Bah A, Muhammad AK, Wegmüller R, Verhoef H, Goheen MM, Sanyang S, Danso E, Sise EA, Pasricha SR, Armitage AE, Drakesmith H, Cross JH, Moore SE, Cerami C, Prentice AM

October 2019 – Lancet Global Health

WHO recommends daily iron supplementation for pregnant women, but adherence is poor because of side-effects, effectiveness is low, and there are concerns about possible harm. The iron-regulatory hormone hepcidin can signal when an individual is ready-and-safe to receive iron. We tested whether a hepcidin-guided screen-and-treat approach to combat iron-deficiency anaemia could achieve equivalent efficacy to universal administration, but with lower exposure to iron. We did a three-arm, randomised, double-blind, non-inferiority trial in 19 rural communities in the The Gambia among pregnant women aged 18–45 years at between 14 and 22 weeks of gestation. Women were randomly allocated women to either WHO’s recommended regimen, a 60 mg screen-and-treat approach, or a 30 mg screen-and-treat approach. Compared with WHO’s recommended regimen, the two screen-and-treat approaches did not result in significantly different hemoglobin concentrations. The hepcidin-guided screen-and-treat approaches had no advantages over WHO’s recommended regimen in terms of adherence, side-effects, or safety outcomes. Our results suggest that the current WHO policy for iron administration to pregnant women should remain unchanged while more effective approaches continue to be sought.

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