TITLE:
Single vs. Double Dose Iron Supplementation for Prevention of Iron Deficiency Anemia in Twin Pregnancy: A Randomized Controlled Clinical Trial
AUTHORS:
Ahmed Mohammed Abbas, Manal Mahmoud Elhalwagy, Khaled Afifi, Khaled Ibrahim, Mohamed Samir Sweed
KEYWORDS:
Iron Supplementation, Iron Deficiency Anemia, Twin Pregnancy, Hepcidin, Mucosal Block
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.12,
December
31,
2020
ABSTRACT: Introduction: It is estimated that about 18% of pregnant women suffer from iron
deficiency anemia throughout their whole pregnancy. In twin pregnancy, owing to the relatively greater feto-placental requirements and greater
expansion in maternal plasma volume and
red cell mass, iron requirements are magnified 1.8 times
compared to singleton pregnancies. However, for prevention of iron deficiency in twin pregnancy,
only sparse data exist regarding the sufficiency of the standard antenatal iron
supplementation dose used in singleton pregnancies to meet the increased iron
demand. In this study, we investigate the effect of single and double dose iron
supplementation for prevention of iron
deficiency anemia in twin pregnancy. Methods: A randomized controlled
clinical trial was conducted at our center in the period between February 2019
and October 2020, and included 450 eligible healthy
non-anemic women aged 18 - 35
years, with twin pregnancy at 12 - 16 weeks of gestation. After informed consent, eligible women were
randomized to receive either single dose 27 mg, or double dose 54 mg elemental
iron supplementation. Monitoring of hemoglobin concentration was done at fixed
time points during gestation: at enrollment, 24 weeks, 32 weeks and before delivery. The primary outcome of the
study was the incidence of iron deficiency anemia during follow up until delivery. Results: The
incidence of iron deficiency anemia in the two groups did not differ
significantly between the single dose group (19.1%) and the double dose group (24.0%). In women who did not develop
Iron Deficiency Anemia, hemoglobin concentration varied significantly along the
different gestational ages during the follow up period. In contrast, they did not show an overall statistically significant difference in the hemoglobin concentrations between the single or double dose groups. Conclusion: This clinical trial did not demonstrate
an added benefit for doubling prophylactic iron supplementation dose in non-anemic
women with twin pregnancy.