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Prenatal Iron-Folate Supplementation: Effects on Maternal and Neonatal Outcomes

Posted:  Thursday, October 06, 2016

A study published in The Journal of Nutrition assessed the effects of prenatal iron-folate supplementation on maternal and neonatal iron status.

For the study, women who were ≥18 years of age, with uncomplicated singleton pregnancy at ≤ 20-week gestation, and with haemoglobin level ≥100 g/L were recruited. The participants were randomly allocated to receive iron (300 mg ferrous sulphate [60 mg elemental iron]) or placebo (starch, sucrose, dextrin, and magnesium stearate) and folate (0.40 mg) daily in a ratio of 1:1, from enrolment to child birth. Iron content was measured in maternal venous blood (at enrolment and at or near term) and cord blood. The following outcomes were evaluated: maternal iron deficiency (ID) (serum ferritin [SF] <15 µg/L and body iron <0 mg/kg), maternal iron deficiency anaemia (IDA) (haemoglobin <110 g/L), and neonatal ID (cord blood ferritin <75 µg/L or zinc protoporphyrin/haeme [ZPP/H] >118 µmol/mol).

Majority of the infants (97%) were born at term. During enrolment, about 8% of women were mildly anaemic with a haemoglobin level of 100–109 g/L. At or near term, maternal haemoglobin levels increased on an average of 5.56 g/L and the risk of ID and IDA decreased in iron supplemented group compared to the placebo group. At or near term, the haematologic and biochemical parameters of maternal iron status such as the mean corpuscular volume, body iron, ZPP/H, serum transferrin receptor (sTfR), SF and sTfR:SF ratio significantly improved with iron supplementation. Regardless of iron supplementation and improvement in iron status, ID was widespread in most women. Despite maternal iron supplementation, >45% of neonates had cord SF <75 µg/L or ZPP/H >118 µmol/mol. According to dose-response analyses, intake of more maternal iron capsules was associated with higher cord SF and lower ZPP/H.

The study demonstrated that prenatal iron supplementation improved maternal iron status and haemoglobin levels and reduced anaemia, ID, and IDA. However, despite supplementation, most women and >45% of neonates had ID.

News source - Zhao G, Xu G, Zhou M, et al. Prenatal Iron Supplementation Reduces Maternal Anemia, Iron Deficiency, and Iron Deficiency Anemia in a Randomized Clinical Trial in Rural China, but Iron Deficiency Remains Widespread in Mothers and Neonates. J Nutr. 2015; 145(8):1916-23.