IRON SUPPLEMENTATION IN PREGNANCY - IS LESS ENOUGH - A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF LOW-DOSE IRON SUPPLEMENTATION WITH AND WITHOUT HEME IRON

Background. The purpose of the present study was to evaluate the effic acy of low dose iron supplementation with and without a heme component , prescribed for women in the second half of pregnancy Method. A rando mized, double-blind, placebo controlled trial. Thirty-one women receiv ed a daily dose of 27 mg elemental iron in a product containing both h eme iron and non-heme iron (Hemofer(R)), 30 women received the same do se as pure non-heme iron with vitamin C (Collets jern med vitamin C(R) ), and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron sta tus markers (s-ferritin, s-iron, Total Iron Binding Capacity and eryth rocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpar tum. The results were analyzed according to the 'intention to treat' p rinciple. Results. The hematological effects were equal in the two tre atment groups. 25% of the supplemented women fell below 110 g/l in Hb vs 52% in the placebo group (p<0.05): none fell below 100 g/l in the s upplemented groups, 14% in the placebo group. Iron status nas signific antly better for all measured parameters in the heme iron group compar ed to placebo at the end of pregnancy. Differences between the other g roups were only shown for some parameters, probably due to the small s ample size. In the heme iron group there were fewer women with empty i ron stores postpartum than at the start of pregnancy (from 14% to 8%), in the non-heme iron group there was a significant increase (from 3% to 27%), and in the placebo group the percentage of women with empty i ron stores was more than doubled (from 21% to 52%). Conclusions. A dai ly dose of 27 mg elemental iron, containing a heme component, given in the second half of pregnancy, prevents depletion of iron stores after birth in most women. An equivalent dose of pure inorganic iron seems less effective, but the sample size in this study was too small to dem onstrate significant differences between the two treatment groups.