Plain language summary
Currently there is no consensus on the best practice for meeting the differing iron needs of pregnant women during the gestational period. Iron needs during pregnancy are influenced by many factors including initial iron status, genetic alterations and dietary intake, and these individual characteristics should be considered when prescribing an iron supplement. The aim of this protocol is to determine a trial design that assesses the effectiveness of iron supplementation adapted to haemoglobin levels at the start of pregnancy relative to the usually prescribed dose. Women in the first trimester will be divided into two groups based on their initial haemoglobin levels and will be randomised to receive either a low or high dose iron supplement. If this protocol is carried out, outcomes should elucidate the optimal iron supplementation dose required to promote maternal and infant health, based on initial haemoglobin levels. These findings would contribute to developing guidelines for good clinical practice.
Abstract
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/DESIGN DESIGN 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. MEASUREMENTS 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. DISCUSSION 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.
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