Iron Supplementation in Pregnancy
Alan Gaby, MD
Author: Angulo-Barroso RM, et al
Reference: Iron supplementation in pregnancy for infancy and motor development: a randomized controlled trial. Pediatrics 2016;137:e20153547.
Design: Randomized, placebo-controlled trial.
Participants: Infants (n = 1,472) in rural China (most of whom were being breastfed) who did not have iron deficiency at birth.
Study Medication and Dosage: Iron at a dosage of 1 mg per kg of body weight per day or placebo, beginning at 6 weeks of age and continuing until age 9 months.
Primary Outcome Measure: Gross motor development, as assessed by the Peabody Developmental Motor Scale.
Key Findings: Compared with placebo, iron supplementation significantly improved motor development at 9 months of age.
Practice Implications: Iron plays an important role in the development of the infant brain. Because the concentration of iron is low in breast milk, it has been recommended that exclusively breastfed infants consume iron-rich or iron-fortified foods beginning at 6 months of age. The results of the present study indicate that infants in rural China may benefit from receiving additional iron as early as 6 weeks of age. Iron deficiency is common in certain regions of China, so it is possible that the concentration of iron was particularly low in the breast milk of the mothers in this study. Further research is needed to determine whether the findings from this study apply to infants in the United States and other countries.
Another method to improve the iron status of infants is to delay the clamping of the umbilical cord for at least 2 minutes after the baby is born. At the time of birth, the placenta contains a relatively large amount of blood, much of which is transferred by a natural process to the baby, if the cord is allowed to remain open. The volume of this placental “transfusion” is approximately 40 ml per kg of body weight, which provides about 75 mg of extra iron, an amount sufficient to meet the baby’s iron needs for more than 3 months.
 Chaparro CM, et al. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006;367:1997-2004.