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      Identification, Prevention and Treatment of Iron Deficiency during the First 1000 Days

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          Abstract

          Iron deficiency is a global problem across the life course, but infants and their mothers are especially vulnerable to both the development and the consequences of iron deficiency. Maternal iron deficiency during pregnancy can predispose offspring to the development of iron deficiency during infancy, with potentially lifelong sequelae. This review explores iron status throughout these “first 1000 days” from pregnancy through two years of age, covering the role of iron and the epidemiology of iron deficiency, as well as its consequences, identification, interventions and remaining research gaps.

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          Robert E Black, Cesar G Victora, Susan P. Walker … (2013)
          The Lancet, 382(9890), 427-451
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            Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial.

            Sunil Sazawal, Robert E Black, Mahdi Ramsan … (2006)
            Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa. However, there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful. We did a randomised, placebo-controlled trial, of children aged 1-35 months and living in Pemba, Zanzibar. We assigned children to daily oral supplementation with: iron (12.5 mg) and folic acid (50 mug; n=7950), iron, folic acid, and zinc (n=8120), or placebo (n=8006); children aged 1-11 months received half the dose. Our primary endpoints were all-cause mortality and admission to hospital. Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59549825. The iron and folic acid-containing groups of the trial were stopped early on Aug 19, 2003, on the recommendation of the data and safety monitoring board. To this date, 24 076 children contributed a follow-up of 25,524 child-years. Those who received iron and folic acid with or without zinc were 12% (95% CI 2-23, p=0.02) more likely to die or need treatment in hospital for an adverse event and 11% (1-23%, p=0.03) more likely to be admitted to hospital; there were also 15% (-7 to 41, p=0.19) more deaths in these groups. Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death. In the presence of an active programme to detect and treat malaria and other infections, iron-deficient and anaemic children can benefit from supplementation. However, supplementation of those who are not iron deficient might be harmful. As such, current guidelines for universal supplementation with iron and folic acid should be revised.
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              Iron requirements in pregnancy and strategies to meet them.

              T BOTHWELL (2000)
              Iron requirements are greater in pregnancy than in the nonpregnant state. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter; the total requirement of a 55-kg woman is approximately 1000 mg. Translated into daily needs, the requirement is approximately 0.8 mg Fe in the first trimester, between 4 and 5 mg in the second trimester, and >6 mg in the third trimester. Absorptive behavior changes accordingly: a reduction in iron absorption in the first trimester is followed by a progressive rise in absorption throughout the remainder of pregnancy. The amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy and a woman must enter pregnancy with iron stores of >/=300 mg if she is to meet her requirements fully. This is more than most women possess, especially in developing countries. Results of controlled studies indicate that the deficit can be met by supplementation, but inadequacies in health care delivery systems have limited the effectiveness of larger-scale interventions. Attempts to improve compliance include the use of a supplement of ferrous sulfate in a hydrocolloid matrix (gastric delivery system, or GDS) and the use of intermittent supplementation. Another approach is intermittent, preventive supplementation aimed at improving the iron status of all women of childbearing age. Like all supplementation strategies, however, this approach has the drawback of depending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective option for the future.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nutrients
                Journal ID (iso-abbrev): Nutrients
                Journal ID (publisher-id): nutrients
                Title: Nutrients
                Publisher: MDPI
                ISSN (Electronic): 2072-6643
                Publication date (Electronic): 10 October 2014
                Publication date Collection: October 2014
                Volume: 6
                Issue: 10
                Pages: 4093-4114
                Affiliations
                [1 ]Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA
                [2 ]Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, USA; E-Mail: juan.leon@ 123456emory.edu
                [3 ]Department of Pediatrics, Emory School of Medicine, 1760 Haygood Dr., Atlanta, GA 30322, USA; E-Mail: psuchde@ 123456emory.edu
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: rmburke@ 123456emory.edu ; Tel.: +1-404-727-7443; Fax: +1-404-727-4590.
                Article
                Publisher ID: nutrients-06-04093
                DOI: 10.3390/nu6104093
                PMC ID: 4210909
                PubMed ID: 25310252
                SO-VID: e444cadd-24e6-4ae5-9b1c-6e0f272f9455
                Copyright © © 2014 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 11 August 2014
                Date revision received : 09 September 2014
                Date accepted : 16 September 2014
                Categories
                Subject: Review

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: iron deficiency,iron supplementation,pediatrics,infants,first 1000 days
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: iron deficiency, iron supplementation, pediatrics, infants, first 1000 days

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