Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental irona and 400 µg (0.4 mg) folic acidb is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth
Status of the recommendation: last assessed as up-to-date: November 2016
• This recommendation supersedes the 2012 WHO Guideline: daily iron and folic acid supplementation in pregnant women and should be considered alongside Recommendation A.2.2 on intermittent iron.
• In settings where anaemia in pregnant women is a severe public health problem (i.e. where at least 40% of pregnant women have a blood haemoglobin [Hb] concentration < 110 g/L), a daily dose of 60 mg of elemental iron is preferred over a lower dose.
• In the first and third trimesters, the Hb threshold for diagnosing anaemia is 110 g/L; in the second trimester, the threshold is 105 g/L.
• If a woman is diagnosed with anaemia during pregnancy, her daily elemental iron should be increased to 120 mg until her Hb concentration rises to normal (Hb 110 g/L or higher). Thereafter, she can resume the standard daily antenatal iron dose to prevent recurrence of anaemia.
• Effective communication with pregnant women about diet and healthy eating – including providing information about food sources of vitamins and minerals, and dietary diversity – is an integral part of preventing anaemia and providing quality ANC.
• Effective communication strategies are vital for improving the acceptability of, and adherence to, supplementation schemes.
• Stakeholders may need to consider ways of reminding pregnant women to take their supplements and of assisting them to manage associated side-effects.
• In areas with endemic infections that may cause anaemia through blood loss, increased red cell destruction or decreased red cell production, such as malaria and hookworm, measures to prevent, diagnose and treat these infections should be implemented.
• Oral supplements are available as capsules or tablets (including soluble tablets, and dissolvable and modified-release tablets). Establishment of a quality assurance process is important to guarantee that supplements are manufactured, packaged and stored in a controlled and uncontaminated environment.
• A better understanding of the etiology of anaemia (e.g. malaria endemnicity, haemoglobinopathies) and the prevalence of risk factors is needed at the country level, to inform context-specific adaptations of this recommendation.
• Standardized definitions of side-effects are needed to facilitate monitoring and evaluation.
• Development and improvement of integrated surveillance systems are needed to link the assessment of anaemia and iron status at the country level to national and global surveillance systems.
• To reach the most vulnerable populations and ensure a timely and continuous supply of supplements, stakeholders may wish to consider task shifting the provision of iron supplementation in community settings with poor access to health-care professionals (see Recommendation Health systems interventions to improve the utilization and quality of ANC).
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WHO recommendations on antenatal care for a positive pregnancy experience.
WHO recommendations on antenatal care for a positive pregnancy experience: web annexes
Systematic review supporting this recommendation
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