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BMJ 2012; 345 doi: (Published 11 July 2012) Cite this as: BMJ 2012;345:e4632

Intermittent iron supplements may be enough for pregnant women


Few pregnant women enjoy taking daily iron supplements because they cause nausea and constipation. Supplements once or twice a week may work equally well, according to a meta-analysis of 18 randomised trials. Women who took intermittent supplements were no more likely to be anaemic at term than those who took the same supplements every day. In addition, they reported significantly fewer side effects (average relative risk 0.56, 95% CI 0.37 to 0.84). Taking supplements less often had no discernible effect on the risk of prematurity or low birth weight. Women in both groups had similar haemoglobin concentrations at term.

Most trials in the review compared daily with weekly or twice weekly supplements—usually iron or iron plus folic acid. All trials were conducted in developing countries, where daily iron supplements are recommended for most pregnant women. The trials were generally small, short term, unblinded, and limited by missing data. None was big enough to explore the effects of intermittent supplements on malaria, other infections in pregnancy, maternal or neonatal deaths, and congenital abnormalities. More work needs to be done, say the authors—future trials need to be bigger, better, and to follow up women and their babies for longer.

In the meantime, intermittent supplements are beginning to look like a feasible alternative to unpopular daily regimens. Women at low risk of anaemia could try this approach, but the authors urge others to wait for a more secure evidence base.

Poor vaccine coverage hampers polio eradication in Afghanistan and Pakistan

Wild-type polio virus is still circulating in southern Afghanistan and in some regions of Pakistan, and a study reports that the incidence of polio has gone up recently in these regions despite the introduction of better vaccines. Not enough children are being vaccinated, say the authors. They blame armed conflict …

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