Prenatal Iron Supplements: Safety and Efficacy in Tanzania

Iron deficiency anemia and malaria are urgent public health problems in sub-Saharan Africa, including Tanzania. There is a paucity of good quality randomized trials assessing the safety and efficacy of iron supplementation in pregnancy, and its effects on perinatal health outcomes. Prenatal iron supplementation is recommended based on its demonstrated benefit in preventing and treating maternal anemia. There is limited data on the efficacy of iron supplementation on pregnancy outcomes, including birth weight. There are also concerns regarding the use of iron supplementation, particularly among non-anemic women. In particular, there is a lack of research on the safety and efficacy of prenatal iron supplementation in developing regions, characterized by extensive burden of iron deficiency, malaria, and other endemic infectious diseases. Evidence from randomized controlled trials is urgently needed to examine the safety and efficacy of iron supplements among pregnant women in malaria endemic regions, particularly among women who are not anemic.

NOTE: The time frames listed for the maternal malaria and hemoglobin outcomes were updated on 4/22/15. This record initially indicated that maternal malaria anemia and hemoglobin would be measured at several specific time points throughout the study. Instead, maternal malaria was measured throughout pregnancy and hemoglobin was measured only at delivery. Due to an oversight, we did not update this record when this protocol change took effect at the start of the study.

Inclusion criteria

• at or before 27 weeks of gestation
• primigravida or secundigravidae
• not anemic (defined as Hb<8.5 g/dL)
• not iron deficient (defined as serum ferritin <12 μg/L)
• HIV-uninfected
• intend to stay in Dar es Salaam until delivery and for at least six weeks thereafter.

Exclusion criteria

• After 27 weeks gestation
• not primigravida or secundigravidae
• anemic
• iron deficient
• HIV-infected
• High iron stores at baseline (i.e., serum ferritin >200 μg/L)
• do not intend to stay in Dar es Salaam until delivery and for at least six weeks thereafter.