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Vol. 115, No. 1-2, 2006
Issue release date: January 2006

Side Effects of Oral Iron Prophylaxis in Pregnancy – Myth or Reality?

Milman N. · Byg K.-E. · Bergholt T. · Eriksen L.
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Abstract

Background: It is a common belief among women that iron compounds have unpleasant gastrointestinal side effects. Objective: To assess the gastrointestinal side effects of iron prophylaxis in pregnancy. Methods: A randomized, double-blind study comprising 404 healthy pregnant women allocated to four groups taking ferrous iron supplement (as fumarate) in doses of 20 (n = 99), 40 (n = 100), 60 (n = 102) and 80 mg (n = 103) daily from 18 weeks of gestation to delivery. Iron supplement was predominantly taken at bedtime. Gastrointestinal symptoms (nausea, vomiting, epigastric pain, eructation, pyrosis, meteorism, borborygmi, colic pain, flatulence, constipation, thin feces, diarrhea), black feces, and use of laxatives were recorded by interview at 18, 32 and 39 weeks of gestation. Results: The frequencies of gastrointestinal symptoms were not significantly different in the four iron supplement groups either at inclusion or at 32 and 39 weeks of gestation and thus not related to the iron dose. Conclusion: This study shows that a supplement of 20–80 mg ferrous iron (as fumarate), taken between meals, has no clinically significant gastrointestinal side effects. The implementation of iron prophylaxis to pregnant women should not be compromised by undue concern of non-existing side effects.



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References

  1. Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N: Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand 1999;78:749–757.
  2. Milman N, Agger OA, Nielsen OJ: Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Dan Med Bull 1991;38:471–476.
  3. Milman N, Clausen J, Byg KE: Iron status in 268 Danish women aged 18–30 years. Influence of menstruation, method of contraception, and iron supplementation. Ann Hematol 1998;76:13–19.
  4. Danish National Board of Health: Recommendations about iron supplementation during pregnancy. Ugeskr Laeger 1992;154:3445.
  5. Kerr DNS, Davidson S: The prophylaxis of iron-deficiency anaemia in pregnancy. Lancet 1958;ii:483–488.
  6. Milman N, Bergholt T, Eriksen, L, Byg KE, Graudal N, Pedersen P, Hertz J: Iron prophylaxis during pregnancy – how much iron is needed? A randomized dose-response study of 20–80 mg ferrous iron daily in pregnant women. Acta Obstet Gynecol Scand 2005;84:238–247.
  7. Milman N: Serum ferritin in Danes: Studies of iron status from infancy to old age, during blood donation and pregnancy. Int J Hematol 1996;63:103–135.
  8. Nordic Council of Ministers: Nordic Nutrition Recommendations 2004, ed 4. Copenhagen. Nord Council of Ministers, 2004, pp 364–366.
  9. Taylor DJ, Mallen C, McDougall N, Lind T: Effect of iron supplementation on serum ferritin levels during and after pregnancy. Br J Obstet Gynaecol 1982;89:1011–1017.
  10. Brise H: Influence of meals on iron absorption in oral iron therapy. Acta Med Scand 1962;171(suppl 376):39–45.

    External Resources

  11. Kerr DNS, Davidson S: Gastrointestinal intolerance to oral iron preparations. Lancet 1958;272:489–492.
  12. Sölvell L: Oral iron therapy. Side effects; in Hallberg L, Harwerth HG, Vannotti A (eds): Iron Deficiency. Pathogenesis, Clinical Aspects, Therapy. London, Academic Press, 1970, pp 573–583.


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