e-Library of Evidence for Nutrition Actions (eLENA)

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

WHO documents

GRC-approved guidelines


Systematic reviews used to develop the guidelines
Other related systematic reviews
Clinical trials

Last update:

15 June 2017 11:06 CEST

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Essential Nutrition Actions

This intervention is an Essential Nutrition Action targeting the first 1000 days of life.

Global targets

Implementation of this intervention may contribute to the achievement of the following targets:

Global nutrition targets

Target 1: 40% reduction in the number of children under-5 who are stunted

Target 2: 50% reduction of anaemia in women of reproductive age

Target 3: 30% reduction in low birth weight

Target 6: Reduce and maintain childhood wasting to less than 5%