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<strong>KCE</strong> reports vol. 6A Prenatale zorg 234 1.b. Iron (and iron + folate) Does routine iron supplementation during pregnancy improve maternal and perinatal outcomes? Study Ref Population Intervention Outcomes Results Comments Study Mahomed, 1999 Date of most recent substantive amendment: 02 September 1999 Cogswell et al., 2003 109 20 RCTs 4496 women 110 US, Cleveland 275 women with heamoglobin 20 out of 513 low-income pregnant women enrolled before 20 wk of gestation Iron during pregnancy vs. placebo or nil Haemoglob PIH, PTL, LBW 30 mg Fe as ferrous sulfate or placebo LBW PTL OR 0.2[0.1- 0.3] No effect No effect No effect 4% compared with 17%; P = 0.003) No effect EL type SR 1a RCT 1b Rytter et al., 1993 111 220 women in Norway Routine iron supplementation Observance 25% CH 2b Christian, 2003 112 4926 women in Nepal In addition to vitamin A (1000 microg retinol equivalents), LBW RR 0.8[0.7- In the DBRCT 1b the intervention groups received either folic acid (FA; 400 0.9] for Folic setting microg), FA + iron (60 mg), FA + iron + zinc (30 mg), or acid-iron where multiple micronutrients (MNs; the foregoing plus 10 microg group. prevalence vitamin D, 10 mg vitamin E, 1.6 mg thiamine, 1.8 mg Multiple of iron riboflavin, 2.2 mg vitamin B-6, 2.6 microg vitamin B-12, 100 micronutrients deficiency mg vitamin C, 64 microg vitamin K, 20 mg niacin, 2 mg Cu, confer no and LBW and 100 mg Mg). The control group received vitamin A only. additional benefit over folic acid-iron in reducing LBW. are high.
<strong>KCE</strong> reports vol. 6A Prenatale zorg 235 Does routine iron + folic acid supplementation during pregnancy improve maternal and perinatal outcomes? Study Ref Population Intervention Outcomes Results Comments Study Mahomed 1997 Date of most recent substantive amendment: 25 August 1997 113 8 RCTs 5449 women At least 350 g daily of folate with iron during pregnancy vs. placebo or nil Haemoglob PIH, PTL, LBW OR 0.2[0.1-0.3] Increased non significantly If iron supplementation is given, should it be given with folate? Study Ref Population Intervention Outcomes Results Comments Study Juarez- Vazquez et al., 2002 34 Mexico, 371 pregnancies with iron deficiency anaemia between 14 and 27 weeks 80 mg iron proteinsuccinylate, with or without 0.370 mg folinic acid daily for 60 days Haemoglobin increase 1.42 (0.14) g/dl for women treated with both compounds vs. 0.80 (0.125) g/dl for those given iron only (P < 0.001). EL type SR 1a Personal comment for Belgium 2004: Consider using a selective approach, assessing haemoglobin, mean corpuscular volume and ferritin at 1st and 3d trimester and treating selectively only depleted patients (see also previous table). Threshold of 12mgr ferritin is often used. Optimal dosage and freqency of iron treatment are unclear 35 . There have been suggestions that PIH may be increased where iron levels are high 114 . 1.c. Iodine Does routine iodine supplementation during pregnancy improve maternal and perinatal outcomes? Study Ref Population Intervention Outcomes Results Comments Study Mahomed and Gulmezoglu, 1997 Date of most recent substantive amendment: 29 July 1997 115 3 RCTs, 1551 women At least 100 g daily of iodine as oil during pregnancy vs. placebo or nil Cretinism RR 0.3[0.1-0.6] All trials in areas of deficiency type RCT DB EL 1b EL type SR 1a Delange and Zimmermann, 36 & Europe Observational Survey of Iodine 72% of households do SU 3
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