Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus.

The lack of standardized clinical practice impeding the optimal management of iron deficiency (ID) and iron deficiency anemia (IDA) in women is a global concern, particularly in the Asia-Pacific region. The aim of this study was to determine best practices through a Delphi consensus process. In Round 1, panelists were asked to rate their level of agreement with 99 statements across four domains: identification, diagnosis and assessment, prevention, and treatment of ID/IDA in women. In Round 2, panelists reappraised their ratings in view of the collective feedback and responses to Round 1. After two rounds, consensus (≥85% agreement) was reached for 84% of the Delphi statements. Experts agreed on the role of presenting symptoms and risk factors in prompting assessments of anemia and iron status in women. Experts repeatedly called for prevention, recommending preventive iron supplementation for pregnant women irrespective of anemia prevalence levels, and for non-pregnant adult women, adolescent girls, and perimenopausal women living in areas with a high prevalence of anemia. Experts unanimously agreed to prescribing oral ferrous iron as first-line therapy for uncomplicated ID/IDA. The recommendations and clinical pathway algorithms generated should be used to inform clinical practice and standardize the care of women at risk or presenting with ID/IDA in the Asia-Pacific region.

Vitamin D supplementation higher than 2000 IU/day compared to lower dose on maternal-fetal outcome: Systematic review and meta-analysis.

INTRODUCTION: Although vitamin D is widely known as an essential micronutrient during pregnancy, the exact supplementation dose to prevent maternal-fetal outcomes remains a question. This study aims to provide a systematic review and a meta-analysis of data from randomized controlled trial on > 2000 IU/day vitamin D supplementation compared to ⩽ 2000 IU/day; and ⩽ 2000 IU/day compared to placebo, on their effects on the incidence of preeclampsia, gestational diabetes mellitus, preterm birth, and differences on birth weight. METHODS: A systematic literature search on PubMed, EBSCO-MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases was carried out to evaluate randomized controlled trial studies on the effects of oral vitamin D > 2000 IU/day versus ⩽ 2000 IU/day; and ⩽ 2000 IU/day versus placebo, on preeclampsia, gestational diabetes mellitus, preterm birth and birth weight. Risk ratio, mean difference, and 95% confidence interval were calculated. RESULTS: There were a total of 27 randomized controlled trials selected. Maternal vitamin D supplementation > 2000 IU/day had a positive effect only on gestational diabetes mellitus (seven randomized controlled trials; risk ratio = 0.70, 95% confidence interval: 0.51-0.95, I2 = 0). Vitamin D supplementation ⩽ 2000 IU/day has reduced the risk of preeclampsia (three randomized controlled trials; risk ratio = 0.29, 95% confidence interval: 0.09-0.95, I2 = 0), with no significant difference when compared to > 2000 IU/day (eight randomized controlled trials; risk ratio = 0.80, 95% confidence interval: 0.51-1.24, I2 = 31). No difference in preterm birth risk and birth weight after vitamin D supplementation. The quality of evidence varies from moderate to very low certainty. The risk of preeclampsia and gestational diabetes mellitus after high-dose versus low-dose vitamin D supplementation was the ones with moderate certainty. CONCLUSION: Vitamin D supplementation > 2000 IU/day might be important to reduce the risk of gestational diabetes mellitus. Lower dose vitamin D supplementation (⩽ 2000 IU/day) seemed adequate to reduce the risk of preeclampsia, with no significant difference compared to the higher dose.

Effects of Bifidobacterium animalis lactis HN019 (DR10TM), inulin, and micronutrient fortified milk on faecal DR10TM, immune markers, and maternal micronutrients among Indonesian pregnant women.

BACKGROUND AND OBJECTIVES: Maternal nutrition affects fetal growth and development. This study evaluates the effects of milk powder fortified with micronutrients, docosahexaenoic acid (DHA), a prebiotic, and probiotic Bifidobacterium animalis subsp. lactis HN019 DR10TM on the micronutrient status, as well as the presence of faecal probiotic and immune markers in pregnant women. METHODS AND STUDY DESIGN: This randomised, double- blind, placebo-controlled trial was conducted at Budi Kemuliaan and Cipto Mangunkusumo Hospital in Jakarta from 2013 to 2014. A total of 104 participants were randomly allocated to receive either completely enriched milk powder (intervention group) or iron- and vitamin folic-acid-enriched milk powder (control group). Data were collected using standardised measures and were statistically analysed using the independent t or Mann-Whitney test. RESULTS: At the baseline, the micronutrient status of the participants was acceptable, except for 25-OH-vitamin D, in both the intervention and control groups. Vitamin B-1, zinc, total free fatty acid, linoleic acid, arachidonic acid, and DHA were significantly higher in the intervention group in the second trimester (p=0.014, 0.028, 0.023, 0.014, 0.001, and 0.032, respectively). Interleukin-6 and tumor necrosis factor-α levels did not significantly vary during pregnancy. B. animalis subsp. lactis DR10TM was present in the faeces of the intervention group but not the control group (61.1% vs 0%). CONCLUSION: Milk fortified with a prebiotic, probiotic, DHA and micronutrients increases the faecal concentration of the organism used for fortification in Indonesian pregnant women. This may represent an improvement in intra-partum maternal gut health.