Iron with or without folic acid supplementation in women in malaria-endemic areas
Full set of recommendations*
WHO recommendations
For all recommendations below: in malaria-endemic areas, the provision of iron and folic acid supplements should be implemented in conjunction with adequate measures to prevent, diagnoses and treat malaria.
Nonpregnant adult women and adolescent girls (1)
In populations where the prevalence of anaemia among nonpregnant women of reproductive age is 20% or higher, intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women, to improve their haemoglobin concentrations and iron status and reduce the risk of anaemia.
Pregnant women (2)
Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental irona and 400 µg (0.4 mg) folic acidb is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.
Intermittent oral iron and folic acid supplementation with 120 mg of elemental ironc and 2800 µg (2.8 mg) folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with an anaemia prevalence among pregnant women of less than 20%.
a The equivalent of 60 mg of elemental iron is 300 mg ferrous sulfate heptahydrate, 180 mg ferrous fumarate or 500 mg of ferrous gluconate.
b Folic acid should be commenced as early as possible (ideally before conception) to prevent neural tube defects.
c The equivalent of 120 mg of elemental iron is 600 mg ferrous sulfate heptahydrate, 360 mg ferrous fumarate or 1000 mg ferrous gluconate.
Postpartum (3)
Oral iron supplementation, either alone or in combination with folic acid, may be provided to postpartum women for 6–12 weeks following delivery for reducing the risk of anaemia in settings where gestational anaemia is of public health concern.d
d WHO considers a 20% or higher population prevalence of gestational anaemia to be a moderate public health problem.
* This is an extract from the relevant guidelines (1-3). Additional guidance information can be found in these documents.
References
1. WHO. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva, World Health Organization; 2011
(http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_
iron_folicacid_suppl_women/en/).
2. WHO. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, World Health Organization; 2016
(http://www.who.int/nutrition/publications/guidelines/antenatalcare-pregnancy-
positive-experience/en/).
3. WHO. Guideline: Daily iron supplementation in postpartum women. Geneva, World Health Organization; 2016
(http://www.who.int/nutrition/publications/micronutrients/guidelines/daily_
iron_supp_postpartum_women/en/).