Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose-response trial

Child Nutrition Research Centre, Flinders Medical Centre and Women's & Children's Hospital, Child Health Research Institute, North Adelaide, SA, Australia.
European journal of clinical nutrition (Impact Factor: 2.71). 10/2007; 63(2):183-90. DOI: 10.1038/sj.ejcn.1602926
Source: PubMed


To compare the efficacy and side effects of low-dose vs high-dose iron supplements to correct anaemia in pregnancy.
One hundred and eighty women with anaemia (haemoglobin <110 g l(-1)) in mid-pregnancy. The women were randomly allocated to 20; 40 or 80 mg of iron daily for 8 weeks from mid-pregnancy.
One hundred and seventy-nine (99%) women completed the trial. At the end of treatment, there was a clear dose-response of increasing mean haemoglobin concentration with iron dose (111+/-13 g l(-1) at 20 mg per day, 114+/-11 g l(-1) at 40 mg per day and 119+/-12 g l(-1) at 80 mg per day, P=0.006). However, the incidence of anaemia did not differ statistically between groups. Compared with women in the 80 mg iron group, the odds ratio of anaemia was 1.9 (95% CI: 0.8, 4.3, P=0.130) and 1.1 (95% CI: 0.5, 2.6, P=0.827), respectively, for women in the 20 mg iron group and the 40 mg iron group. The incidence of gastrointestinal side effects was significantly lower for women in the 20 mg iron group compared with women in the 80 mg iron group; the odds ratio was 0.4 (95% CI: 0.2, 0.8, P=0.014) for nausea, 0.3 (95% CI: 0.2, 0.7, P=0.005) for stomach pain and 0.4 (95% CI: 0.2, 0.9, P=0.023) for vomiting.
Low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with high-dose supplements.

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    • "Please cite this article as: Van Der Woude DAA, et al, A randomized controlled trial examining the addition of folic acid to iron supplementation in the treatment of postpartum anemia, Int J Gynecol Obstet (2014), 100–200 mg/day ferrous iron in women with slight-to-moderate postpartum anemia [23]. Non-compliance owing to gastrointestinal adverse effects is consistent with previous findings [22]. Although the study participants were randomized between the two treatment arms, the results of randomization were not blinded, and therefore may have influenced study outcomes. "
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    ABSTRACT: Objective To evaluate the efficacy of adding folic acid to oral iron supplementation in postpartum women with anemia. Methods A randomized controlled trial was conducted in the Netherlands between April 8, 2008, and August 31, 2010. A total of 112 postpartum women with anemia (hemoglobin < 10.5 g/dL) were randomly allocated to receive 600 mg/day ferrous fumarate plus 1 mg/day folic acid (FFFA group) or 600/day ferrous fumarate alone (FF group) for 4 weeks. Primary outcome measures were hemoglobin and health status. Secondary outcome measures were fatigue, compliance, and adverse reactions. Results No between-group differences were observed in hemoglobin and health status after treatment, and no differences were found in fatigue scores. Approximately 75% of all women reported having at least one symptom resulting from ferrous fumarate use. Constipation caused by ferrous fumarate was significantly associated with non-compliance (P = 0.014). Conclusion The addition of folic acid to iron supplementation is not beneficial in women with postpartum anemia, as it has no effect on hematologic or health status parameters. Clinical Trial Registration: CCMO website NL21797.028.08 and Netherlands Trial Register NTR2232.
    International Journal of Gynecology & Obstetrics 08/2014; DOI:10.1016/j.ijgo.2014.02.013 · 1.54 Impact Factor
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    • "With respect to iron status during the first trimester, when gestation begins with low levels of iron, the percentage of women with deficit at the end of pregnancy is much greater [6,16,17]. On the other hand, high levels of hemoglobin at the start of pregnancy in women taking high dose supplements (>60 mg/d) increases the risk of hemoconcentration by the end of gestation [4,10,19]. "
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    ABSTRACT: Background: Currently, there is no consensus regarding iron supplementation dose that is most beneficial for maternal and offspring health during gestation. Recommended iron supplementation dose does not preempt anemia in around 20% of the pregnancies, nor the risk of hemoconcentration in 15%. This deficit, or excess, of iron prejudices the mother-child wellbeing. Therefore the aims of the study are to determine the highest level of effectiveness of iron supplementation adapted to hemoglobin (Hb) levels in early pregnancy, which would be optimum for mother-child health. Methods/design: Design: Randomized Clinical Trial (RCT) triple-blindedSetting: 10 Primary Care Centers from Catalunya (Spain)Study subjects: 878 non-anemic pregnant women at early gestation stage, and their subsequent newborns Methods: The study is structured as a RCT with 2 strata, depending on the Hb levels before week 12 of gestation. Stratum #1: If Hb from 110 to 130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 80 mg/d. Stratum #2: If Hb >130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 20 mg/d. Measurements: In the mother: socio-economic data, clinical history, food item frequency, lifestyle and emotional state, and adherence to iron supplement prescription. Biochemical measurements include: Hb, serum ferritin, C reactive protein, cortisol, and alterations in the HFE gene (C282Y, H63D). In children: ultrasound fetal biometry, anthropometric measurements, and temperament development.Statistical analyses, using the SPSS program for Windows, will include bivariate and multivariate analyses adjusted for variables associated with the relationship under study. Discussion: Should conclusive outcomes be reached, the study would indicate the optimal iron supplementation dose required to promote maternal and infant health. These results would contribute towards developing guidelines for good clinical practice.
    BMC Pregnancy and Childbirth 01/2014; 14(1):33. DOI:10.1186/1471-2393-14-33 · 2.19 Impact Factor
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    • "Since the duodenum can maximally absorb 10–20 mg of iron daily, >90% of ingested iron is not absorbed, where it can produce erosions and enteric siderosis [58, 59]. Successful iron repletion is possible with lower doses such as 15 mg elemental iron/day [60–62]. Enteric-coated iron tablets are better tolerated but are less effective because the iron may not be released in the duodenum, where it is primarily absorbed [10, 11]. "
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    ABSTRACT: A substantial volume of the consultations requested of gastroenterologists are directed towards the evaluation of anemia. Since iron deficiency anemia often arises from bleeding gastrointestinal lesions, many of which are malignant, establishment of a firm diagnosis usually obligates an endoscopic evaluation. Although the laboratory tests used to make the diagnosis have not changed in many decades, their interpretation has, and this is possibly due to the availability of extensive testing in key populations. We provide data supporting the use of the serum ferritin as the sole useful measure of iron stores, setting the lower limit at 100 microg/l for some populations in order to increase the sensitivity of the test. Trends of the commonly obtained red cell indices, mean corpuscular volume, and the red cell distribution width can provide valuable diagnostic information. Once the diagnosis is established, upper and lower gastrointestinal endoscopy is usually indicated. Nevertheless, in many cases a gastrointestinal source is not found after routine evaluation. Additional studies, including repeat upper and lower endoscopy and often investigation of the small intestine may thus be required. Although oral iron is inexpensive and usually effective, there are many gastrointestinal conditions that warrant treatment of iron deficiency with intravenous iron.
    Digestive Diseases and Sciences 03/2010; 55(3):548-59. DOI:10.1007/s10620-009-1108-6 · 2.61 Impact Factor
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