الفهرس 
PHYSIOLOGICAL CHANGES IN HEMATOLOGICAL PARAMETERS DURING PREGNANCYOnly 14 pages are availabe for public view
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Abstract
Lron deficiency anemia is the most common micronutrient
deficiency in the world today. It impacts the lives of
millions of women and children contributing to poor cognitive
development, increased maternal mortality and decreased work
capacity.
Yet with appropriate public health action, this form of
micronutrient malnutrition can be brought under control,
various interventions exist that are designed to prevent and
correct iron deficiency anemia.
The major concern about the adverse effects of anemia on
pregnant women is the belief that this population is at greater
risk of perinatal mortality and morbidity, during pregnancy a
series of continuous, physiological adjustments affect nutrient
metabolism and energy requirements, malnourished women
more likely bear growth-restricted babies. Nutrition and
supplementation of minerals and vitamins are likely key factors
in the prophylaxis and management (Bouzari 2011).
Iron is a micronutrient essential for hemoglobin synthesis
and several organ functions. Fe deficiency is the most
widespread nutrient deficiency in the world, affecting more
than 50% of all pregnant women in developing countries. It
may lead to anemia, intrauterine growth retardation (IUGR),
and small for gestational age fetuses.Folate is a water-soluble B vitamin that plays a major coenzymatic role in carbon metabolism and in the synthesis of
DNA, RNA and certain amino acids. Dietary folate deficiency
is prevalent in developing countries. Deficiency may lead to
congenital malformations (neural tube damage, orofacial clefts,
cardiac anomalies), anemia and certain complications during
pregnancy (spontaneous abortions, bleeding, pre-eclampsia,
IUGR and abruptio- placentae).
Low folate status may also cause hyperhomocystemia,
hypercoagulability and venous thrombosis.
To reduce risk of congenital malformations and
pregnancy complications a daily supplemental dose of 400
mg/day of folate is recommended when planning pregnancy.
Increased risk of fetal neural tube defects is seen in several
conditions: obesity, personal or family history of neural tube
defects, pregestational diabetes, and epilepsy. A higher dose (5
mg) is recommended in these previous situations (Hovdenak
and Haram, 2012).
In this study a randomized controlled trail done on women
selected from pregnant women attending the ante natal outpatient
clinic of Ain Shams University maternity hospital according to
the eligibility criteria measuring the efficacy of daily versus
weekly iron and folate supplementation. The study was done on
160 pregnant non-anemic women, 14-22 weeks gestation, all
patients were subjected to full present, past and obstetric history taking, full clinical examination, they were divided into two equal
groups, hemoglobin and serum ferritin measured at the start of the
study and repeated after four months of unsupervised treatment at
home, first group had regimen contain 60 mg elemental iron and 1
mg folic acid for daily supplementation and second group receive
120 mg elemental iron and 3 mg folic acid weekly.
After four months of self-monitored treatment at home
hemoglobin and serum ferritin levels re-measured with
assessment of side effects and compliance as reported by
candidates in both groups.
The results showed hemoglobin and serum ferritin levels
elevation in both groups with non-significant difference
between the two groups and better compliance in the weekly
administration group showed by more commitment by women
in this group to take their medications and lesser side effects in
weekly group than daily one.
Side effects reported were, nausea, vomiting,
constipation and gastric upset which were more applied to the
daily group than weekly supplementation group.
About cost effectiveness as reported from study
candidates the weekly regimen was more applicable to women
and cheaper than daily one with fewer packages of iron and
folate thus even for poor families they afforded to buy the
treatment.So we recommend that weekly regimen can be an
effective alternative to daily supplementation in prophylaxis of
iron deficiency anemia in non-anemic pregnant women.
Future studies could focus on effect of weekly regimen
on treatment of anemia not just prophylaxis and linking the
supplementation with pregnancy outcome measuring the effect
of iron and folate supplementation on the fetuses.
Research in the near future, and international
organizations, should perform the task to improve management
of anemia worldwide, lowering costs of diagnostic tools in
developing countries, finding new markers for iron states and
revealing other relations between iron deficiency states and
fetal–maternal complications.