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Community and International Nutrition

Intermittent Iron Supplementation Regimens Are Able to Maintain Safe Maternal Hemoglobin Concentrations during Pregnancy in Venezuela¹

Juan P. Pena-Rosas, Malden C. Nesheim², Maria N. Garcia-Casal^*, D. W. T. Crompton, Diva Sanjur, Fernando E. Viteri^**, Edward A. Frongillo and Paulina Lorenzana

Division of Nutritional Sciences, Cornell University, Ithaca, NY; ^* Instituto Venezolano de Investigaciones Cientificas, Centro de Medicina Experimental, Laboratorio de Fisiopatología, Caracas, Venezuela; WHO Collaborating Centre for Soil-transmitted Helminthiases, University of Glasgow, Glasgow, Scotland; ^** Nutritional Sciences and Toxicology, University of California, Berkeley, CA, and Children’s Hospital Oakland Research Institute (CHORI), Oakland, CA; and Departamento de Procesos Bioquimicos y Biologicos, Universidad Simon Bolivar, Caracas, Venezuela

²To whom correspondence should be addressed. E-mail: mcn2{at}cornell.edu.

Daily iron supplementation programs for pregnant women recommend amounts of iron that are considered by some to be excessive, and either lower-dose or less frequent iron supplementation regimens have been proposed. A randomized, placebo-controlled study was performed to assess and compare the relative effectiveness of a weekly (WS) or twice weekly (TW) iron supplementation schedule in maintaining or achieving hemoglobin (Hb) levels at term considered to carry minimal maternal and fetal risk (90–130 g/L). Pregnant women (n = 116) at wk 10–30 of gestation (63 WS and 53 TW) were enrolled in the study (52 in WS and 44 TW completed the study). Women were randomly allocated to receive a 120-mg oral dose of iron as ferrous sulfate and 0.5 mg of folic acid weekly (n = 52) or 60 mg iron and 0.25 mg folic acid and a placebo twice weekly (n = 44). Hb, hematocrit, serum ferritin, and transferrin saturation were estimated at baseline and at 36–39 wk of gestation. Baseline dietary data and the presence and intensity of intestinal helminthic infections were assessed. The duration of supplementation was 14 ± 4 wk and the median level of adherence was 60.5%. Hb concentrations improved in women following the TW regimen and in women following WS who had low baseline Hb levels. About 89% of WS women and 95% of TW women maintained Hb levels at term (between 90 g/L and130 g/L), a range associated with optimal pregnancy outcomes. One woman in the TW group exhibited higher Hb levels that potentially carried perinatal risk (>130 g/L). Intermittent iron and folic acid supplementation may be a valid strategy when used as a preventive intervention in prenatal care settings.

KEY WORDS: • anemia • iron supplementation • pregnancy • Venezuela • randomized, controlled trial

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