Intermittent oral iron and folic acid supplementation with 120 mg of elemental irona and 2800 µg (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to sideeffects, and in populations with an anaemia prevalence among pregnant women of less than 20%
Status of this recommendation: assessed as up-to-date: November 2016
• This recommendation supersedes the previous WHO recommendation in the 2012 Guideline: intermittent iron and folic acid supplementation in non-anaemic pregnant women and should be considered alongside Recommendation of daily iron and folic acid supplementation in pregnant women
• In general, anaemia prevalence of less than 20% is classified as a mild public health problem.
• Before commencing intermittent iron supplementation, accurate measurement of maternal blood Hb concentrations is needed to confirm the absence of anaemia. Therefore, this recommendation may require a strong health system to facilitate accurate Hb measurement and to monitor anaemia status throughout pregnancy.
• If a woman is diagnosed with anaemia (Hb < 110 g/L) during ANC, she should be given 120 mg of elemental iron and 400 µg (0.4 mg) of folic acid daily until her Hb concentration rises to normal (Hb 110 g/L or higher). Thereafter, she can continue with the standard daily antenatal iron and folic acid dose (or the intermittent regimen if daily iron is not acceptable due to side-effects) to prevent recurrence of anaemia.
• Stakeholders may need to consider ways of reminding pregnant women to take their supplements on an intermittent basis and of assisting them to manage associated side-effects.
Evidence supporting this recommendation
Systematic review supporting this recommendation
All WHO recommendations on antenatal care
All WHO recommendations on nutritional interventions in antenatal care
WHO recommendations on antenatal care for a positive pregnancy experience: web annexes
All WHO recommendations on sexual and reproductive health
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WHO Recommendations on daily iron and folic acid supplementation in pregnant women.