Hi Pierre,

Nice to hear from you. I can't give you factual research based
statistics on what your looking at but I can give a opinion based on
lots of practical prenatal work: getting women to take iron
supplementation in Canada is very hard, it often constipates them and
makes them nauseous. I often find getting women with iron deficiency to
take supplements is a constant frustrating battle. For me to consider
this as routine for women with a normal Hb I would need 100% proof of
significant outcome difference, and I am not aware of any that exists.

Of course Africa is different because the average woman is walking
around with Hb of 9 and a bout of malaria can send them plummeting. And
unlike here blood transfusion in general is not a safe option as a bail
out in an emergency.

Hope you are well.

Ann Duggan

--- Pierre and Lee Ann Dil <[log in to unmask]> wrote:
> Dear colleagues,
>
> I want to do a small literature review
> as part of my family practice residency, which
> should answer a "clinical
> question".
> I have been involved in iron supplementaion
> programmes in Malawi in
> Africa and Zambia, and I know that in Africa we
> generally say that
> iron supplementation is imperative in the antenatal
> period, for all
> women. Here in Canada I find that only select groups
> receive iron in
> pregnancy, such as those with a short birth
> interval, those with
> established low haemoglobin, and a few other
> instances.
>
> I am interested in hearing back as to whether you
> think it is valid to
> NOT give iron supplementation to all pregnant women?
> Is this at all a
> contentious area, or have there been very clear
> clinical guidelines
> established (and are these based on good reserach)?
>
> Another question, which might be outside of the
> expertise in this
> group, is whether there is proven maternal morbidity
> and perinatal
> mortality, in women with low iron stores (as
> measured for instance
> through ferritin or transeferrin receptor levels)
> and NORMAL
> haemoglobin?
>
> Many thanks and I hope to hear from you.
>
> Pierre Dil
> home page
> http://members.truepath.com/dil/dil.html
>
> international health page
> http://www.geocities.com/HotSprings/Falls/2949/ihealth.htm
>

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