title: Safety and benefits of antenatal oral iron supplementation in low-income countries: a review.
abstract: The World Health Organization recommends universal iron supplementation of 30-60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of malaria and other infectious diseases. We reviewed the evidence on the safety and efficacy of antenatal iron supplementation in low-income countries. We found no evidence that daily supplementation at a dose of 60 mg leads to increased maternal Plasmodium infection risk. On the other hand, recent meta-analyses found that antenatal iron supplementation provides benefits for maternal health (severe anaemia at postpartum, blood transfusion). For neonates, there was a reduced prematurity risk, and only a small or no effect on birth weight. A recent trial showed, however, that benefits of antenatal iron supplementation on maternal and neonatal health vary by maternal iron status, with substantial benefits in iron-deficient women. The benefits of universal iron supplementation are likely to vary with the prevalence of iron deficiency. As a consequence, the balance between benefits and risks is probably more favourable in low-income countries than in high-income countries despite the higher exposure to infectious pathogens.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.|Nutrition and Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya.
authors.forename: Martin N
authors.identifier: 0000-0002-8358-4448
authors.initials: MN
authors.lastname: Mwangi
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Prentice
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.|MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.|Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands.
authors.forename: Hans
authors.identifier: 0000-0002-9346-9689
authors.initials: H
authors.lastname: Verhoef
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000517:prevention & control*; D003906:Developing Countries; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006801:Humans; D007501:Iron / Q000009:adverse effects / Q000502:physiology / Q000627:therapeutic use*; D008288:Malaria / Q000209:etiology / Q000635:transmission; D018384:Oxidative Stress / Q000502:physiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D015597:Pregnancy Complications, Parasitic / Q000209:etiology; D011295:Prenatal Care / Q000379:methods*
chemical_list: D007501:Iron
keywords: anaemia; iron supplementation; low-income countries; malaria; pregnancy