Adapting iron dose supplementation in pregnancy for greater effectiveness on mother and child health: protocol of the ECLIPSES randomized clinical trial.
BACKGROUND
Currently, there is no consensus regarding iron supplementation dose that is most beneficial for maternal and offspring health during gestation. Recommended iron supplementation dose does not preempt anemia in around 20% of the pregnancies, nor the risk of hemoconcentration in 15%. This deficit, or excess, of iron prejudices the mother-child wellbeing. Therefore the aims of the study are to determine the highest level of effectiveness of iron supplementation adapted to hemoglobin (Hb) levels in early pregnancy, which would be optimum for mother-child health.


METHODS



METHODS
Randomized Clinical Trial (RCT) triple-blindedSetting: 10 Primary Care Centers from Catalunya (Spain)Study subjects: 878 non-anemic pregnant women at early gestation stage, and their subsequent newborns


METHODS
The study is structured as a RCT with 2 strata, depending on the Hb levels before week 12 of gestation. Stratum #1: If Hb from 110 to 130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 80 mg/d. Stratum #2: If Hb >130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 20 mg/d.


METHODS
In the mother: socio-economic data, clinical history, food item frequency, lifestyle and emotional state, and adherence to iron supplement prescription. Biochemical measurements include: Hb, serum ferritin, C reactive protein, cortisol, and alterations in the HFE gene (C282Y, H63D). In children: ultrasound fetal biometry, anthropometric measurements, and temperament development.Statistical analyses, using the SPSS program for Windows, will include bivariate and multivariate analyses adjusted for variables associated with the relationship under study.


CONCLUSIONS
Should conclusive outcomes be reached, the study would indicate the optimal iron supplementation dose required to promote maternal and infant health. These results would contribute towards developing guidelines for good clinical practice.
Unitat de Suport a la Recerca Tarragona-Reus, Institut d'Investigació en Atenció Primària Jordi Gol, Tarragona, Spain. victoria.arija@urv.cat.
Victoria
V
Arija
Francesc
F
Fargas
Gemma
G
March
Susana
S
Abajo
Josep
J
Basora
Josefa
J
Canals
Blanca
B
Ribot
Estefania
E
Aparicio
Nuria
N
Serrat
Carmen
C
Hernández-Martínez
Núria
N
Aranda
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000517:prevention & control*; D000886:Anthropometry; D001724:Birth Weight; D002097:C-Reactive Protein / Q000378:metabolism; D004032:Diet; D019587:Dietary Supplements / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005293:Ferritins / Q000097:blood; D047109:Fetal Development; D000071020:Hemochromatosis Protein; D006454:Hemoglobins / Q000378:metabolism*; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D008019:Life Style; D055118:Medication Adherence; D008565:Membrane Proteins / Q000235:genetics; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D012107:Research Design; D013694:Temperament; D016216:Ultrasonography, Prenatal; D055815:Young Adult
C103673:HFE protein, human; D000071020:Hemochromatosis Protein; D006454:Hemoglobins; D015395:Histocompatibility Antigens Class I; D008565:Membrane Proteins; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron; D006854:Hydrocortisone