Intermittent iron and folic acid supplementation in non-anaemic pregnant women
Guidance summary*
WHO recommendations
Intermittent oral iron and folic acid supplementation with 120 mg of elemental irona 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 120 mg of elemental iron is 600 mg ferrous sulfate heptahydrate, 360 mg ferrous fumarate or 1000 mg ferrous gluconate.
Remarks
- This recommendation supersedes the previous WHO recommendation in the 2012 Guideline: intermittent iron and folic acid supplementation in non-anaemic pregnant women (1) and should be considered alongside Recommendation A.1.1 on daily iron supplementation found within the guideline, WHO recommendations on antenatal care for a positive pregnancy experience.
- In general, anaemia prevalence of less than 20% is classified as a mild public health problem (2).
- Before commencing intermittent iron supplementation, accurate measurement of maternal blood Hb concentrations is needed to confirm the absence of anaemia. Therefore, this recommendation may require a strong health system to facilitate accurate Hb measurement and to monitor anaemia status throughout pregnancy.
- If a woman is diagnosed with anaemia (Hb < 110 g/L) during ANC, she should be given 120 mg of elemental iron and 400 µg (0.4 mg) of folic acid daily until her Hb concentration rises to normal (Hb 110 g/L or higher) (3, 4). Thereafter, she can continue with the standard daily antenatal iron and folic acid dose (or the intermittent regimen if daily iron is not acceptable due to side-effects) to prevent recurrence of anaemia.
- Stakeholders may need to consider ways of reminding pregnant women to take their supplements on an intermittent basis and of assisting them to manage associated side-effects.
* This is an extract from the relevant guideline (5). Additional guidance information can be found in this document.
References
1. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: World Health Organization; 2012 (http://www.who.int/nutrition/publications/micronutrients/guidelines/
guideline_intermittent_ifa_non_anaemic_pregnancy/en/).
2. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/ 10665/177094/1/9789241564960_eng.pdf).
3. WHO; de Benoist B, McLean E, Egli I, Cogswell M, editors. Worldwide prevalence of anaemia 1993–2005. WHO global database on anaemia. Geneva: World Health Organization (WHO); 2008 (http://apps.who.int/iris/
bitstream/10665/43894/1/9789241596657_eng.pdf).
4. Iron and folate supplementation: integrated management of pregnancy and childbirth (IMPAC). Standards for maternal and neonatal Geneva: Department of Making Pregnancy Safer, World Health Organization; 2006 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_
health/iron_folate_supplementation.pdf).
5. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/
anc-positive-pregnancy-experience/en/).