Daily iron and folic acid supplementation during pregnancy in malaria-endemic areas
It is estimated that more than 40% of pregnant women worldwide are anaemic. At least half of this anaemia burden is assumed to be due to iron deficiency.
Pregnant women require additional iron and folic acid to meet their own nutritional needs as well as those of the developing fetus. Deficiencies in iron and folic acid during pregnancy can potentially negatively impact the health of the mother, her pregnancy, as well as fetal development.
Pregnancy also reduces a woman’s immunity, making pregnant women more susceptible to malaria infection and increasing the risk of illness, anaemia, severe disease and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight – a leading cause of child mortality.
Evidence has shown that the use of iron and folic acid supplements is associated with a reduced risk of iron deficiency and anaemia in pregnant women, including in settings where malaria is endemic.
WHO recommendations
Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron* and 400 µg (0.4 mg) folic acid** is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.***
In malaria-endemic areas, the provision of iron and folic acid supplements should be implemented in conjunction with adequate measures to prevent, diagnose and treat malaria.
*The equivalent of 60 mg of elemental iron is 300 mg ferrous sulfate heptahydrate, 180 mg ferrous fumarate or 500 mg of ferrous gluconate.
** Folic acid should be commenced as early as possible (ideally before conception) to prevent neural tube defects.
*** This recommendation supercedes the previous recommendation found within the WHO guideline ‘Daily iron and folic acid supplementation in pregnant women’ (2012).
Additional information for this recommendation can be found in the guidance summary and in the guideline, under 'WHO documents' below.
This is one of several WHO recommendations on iron and folic acid supplementation. The full set of recommendations can be found in 'Full set of recommendations'.
WHO documents
GRC-approved guidelines
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Daily iron and folic acid supplementation in pregnant women
Publication date: 2016
Evidence
Systematic reviews used to develop the guidelines
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Daily oral iron supplementation during pregnancy
Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T.
Cochrane Database of Systematic Reviews. 2015; Issue 7. Art. No.: CD004736. - Summary of this review
Related systematic reviews
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Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW et al.
BMJ 2013;346:f3443. -
Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes
Imdad A, Bhutta ZA.
Paediatric and Perinatal Epidemiology. 2012, 26:168–177.
