Intermittent iron and folic acid supplementation during pregnancy
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.
The use of daily iron and folic acid supplements throughout pregnancy has been the standard approach to prevent and treat iron deficiency anaemia. Despite its proven efficacy, the use of daily iron supplementation has been limited in programme settings, possibly due to a lack of compliance, concerns about the safety of the intervention among women with an adequate iron intake, and variable availability of the supplements at community level. Experience has shown that intermittent regimens may be more accepted by women, with increased adherence to supplementation programmes.
WHO recommendations
Intermittent oral iron and folic acid supplementation with 120 mg of elemental iron* 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%.**
* The equivalent of 120 mg of elemental iron is 600 mg ferrous sulfate heptahydrate, 360 mg ferrous fumarate or 1000 mg ferrous gluconate.
**This recommendation supercedes the previous recommendation on WHO guideline ‘Intermittent iron and folic acid supplementation in non-anaemic 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
-
WHO recommendations on antenatal care for a positive pregnancy experience
Publication date: 2016
Evidence
Systematic reviews used to develop the guidelines
-
Intermittent oral iron supplementation during pregnancy
Peña-Rosas JP, De-Regil LM, Gomez Malave H, Flores-Urrutia MC, Dowswell T.
Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD009997. - Summary of this review
Other related systematic reviews
-
Effect of routine iron supplementation with or without folic acid on anemia during pregnancy
Yakoob MY, Bhutta ZA.
BMC Public Health. 2011; 11(suppl3):S21.
