestation (2.95 ± 0.31 vs 2.86 ± 0.43 kg).
Suharno et al168West Java, Indonesia; rural setting; double-blind, randomized, placebo-controlled trial (DBRPCT)Women (n = 251) with Hb levels between 80 and 109 g/L were randomized to 1 of 4 groups receiving vitamin A and placebo iron (n = 63), iron and placebo vitamin A (n = 63), iron and vitamin A (n = 63), or both placebos (n = 62) for 8 wk.Maximum Hb was achieved in women receiving both vitamin A and iron (12.78 g/L; CI: 10.86–14.70); one third of the response was attributable to vitamin A, and two thirds of the response was attributable to iron; the proportion of women who became nonanemic was 35% in the vitamin A-supplemented group, 68% in the iron-supplemented group, 97% in the group receiving vitamin A plus iron, and 16% in the placebo group.