In the Journals Plus

Iron supplementation may not be helpful to young women in malaria-endemic regions

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May 11, 2018

In young, nulliparous women in the landlocked West African country of Burkina Faso, weekly supplementation with iron does not appear to increase malaria risk, nor does it improve iron status or decrease anemia, according to recent findings.

In a double-blind, randomized controlled noninferiority trial, researchers recruited 1,959 eligible participants from Burkina Faso, where malaria is hyperendemic. The participants, who were identified from the Nanoro Health and Demographic Surveillance System (DHSS) database, were nulliparous, nonpregnant, aged 15 to 24 years, and resided in one of 30 villages within the DHSS area.

Participants were randomly assigned to receive weekly supplements consisting of either ferrous gluconate (60 mg elemental iron, 489 mg gluconate) and 2.8 mg of folic acid (n = 980) or folic acid monotherapy (n = 979) until their first antenatal visit (ANC1) or 18 months if nonpregnant. According to the researchers, 315 women attended ANC1, and 916 remained nonpregnant.

The median adherence rate to the supplement regimen at ANC1 was 79% (95% CI, 65%-90%) for iron and 80% (95% CI, 59%-91%) for folic acid. The median adherence rate for nonpregnant women was 83% (95% CI, 72%-91%) for iron and 84% (95% CI, 70%-92%) for folic acid.

The researchers found no significant difference in the prevalence of Plasmodium parasitemia — the study’s primary outcome — among pregnant women who took iron and those who did not (53.4% vs. 55.3%). There was also no significant difference observed between the study groups in anemia (adjusted effect = 0.96; 95% CI, 0.83-1.1), rates of iron deficiency (adjusted risk ratio = 0.84; 95% CI, 0.46-1.54) or mean concentrations of iron biomarkers, the researchers said.

Among nonpregnant women, the rate of Plasmodium parasitemia was similar between study groups as well (42.9% vs. 39.2%), and no differences were noted between the study arms regarding anemia (adjusted risk ratio = 0.90; 95% CI, 0.78-1.05), iron deficiency (adjusted risk ratio = 0.99; 95% CI, 0.77-1.28), or mean concentrations of iron biomarkers.

The researchers said these findings may warrant the need to re-evaluate WHO guidelines for universal supplementation in young nulliparous women.

“Studies are warranted to improve malaria prevention and control in adolescent populations and to shape relevant interfacing iron deficiency reduction strategies,” the researchers wrote. “Iron supplementation, as is routinely given to populations such as this, is not helpful and possibly harmful.” – by Jennifer Byrne

Disclosures: The researchers report no relevant financial disclosures.