Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 24, 2013

Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial

Nils Milman, Lisbeth Jønsson, Pernille Dyre, Palle Lyngsie Pedersen and Lise Grupe Larsen

Abstract

Objective: To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women. Design: Randomized, double-blind, intention-to-treat study. Setting: Antenatal care clinic. Sample: 80 healthy ethnic Danish pregnant women.

Methods: Women were allocated to ferrous bisglycinate 25 mg elemental iron (Aminojern®) (n=40) or ferrous sulfate 50 mg elemental iron (n=40) from 15 to 19 weeks of gestation to delivery. Hematological status (hemoglobin, red blood cell indices) and iron status (plasma iron, plasma transferrin, plasma transferrin saturation, plasma ferritin) were measured at 15–19 weeks (baseline), 27–28 weeks and 36–37 weeks of gestation. Main outcome measures: Occurrence of ID (ferritin <15 μg/L) and IDA (ferritin <12 μg/L and hemoglobin <110 g/L).

Results: At inclusion, there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status. The frequencies of ID and IDA were low and not significantly different in the two iron groups. The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group (P=0.001). Newborns weight was slightly higher in the bisglycinate vs. the sulfate group (3601±517 g vs. 3395±426 g, P=0.09).

Conclusions: In the prevention of ID and IDA, ferrous bisglycinate was not inferior to ferrous sulfate. Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95% of Danish women during pregnancy and postpartum.


Corresponding author: Nils Milman, Senior Consultant, Lindevangen 87B, DK-2830 Virum, Denmark, Tel.: +45 20103577, Fax: +45 32719401, E-mail:

Acknowledgments

The authors appreciate the assistance of the staff at the Department of Gynaecology and Obstetrics, Næstved Hospital and the assistance with statistical analyses by Chief Physician Anne-Mette Hvas, Department of Clinical Biochemistry, Skejby University Hospital, Aarhus, Denmark.

References

[1] Brise H. Influence of meals on iron absorption in oral iron therapy. Acta Med Scand. 1962;171, suppl. 376: 39–45.10.1111/j.0954-6820.1962.tb18681.xSearch in Google Scholar

[2] Drachenberg CD, Papadimitriou JC. Placental iron deposits: significance in normal and abnormal pregnancies. Hum Pathol. 1994;25:379–85.10.1016/0046-8177(94)90146-5Search in Google Scholar

[3] Lund EK, Wharf SG, Fairweather-Tait SJ, Johnson IT. Oral ferrous sulfate supplements increase the free radical-generating capacity of feces from healthy volunteers. Am J Clin Nutr. 1999;69:250–5.10.1093/ajcn/69.2.250Search in Google Scholar PubMed

[4] Marsál K, Persson P-H, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Pædiatr. 1996;85:843–8.10.1111/j.1651-2227.1996.tb14164.xSearch in Google Scholar PubMed

[5] Milman N. Iron and pregnancy – a delicate balance. Ann Hematol. 2006;85:559–65.10.1007/s00277-006-0108-2Search in Google Scholar PubMed

[6] Milman N. Iron prophylaxis in pregnancy general or individual and in which dose? Ann Hematol. 2006;85:821–8.10.1007/s00277-006-0145-xSearch in Google Scholar PubMed

[7] Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008;87:949–59.10.1007/s00277-008-0518-4Search in Google Scholar PubMed

[8] Milman N. Iron in pregnancy how do we secure an appropriate iron status in mother and child? Ann Nutr Metab. 2011;59:50–4.10.1159/000332129Search in Google Scholar PubMed

[9] Milman N, Agger OA, Nielsen OJ. Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Dan Med Bull. 1991;38:471–6.Search in Google Scholar

[10] Milman N, Bergholt T, Byg K-E, Eriksen L, Graudal N. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand. 1999;78:749–57.Search in Google Scholar

[11] Milman N, Bergholt T, Eriksen L, Byg K-E, Graudal N, Pedersen P, et al. Iron prophylaxis during pregnancy how much iron is needed? A randomized dose-response study of 20–80 mg ferrous iron daily in pregnant women. Acta Obstet Gynecol Scand. 2005;84:238–47.10.1111/j.0001-6349.2005.00610.xSearch in Google Scholar PubMed

[12] Milman N, Byg K-E, Graudal N, Agger AO. Reference values for hemoglobin and erythrocyte indices during normal pregnancy in 206 women with and without iron supplementation. Acta Obstet Gynecol Scand. 2000;78:89–98.10.1034/j.1600-0412.2000.079002089.xSearch in Google Scholar PubMed

[13] Milman N, Clausen J, Byg K-E. Iron status in 268 Danish women aged 18–30 years. Influence of menstruation, method of contraception, and iron supplementation. Ann Hematol. 1998;76:13–9.10.1007/s002770050405Search in Google Scholar

[14] Milman N, Ibsen KK, Christensen JM. Serum ferritin and iron status in mothers and newborn infants. Acta Obstet Gynecol Scand. 1987;66:205–11.10.3109/00016348709020748Search in Google Scholar

[15] Nordic Council of Ministers. Nordic Nutrition Recommendations. Scand J Nutr. 1996;40:161–5.Search in Google Scholar

[16] Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK Guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2012;156:588–600.10.1111/j.1365-2141.2011.09012.xSearch in Google Scholar

[17] Pedersen P, Melsen GV, Milman N. Frequencies of the hemochromatosis gene (HFE) variants C282Y, H63D and S65C in 6,020 ethnic Danish men. Ann Hematol. 2008;87:735–40.10.1007/s00277-008-0506-8Search in Google Scholar

[18] Pineda O. Ashmead HDW. Effectiveness of treatment of iron-deficiency anemia in infants and young children with ferrous bisglycinate chelate. Nutrition. 2001;17;381–4.10.1016/S0899-9007(01)00519-6Search in Google Scholar

[19] Rossander-Hultén L, Brune M, Sandström B, Lönnerdal B, Hallberg L. Competitive inhibition of iron absorption by manganese and zinc in humans. Am J Clin Nutr. 1991;54:152–6.10.1093/ajcn/54.1.152Search in Google Scholar PubMed

[20] Skikne B, Baynes RD. Iron absorption. In: Brock JH, Halliday JW, Pippard MJ, Powell LW, editors. Iron metabolism in health and disease. London: Saunders; 1994:51–87.Search in Google Scholar

[21] Sölvell L. Oral iron therapy. Side effects. In: Hallberg L, Harwerth H-G, Vannotti A, editors. Iron deficiency. Pathogenesis, clinical aspects, therapy. London: Academic Press; 1970:573–83.Search in Google Scholar

[22] Swedish Society of Obstetrics and Gynecology. Mödrahälsovård, sexuell och reproduktiv hälsa. 2008; rapport nr 59:47–8.Search in Google Scholar

[23] Szarfarc SC, Cassana LMN, Fujimori E, Guerra-Shinohara EM, Oliveira IMV. Relative effectiveness of iron bis-glycinate chelate (Ferrochel) and ferrous sulphate in the control of iron deficiency in pregnant women. Archivos Latinoamericanos de Nutricion. 2001;51 suppl 1:42–7.Search in Google Scholar

[24] Tetens I, Bendtsen KM, Hansen M, Ersbøll AK, Milman N. The impact of a meat versus a vegetable-based diet on iron status in women of childbearing age with low iron stores. Eur J Nutr. 2007;46:439–45.10.1007/s00394-007-0683-6Search in Google Scholar PubMed

[25] Thomsen JK, Prien-Larsen JC, Devantier A, Fogh-Andersen N. Low dose iron supplementation does not cover the need for iron during pregnancy. Acta Obstet Gynecol Scand. 1993;72:93–8.10.3109/00016349309023419Search in Google Scholar PubMed

[26] Worwood M. Laboratory determination of iron status. In: Brock, JH, Halliday JW, Pippard MJ, Powell LW, editors. Iron Metabolism in health and disease. London: WB Saunders; 1994:449–76.Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-6-25
Accepted: 2013-9-8
Published Online: 2013-10-24
Published in Print: 2014-3-1

©2014 by Walter de Gruyter Berlin Boston