Supplementary iron dose in pregnancy anemia prophylaxis

Reddaiah, V. P.; Raj, P.; Ramachandran, K; Nath, L. M.; Sk, Sood; Madan, N; Rusia, Usha

doi:10.1007/bf02749720

Cited by 29 publications

(14 citation statements)

References 4 publications

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“…156 There are several other reports of iron therapy in pregnancy from developing countries that are relatively less stringent in their inclusion and exclusion criteria. [157][158][159][160][161][162][163] However, most of these studies were based in health facilities within developing countries and varied considerably in design. The overall effects of iron therapy in these studies were largely mixed and did not suggest a particular effect.…”

Section: Iron Supplementationmentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Section: Iron Supplementationmentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…Currently, the most common practice in Australia and other industrialized countries is to treat anaemia with iron tablets containing at least 80 mg elemental iron as ferrous sulphate, which may cause gastrointestinal side effects (Hallberg et al, 1966;Reddaiah et al, 1989), impair mineral absorption (Solomons, 1986) and increase the risk of haemoconcentration (Pena-Rosas and Viteri, 2006), a condition that is associated with adverse pregnancy outcomes. Although different forms of iron may result in fewer or no gastrointestinal side effects, the Recommended Upper Limit of iron for pregnant women in Australia is 45 mg per day based on minimizing gastrointestinal side effects (DHA and NHMRC, 2006).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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Background/Objectives: To compare the efficacy and side effects of low-dose vs high-dose iron supplements to correct anaemia in pregnancy. Subjects/Methods: One hundred and eighty women with anaemia (haemoglobin o110 g l À1 ) in mid-pregnancy. The women were randomly allocated to 20; 40 or 80 mg of iron daily for 8 weeks from mid-pregnancy. Results: One hundred and seventy-nine (99%) women completed the trial. At the end of treatment, there was a clear doseresponse of increasing mean haemoglobin concentration with iron dose (111713 g l À1 at 20 mg per day, 114711 g l À1 at 40 mg per day and 119712 g l À1 at 80 mg per day, P ¼ 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 ¼ 0.130) and 1.1 (95% CI: 0.5, 2.6, P ¼ 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 ¼ 0.014) for nausea, 0.3 (95% CI: 0.2, 0.7, P ¼ 0.005) for stomach pain and 0.4 (95% CI: 0.2, 0.9, P ¼ 0.023) for vomiting. Conclusions: 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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“…If 100 mg Fe/day is taken as LOAEL, a safety factor of 2 leads to an USL of 50 mg Fe/day for mucosal irritation by nonheme iron salts. Reddajah et al [28] described gastrointestinal side effects at doses of 50 mg Fe/day in non-placebo-controlled study. Thus, the USL for this effect should be below 50 mg Fe/ day, e.g.…”

Section: Damage After Acute Iron Exposurementioning

confidence: 99%

Safety Aspects of Iron in Food

Schümann¹

2001

Ann Nutr Metab

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During the last decades efforts regarding dietary iron supply focused mostly on the prevention of deficiencies, especially during growth and pregnancy. Correspondingly, homeostatic mechanisms increase intestinal iron absorption in iron deficiency, but its downregulation at high intake levels seems insufficient to prevent accumulation of high iron stores at high intake. There is no regulated iron excretion in overload. Excess of pharmaceutical iron may cause toxicity and therapeutic doses may cause gastrointestinal side effects. Chronic iron excess, e.g. in primary and secondary hemochromatosis, may lead to hepatic fibrosis, diabetes mellitus and cardiac failure. Chronic intake of 50–100 mg Fe/day of highly bioavailable iron with home-brewed beer in sub-Saharan Africans lead to cirrhosis and diabetes. Applying a safety factor of 2 would lead to an upper safe level of 25–50 mg Fe/day for this endpoint of conventional iron toxicity. However, beyond this kind of damage iron is known to catalyze the generation of hydroxyl radicals from superoxide anions and to increase oxidative stress which, in turn, increases free iron concentration. This self-amplifying process may cause damage to lipid membranes and proteins, which relates radical generation and organ damage after ischemia-reperfusion events to available free iron in clinical and experimental settings. Correspondingly, epidemiological studies as well as observations in heterozygotes for hereditary hemochromatosis suggest that the risk of atherosclerosis and acute myocardial infarction is related to body iron stores, though there is conflicting epidemiological evidence as well. The most recent and best controlled studies, however, support the hypothesis that iron stores are related to cardiovascular risk. Iron-amplified oxidative stress may also increase DNA damage, oxidative activation of precancerogens and support tumor cell growth. This is supported by experimental, clinical and epidemiological observations. Due to these mechanisms high iron stores may present a health hazard. Though this has not been finally proven, available evidence strongly recommends not to increase iron intake beyond physiological requirements. To avoid iron deficiency symptoms, on the other hand, care must be taken to meet recommended daily intake.

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Supplementary iron dose in pregnancy anemia prophylaxis

Cited by 29 publications

References 4 publications

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

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

Safety Aspects of Iron in Food

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