Iron supplements don’t increase malaria risk

Pregnant woman

Photo by Nina Matthews

Taking iron supplements during pregnancy does not increase a woman’s risk of contracting malaria,  according to research published in JAMA.

Investigators studied nearly 500 pregnant women in a malaria-endemic region, comparing those who received daily iron supplements to those who received placebo.

Roughly half of the women in each group developed malaria, and iron supplementation was associated with benefits for mothers and children.

Martin N. Mwangi, PhD, of Wageningen University in The Netherlands, and his colleagues conducted this research.

The team said current estimates suggest that anemia affects 57% of pregnant women in Africa. And although iron deficiency is the most common cause, iron supplementation during pregnancy has uncertain health benefits.

There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria.

To investigate this association, Dr Mwangi and his colleagues studied 470 pregnant women living in a malaria-endemic area in Kenya. The subjects were randomized to daily supplementation with 60 mg of iron (n=237) or placebo (n=233) until 1 month postpartum.

All women received 5.7 mg iron per day through flour fortification during the intervention, as well as the usual intermittent preventive treatment against malaria.

Among the 470 participating women, 40 women (22 in the iron group and 18 in the placebo group) were lost to follow-up or excluded at birth. Twelve mothers were lost to follow-up postpartum (5 iron, 7 placebo). At study entry, 190 of 318 women (60%) were iron-deficient.

After childbirth, there was no significant difference in Plasmodium infection between the treatment groups. Infection occurred in 50.9% of women in the iron group and 52.1% in the placebo group (P=0.83).

There was a significant increase in hemoglobin concentration and a significant decrease in anemia among mothers who received iron (P<0.001 for both). Mothers in the iron group also had a significantly lower mean zinc protoporphyrin (ZPP)-heme ratio in whole blood (P<0.001) and erythrocytes (P<0.001).

Children born to mothers in the iron group had a significantly higher mean birth weight (P=0.002), lower risk of low birth weight (<2500 g, P=0.02), older gestational age at delivery (P=0.009), and lower risk of premature birth (P=0.02).

However, there was no significant difference between the treatment groups with regard to birth-weight-for-gestational-age z score (P=0.20), neonatal length (P=0.07), head circumference (P=0.28), hemoglobin concentration in cord blood (P=0.14), cord blood ZPP-heme ratio (P=0.82), or cord erythrocyte ZPP-heme ratio (P=0.88).

Based on these results, the investigators said the benefits of universal iron supplementation during pregnancy (in countries where it is impractical to screen for iron status) outweigh the possible risks.

Pregnant woman

Photo by Nina Matthews

Taking iron supplements during pregnancy does not increase a woman’s risk of contracting malaria,  according to research published in JAMA.

Investigators studied nearly 500 pregnant women in a malaria-endemic region, comparing those who received daily iron supplements to those who received placebo.

Roughly half of the women in each group developed malaria, and iron supplementation was associated with benefits for mothers and children.

Martin N. Mwangi, PhD, of Wageningen University in The Netherlands, and his colleagues conducted this research.

The team said current estimates suggest that anemia affects 57% of pregnant women in Africa. And although iron deficiency is the most common cause, iron supplementation during pregnancy has uncertain health benefits.

There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria.

To investigate this association, Dr Mwangi and his colleagues studied 470 pregnant women living in a malaria-endemic area in Kenya. The subjects were randomized to daily supplementation with 60 mg of iron (n=237) or placebo (n=233) until 1 month postpartum.

All women received 5.7 mg iron per day through flour fortification during the intervention, as well as the usual intermittent preventive treatment against malaria.

Among the 470 participating women, 40 women (22 in the iron group and 18 in the placebo group) were lost to follow-up or excluded at birth. Twelve mothers were lost to follow-up postpartum (5 iron, 7 placebo). At study entry, 190 of 318 women (60%) were iron-deficient.

After childbirth, there was no significant difference in Plasmodium infection between the treatment groups. Infection occurred in 50.9% of women in the iron group and 52.1% in the placebo group (P=0.83).

There was a significant increase in hemoglobin concentration and a significant decrease in anemia among mothers who received iron (P<0.001 for both). Mothers in the iron group also had a significantly lower mean zinc protoporphyrin (ZPP)-heme ratio in whole blood (P<0.001) and erythrocytes (P<0.001).

Children born to mothers in the iron group had a significantly higher mean birth weight (P=0.002), lower risk of low birth weight (<2500 g, P=0.02), older gestational age at delivery (P=0.009), and lower risk of premature birth (P=0.02).

However, there was no significant difference between the treatment groups with regard to birth-weight-for-gestational-age z score (P=0.20), neonatal length (P=0.07), head circumference (P=0.28), hemoglobin concentration in cord blood (P=0.14), cord blood ZPP-heme ratio (P=0.82), or cord erythrocyte ZPP-heme ratio (P=0.88).

Based on these results, the investigators said the benefits of universal iron supplementation during pregnancy (in countries where it is impractical to screen for iron status) outweigh the possible risks.

Pregnant woman

Photo by Nina Matthews

Taking iron supplements during pregnancy does not increase a woman’s risk of contracting malaria,  according to research published in JAMA.

Investigators studied nearly 500 pregnant women in a malaria-endemic region, comparing those who received daily iron supplements to those who received placebo.

Roughly half of the women in each group developed malaria, and iron supplementation was associated with benefits for mothers and children.

Martin N. Mwangi, PhD, of Wageningen University in The Netherlands, and his colleagues conducted this research.

The team said current estimates suggest that anemia affects 57% of pregnant women in Africa. And although iron deficiency is the most common cause, iron supplementation during pregnancy has uncertain health benefits.

There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria.

To investigate this association, Dr Mwangi and his colleagues studied 470 pregnant women living in a malaria-endemic area in Kenya. The subjects were randomized to daily supplementation with 60 mg of iron (n=237) or placebo (n=233) until 1 month postpartum.

All women received 5.7 mg iron per day through flour fortification during the intervention, as well as the usual intermittent preventive treatment against malaria.

Among the 470 participating women, 40 women (22 in the iron group and 18 in the placebo group) were lost to follow-up or excluded at birth. Twelve mothers were lost to follow-up postpartum (5 iron, 7 placebo). At study entry, 190 of 318 women (60%) were iron-deficient.

After childbirth, there was no significant difference in Plasmodium infection between the treatment groups. Infection occurred in 50.9% of women in the iron group and 52.1% in the placebo group (P=0.83).

There was a significant increase in hemoglobin concentration and a significant decrease in anemia among mothers who received iron (P<0.001 for both). Mothers in the iron group also had a significantly lower mean zinc protoporphyrin (ZPP)-heme ratio in whole blood (P<0.001) and erythrocytes (P<0.001).

Children born to mothers in the iron group had a significantly higher mean birth weight (P=0.002), lower risk of low birth weight (<2500 g, P=0.02), older gestational age at delivery (P=0.009), and lower risk of premature birth (P=0.02).

However, there was no significant difference between the treatment groups with regard to birth-weight-for-gestational-age z score (P=0.20), neonatal length (P=0.07), head circumference (P=0.28), hemoglobin concentration in cord blood (P=0.14), cord blood ZPP-heme ratio (P=0.82), or cord erythrocyte ZPP-heme ratio (P=0.88).

Based on these results, the investigators said the benefits of universal iron supplementation during pregnancy (in countries where it is impractical to screen for iron status) outweigh the possible risks.