Effectiveness of twice weekly iron supplementation compared with daily regimen in reducing anemia and iron deficiency during pregnancy: a randomized trial in Iran

Abstract

• BACKGROUND: Over 40 millions pregnant women are suffering from iron deficiency (ID) and it’s consequences in developing countries presently. If the effects of twice weekly iron supplementation on hemoglobin (Hb) and serum ferritin (SF) to be shown comparable to daily iron supplementation in pregnancy, it will reduce the cost, will diminish the side effects, will increase the compliance and will prevent the potential harmful effects of extra iron supplement.
• METHODS: A total of 152 pregnant women were enrolled in the study in two different clinics in Isfahan, Iran. The inclusion criteria were 2nd trimester pregnant women aged between 18-38 years with the initial Hb >= 110 g/L. They were randomized into two treatment groups, either the twice weekly (TW) taking iron group (two 45-mg ferrous sulfate tablets per week) or daily taking iron group (45 mg ferrous sulfate tablet). The age, weight, education and employment status of pregnant women along with their parity distributions and gestational age at onset of treatment in the two groups were comparable. Sixty nine and fifty three pregnant women of daily group and TW group, respectively, could be followed up regularly at 4 weekly intervals until 16 weeks of supplementation. Side effects, compliance and the number of tablets consumed were noted for each group. Blood was sampled at 15-16 and 37-39 weeks of pregnancy and blood indices were evaluated to see the effect of iron supplementation.
• RESULTS: The mean initial Hb concentrations were 133 ± 11 g/L and 130 ± 12 g/L in daily and TW groups, respectively, which were not significant. The mean final Hb concentrations were 127 ± 15 g/L in daily group and 120 ± 13 g/L in TW group (p < 0.05). The decrease of Hb from the start to the end of therapy was significant in both groups and the decrements significantly were less in daily group. The SF increased non-significantly in daily group and decreased nonsignificantly in TW group but, there was no difference in ferritin values of the two groups at near term.
• CONCLUSIONS: Daily regimen was more effective than TW regimen in preventing Hb decrement at near term in our study.
• KEY WORDS: Pregnancy, anemia, iron deficiency, hemoglobin, ferritin, developing countries, iron supplementation.