What is the difference between iron and folic acid

FDA Resources. Arms and Interventions. Mothers randomized to receive 2 capsules per day: one with placebo and one with 0. Mothers randomized to receive 2 capsules per day: one with iron mg ferrous sulfate [60 mg elemental iron] and the other with 0. Outcome Measures. Primary Outcome Measures : Maternal iron status at follow-up prenatal visit [ Time Frame: weeks ] Maternal iron status at follow-up prenatal visit [ Time Frame: weeks ]. Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.

Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials. More Information.

Publications automatically indexed to this study by ClinicalTrials. J Nutr. Epub Jun National Library of Medicine U. Figure 1. Table 1 Sociodemographic and obstetric history of the study participants.

Mean change in hemoglobin level The mean SD net gain in hemoglobin level for control and intervention arm during the intervening period between recruitment and end of the study was 0. Table 2 Mean change in hemoglobin and serum ferritin level in two arms of the study. Mean change in serum ferritin level The mean serum ferritin level at the end of the study was lower than the baseline level despite oral iron supplementation prescribed as per the national guidelines.

Discussion Study background Many factors including formulation and mode of delivery affect the bioavailability of iron. Comparison of capsule and tablet as iron supplementation To the best of our knowledge, there is no head-to-head RCT comparing compliance and hematological parameters with iron supplementation as capsule and tablet formulation during pregnancy. Strengths and limitations To the best of our knowledge, this is the first study to do head-to-head RCT comparing compliance and hematological parameters with iron supplementation as capsule and tablet formulation during pregnancy with a sample size of more than Conclusion and Future Directions Thus, we conclude that the compliance to oral iron supplementation among pregnant Indian women, irrespective of formulation, was poor.

Thus, it is important to do qualitative study to develop hypothesis regarding poor compliance followed by quantitative study so as to improve the compliance Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

References 1. Anemia Prevention and Control: What Works. World Health Organization. Geneva: World Health Organization; Nutrition Programme.

Anemia and iron-deficiency anemia: Compilation of data on pregnancy outcome. Am J Clin Nutr. Gillespie S. Ottawa, Canada: Micronutrient Initiative; Major Issues in the Control of Iron Deficiency.

Mumbai: IIPS; Hyderabad: National Institute of Nutrition. Perceptions of antenatal iron-folic acid supplements in urban and rural Pakistan: A qualitative study. BMC Pregnancy Childbirth. Coverage Evaluation Survey. India National Fact Sheet. Available from: www.

Low adherence with an iron-supplementation program: A study among pregnant women in Jakarta, Indonesia. Guidelines for iron supplementation in pregnancy: Adherence among parous Scandinavian women. Eur J Clin Pharmacol. Br J Clin Pharmacol. Sharma R. Kuppuswamy's socioeconomic status scale--revision for and formula for real-time updating. Indian J Pediatr. BMC Clin Pathol. A comparison of the bioavailability of ferrous fumarate and ferrous sulfate in non-anemic Mexican women and children consuming a sweetened maize and milk drink.

Eur J Clin Nutr. Iron supplementation in pregnancy-does the preparation matter? Arch Gynecol Obstet. Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: A cross-sectional study. BMC Public Health. Effect of dose and formulation on iron tolerance in pregnancy.

Natl Med J India. Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women. Med Gen Med. Folic acid folate is a type of vitamin B. Iron and vitamin B help your body produce and maintain healthy red blood cells.

Ferrous fumarate and folic acid is a combination medicine used to treat or prevent certain types of anemia low red blood cells caused by an iron or folate deficiency.

Ferrous fumarate and folic acid may also be used for purposes not listed in this medication guide. You should not use this medicine if you are allergic to ferrous fumarate or folic acid, or if you have:. Tell your doctor if you are pregnant or breastfeeding. You may need special tests before using this medicine during pregnancy. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Use the medicine exactly as directed. Take your doses at regular intervals to keep a steady amount of the drug in your body at all times. You may need to follow a special diet while using ferrous fumarate and folic acid.

Follow all instructions of your doctor or dietitian. Learn about the foods to eat or avoid to help control your condition. Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. CHERG rules were then applied to evaluate the impact of these interventions on iron deficiency anemia during pregnancy.

There was no difference in rates of anemia at term with intermittent iron-folate vs. Given the paucity of studies of intermittent iron or iron-folate supplementation, especially in developing countries, we recommend further evaluation of this intervention in comparison with daily supplementation regimen.

Iron deficiency is the most prevalent and also the most neglected nutrient deficiency in the world, particularly among pregnant women and children, especially in developing countries [ 2 ]. It is also significantly prevalent in industrialized countries. Estimates say that globally, fifty six million pregnant women It may also lead to other perinatal complications like pre-eclampsia, low birth weight, prematurity and perinatal mortality [ 5 ].

It is the poorest, most vulnerable and least educated who are disproportionately affected by iron deficiency, and it is this group that stands to gain the most by its reduction. Anemia, as defined by low hemoglobin or hematocrit, is commonly used to assess the severity of iron deficiency in populations without high rates of malaria.

The high physiological requirement for iron in pregnancy is difficult to meet with most diets. Therefore, pregnant women should routinely receive iron supplementation, especially in developing countries. Prenatal iron supplementation is not compulsory in many industrialized countries and the recommended dose is usually small 30 mg ferrous iron daily [ 6 ]. However, for developing countries, the recommendation is a daily dose of 60 mg of iron for pregnant, non-anemic women for six months and an increased dose of mg of iron daily if the duration of supplementation is shorter, if iron deficiency prevalence in women of a given country is high, and if pregnant women are anemic.

Earlier studies have provided sufficient evidence to show that iron supplementation with or without folic acid results in a significant reduction in the incidence of anemia during pregnancy [ 2 , 8 ]. There has also been a limited impact of iron supplementation in community settings owing to lack of compliance and poor infrastructure [ 9 ].

However, data regarding quality of evidence for the effectiveness of iron during pregnancy are lacking. Besides, the data on studies in developing countries have not been presented separately. This article is one of the series of papers that aim to determine efficacy of interventions for recommendations into the Lives Saved Tool LiST , especially in developing countries and is, therefore, different from previously published systematic reviews.

In LiST, increases in coverage of an intervention results in a reduction of risk factor or one or more causes of mortality. We systematically reviewed all published literature up to June 21, to identify studies of iron supplementation with or without folic acid during pregnancy on maternal anemia.

Every effort was made to gather unpublished data when reports were available for full abstraction. Previous reviews on the topic were also hand-searched to look for relevant studies [ 2 , 8 , 11 ]. We used the Medical Subject Heading Terms MeSH and free text terms for the search strategy using a combination of terms for iron, folic acid and pregnancy, as follows:. Pregnant mothers could be of any age or parity. Studies were included if iron or iron-folate was given alone to the intervention group.

All included studies contained a placebo or a suitable control group that did not contain iron or iron-folate. There were no limits on gestational age at the time of enrolment in the study and the duration of supplementation.

Similarly, studies where iron or iron-folate was given in any parenteral formulation were excluded. The therapeutic role of iron for anemia during pregnancy had been reviewed elsewhere [ 14 ].

We conducted sub-group analyses with respect to study country setting i. However, we did not specifically evaluate minor adverse effects of the supplements such as nausea, vomiting, headache or constipation among the pregnant mothers. Studies were included if data from one of the following outcomes was provided: anemia at term, iron deficiency anemia at term, severe anemia at term and severe anemia at any time during the second and third trimester.

All outcome measures to be included were determined a priori. All studies that met final inclusion and exclusion criteria were double-data abstracted into a standardized form for each outcome of interest. We abstracted key variables with regard to the study identifiers and context, study design and limitations, intervention specifics, and outcome effects. The grade was decreased by 0. Any study with a final grade of very low was excluded on the basis of inadequate study quality. All analyses were conducted using RevMan 5 statistical software.

We summarized the evidence based on outcome by including assessment of the study quality and quantitative measures according to standard guidelines [ 10 ] for each outcome. Additional file 1 contains a list of studies from the search that were excluded from the meta-analyses with a brief explanation for why the study was excluded. The search generated hits on PubMed and in Cochrane Library that were screened and after removing duplicates, 81 abstracts were preliminarily selected.

These were reviewed in detail, including full texts and finally 31 [ 16 — 47 ] studies were selected for inclusion in this paper. A detailed account of the number of abstracts and titles scanned is given as a flow chart Figure 1. Table 1 gives the summary of the quality of evidence and the impact estimates of different interventions. There was, however, no difference between intermittent iron-folic acid supplementation vs.

This outcome was reported by seven studies [ 23 , 27 , 31 , 33 , 34 , 43 , 45 ]. This outcome was estimated by 13 studies [ 16 , 18 , 20 , 23 , 27 , 30 — 35 , 41 , 45 ]. This result was primarily based on one study [ 33 ] as all the other studies had zero events in both groups. Three studies evaluated the impact of daily supplementation with iron and folate both on severe anemia at term [ 16 , 18 , 31 ], but the number of events in these studies in both groups was nil.

Intermittent supplementation with iron and folate vs.