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Iron supplementation in pregnancy

ADELAIDE, AUSTRALIA. Iron deficiency during pregnancy is quite common as is the more serious condition, iron deficiency anemia. The medical protocol for treating pregnancy-related iron deficiency varies considerably by country with the USA and France recommending routine supplementation with 30-60 mg/day of elemental iron while Australia, Canada, the UK, and New Zealand only recommend supplementation if an iron deficiency is actually diagnosed. Supplementation with high doses of iron can cause nausea and constipation, inhibits the absorption of zinc, and is a common cause of poisoning in early childhood.

Australian researchers now report that routine supplementation with just 20 mg/day of iron in the form of ferrous sulfate is effective in preventing iron deficiency during pregnancy. The randomized, double-blind, placebo-controlled trial involved 386 women who were assigned to receive either an iron supplement or a placebo from week 20 of gestation until delivery. At time of delivery only 3% of the women in the iron group had iron deficiency anemia as compared to 11% in the placebo group. Similarly, only 35% had iron deficiency as such in the iron group as compared to 58% in the placebo group. The benefits of supplementation extended beyond the delivery and termination of supplementation. Six months postpartum only 16% of the women in the iron group had an iron deficiency as compared to 29% in the placebo group. There were no differences in serum zinc concentrations between the two groups and pregnancy outcomes were not different either. All women were screened for iron deficiency anemia at week 28 and those identified as having anemia were placed on high-dose iron supplementation. Eighteen per cent of the women in the 20 mg/day iron supplementation were found to have anemia at week 28 as compared to 30% in the placebo group.

The researchers conclude that supplementing with 20 mg/day of iron from week 20 of gestation until delivery is effective in preventing iron deficiency in pregnant women.
Makrides, Maria, et al. Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled trial. American Journal of Clinical Nutrition, Vol. 78, July 2003, pp. 145-53

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