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Comparison Effects of Giving Iron 60mg Folic Acid 0.4 mg Day And Iron 120 mg Folic Acid 2.8 mg Week On Hemoglobin Levels, Side Effects In Pregnant Women In Trimesters II-III And Fetal Welfare
Corresponding Author(s) : Desiska Pricilia Tumatar
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 12 No. 3 (2024): 2024 Volume -12 - Issue 3
Abstract
Background: Iron plays an essential role during pregnancy. However, pregnant women who use it daily may experience negative effects. There are suggestions that can be taken to reduce discomfort associated with iron consumption by administering weekly.
Destination: Researchers analyzed the difference between daily and weekly iron and folic acid administration on hemoglobin levels, side effects and fetal well-being.
Method: This study utilized a quasi-experimental, pretest-posttest, two-group design. 40 pregnant women in their second or third trimester were divided into two groups, each containing 20 participants: the group receiving iron 60 mg folic acid 0.4 mg per day and the group receiving iron 120 mg folic acid 2.8 mg per week. Examination of hemoglobin levels was performed once per month for three months during the intervention, while evaluation of side effects was done once per week and monitoring of fetal well-being was conducted at the beginning of the intervention and three months following the intervention.
Results: Result of hemoglobin level test using repeated measure ANOVA, administering 60 mg of folic acid 0.4 per day (0.012), and administering iron 120 mg of folic acid 2.8 mg per week (0.000), side effects using mcNemar test (0.125 nausea and vomiting 0.250 constipation) daily administration (0.625 nausea and vomiting 0.500 constipation) weekly administration, and fetal well-being using the Wilcoxon 0.000 test for daily administration, 0.000 for weekly.
Conclusion: Iron tablets can be administered weekly as an alternative to prevent oxidative stress and reduce digestive discomfort in pregnant women.
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- Aksari ST, Imanah NDN. Gestational Age as a Factor Related to the Incidence of Anemia in Pregnant Women During the Covid 19 Pandemic. Indonesian Journal of Midwifery. 2022;13(1):94–102. Doi:doi.org/10.36419/jki.v13i1.569
- Alaoddolehel H, Samiel H, Sadighian F, Kalantari N. Efficacy of daily versus intermittent administration of iron supplementation in anemia or blood indices during pregnancy. Caspian Journal of Internal Medicine. 2013;4(Md):1–5. https://www.ncbi.nlm.nih.gov
- Ali MK, Abbas AM, Abdelmagied AM, Mohammed GE, Abdalmaged OS. A randomized clinical trial of the efficacy of single versus double-daily dose of oral iron for prevention of iron deficiency anemia in women with twin gestations. Journal of Maternal Neonatal Medical. 2016. http://dx.doi.org/10.1080/14767058.2016.1266478
- Anger GJ, Piquette-miller M. Pharmacokinetics in Pregnancy. Reproductive and Developmental Toxicology. Elsevier.; 2017. 39-49 p. Available from: http://dx.doi.org/10.1016/B978-0-12-804239-7.00003-2
- Arini, Liss Dyah Dewi; Harsiwi UB. Effect of Giving Ferrum (Fe) Tablets with Hemoglobin Levels in Third Trimester Pregnant Women Influence of Giving Ferrum (Fe) Tablets with Hemoglobin Levels. Biomedical journal. 2019;12(1). http://dx.doi.org/10.31001/biomedika.V12i1.399
- Baghavan N. Metabolism of Iron and Heme. Elsevier.2015. 511-529 p. http://dx.doi.org/10.1016/B978-0-12-416687-5-00027
- Bouzari Z, Basirat Z, Zadeh MZ, Cherati SY, Ardebil MD, Mohammadnetaj M, et al. Daily versus intermittent iron supplementation in pregnant women. BMC Research Notes. 2011;0–4. http://dx.doi.org/10-1186/1756-0500-4-444
- Demuth IR, Martin A, Weissenborn A. Iron supplementation during pregnancy – a cross-sectional study undertaken in four German states. Journal of BMC Pregnancy Childbirth. 2018;5:1–10. http://dx.doi.org/10.1186/s12884-018-2130-5
- Goonewardene IMR, Senadheera DI. Randomized control trial comparing effectiveness of weekly versus daily antenatal oral iron supplementation in preventing anemia during pregnancy. Journal of Obstetrics and Gynecology Res. 2017;1–8. http://dx.doi.org/10.111/jog.13546
- Ministry of Health of the Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 88 of 2014 concerning Standards for Blood Adding Tablets for Women of Childbearing Age and Pregnant Women. Indonesia; 2014.
- Lewandowska M, Sajdak S, Lubinski J. Can Serum Iron Concentrations in Early Healthy Pregnancy Be a Risk Marker of Pregnancy-Induced Hypertension? Journal of Nutrients. 2019;11. http://dx.doi.org/10.3390/nu11051086
- Maaita M. Perception of iron deficiency anemia (IDA) and compliance of iron supplements among pregnant women admitted to the labor ward at King Hussein Medical Center,. Journal of the Royal Medical Services. 2018;25(2). http://dx.doi.org/10.12816/0049829
- Milman N. Iron in Pregnancy – How Do We Secure an Appropriate Iron Status in the Mother and Child ? Journal Annals of Nutrition and Metabolism. 2011;50–4. http://dx.doi.org/10.1159/000332129
- Rajoria L, Dalia Y, Sharma A, Agrawal M, Chaturvedi H. Comparative study of daily vs intermittent iron supplementation in pregnant women. International Journal of Clinical Obstetrics and Gynecology. 2018;2(1):25–8. https://www.gynaecologyjournal.com
- Shankar H, Kumar N, Sandhir R, Mittal S. Weekly iron folic acid supplementation plays a differential role in maintaining iron markers level in non-anaemic and anaemic primigravida : A randomized controlled study. Saudi Journal of Biology Science. 2016;23(6):724–30. http://dx.doi.org/10.1016/j.sjbs.2015.09.007
- Suhartati S, Rahmawaty L, Hestiyana N. The Relationship of Anemia in Pregnant Women with the Incidence of Low Birth Weight Babies in the Work Area of the Tanta Health Center, Tabalong Regency in 2016. Journal of the Dynamics of Midwifery and Nursing Health. 2017;8(1).
- https://ojs.dinamikakesehatan.unism.ac.id
- Susiloningtyas I. Provision Of Iron (Fe) In Pregnancy. Unissula Journal. 2012; 50. http://jurnal.unissula.ac.idd
- Utari DM, Achadi EL, Pujonarti SA, Salimar. Impact of Weekly Versus Daily Iron-folic Acid Supplementation for Pregnant Women with Anemia on Hemoglobin Levels , Clinical Symptoms and Subjective Complaints. Pakistan Journal of Nutrients. 2017;16(6). http://dx.doi.org/10.3923/pjn.2017.463.469
- Vernissa V, Andrajati R, Study P, Science M, Faculty K, University F, et al. The Effectiveness of Leaflets and Counseling on Compliance with Taking Iron Tablets and Hemoglobin Levels of Pregnant Women with Anemia at Public Health Centers in Bogor Regency. Research and Development Media. 2017;4:229–36. http://dx.doi.org/10.22435/mpk.v27i4.6628.229-236
- World Health Organization. Guideline : Daily iron and folic acid supplementation in pregnant women. Geneva: WHO; 2012.
- World Health Organization. Guideline : Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: WHO; 2012.
- Yaznil MR, Lubis MP, Lumbanraja SN, Barus MNG, Sakina A, Sarirah M. Side Effects of Daily Versus Weekly Iron Supplementation in Pregnant Women. Journal of the Bahrain Medical Society. 2019;31(1):17–22. https://repository.usu.ac.id
- Zhuang T, Han H, Yang Z. Iron, Oxidative Stress and Gestational Diabetes. Journal of Nutrients. 2014;6:3968–80. http://dx.doi.org/10.3390/nu6093968
References
Aksari ST, Imanah NDN. Gestational Age as a Factor Related to the Incidence of Anemia in Pregnant Women During the Covid 19 Pandemic. Indonesian Journal of Midwifery. 2022;13(1):94–102. Doi:doi.org/10.36419/jki.v13i1.569
Alaoddolehel H, Samiel H, Sadighian F, Kalantari N. Efficacy of daily versus intermittent administration of iron supplementation in anemia or blood indices during pregnancy. Caspian Journal of Internal Medicine. 2013;4(Md):1–5. https://www.ncbi.nlm.nih.gov
Ali MK, Abbas AM, Abdelmagied AM, Mohammed GE, Abdalmaged OS. A randomized clinical trial of the efficacy of single versus double-daily dose of oral iron for prevention of iron deficiency anemia in women with twin gestations. Journal of Maternal Neonatal Medical. 2016. http://dx.doi.org/10.1080/14767058.2016.1266478
Anger GJ, Piquette-miller M. Pharmacokinetics in Pregnancy. Reproductive and Developmental Toxicology. Elsevier.; 2017. 39-49 p. Available from: http://dx.doi.org/10.1016/B978-0-12-804239-7.00003-2
Arini, Liss Dyah Dewi; Harsiwi UB. Effect of Giving Ferrum (Fe) Tablets with Hemoglobin Levels in Third Trimester Pregnant Women Influence of Giving Ferrum (Fe) Tablets with Hemoglobin Levels. Biomedical journal. 2019;12(1). http://dx.doi.org/10.31001/biomedika.V12i1.399
Baghavan N. Metabolism of Iron and Heme. Elsevier.2015. 511-529 p. http://dx.doi.org/10.1016/B978-0-12-416687-5-00027
Bouzari Z, Basirat Z, Zadeh MZ, Cherati SY, Ardebil MD, Mohammadnetaj M, et al. Daily versus intermittent iron supplementation in pregnant women. BMC Research Notes. 2011;0–4. http://dx.doi.org/10-1186/1756-0500-4-444
Demuth IR, Martin A, Weissenborn A. Iron supplementation during pregnancy – a cross-sectional study undertaken in four German states. Journal of BMC Pregnancy Childbirth. 2018;5:1–10. http://dx.doi.org/10.1186/s12884-018-2130-5
Goonewardene IMR, Senadheera DI. Randomized control trial comparing effectiveness of weekly versus daily antenatal oral iron supplementation in preventing anemia during pregnancy. Journal of Obstetrics and Gynecology Res. 2017;1–8. http://dx.doi.org/10.111/jog.13546
Ministry of Health of the Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 88 of 2014 concerning Standards for Blood Adding Tablets for Women of Childbearing Age and Pregnant Women. Indonesia; 2014.
Lewandowska M, Sajdak S, Lubinski J. Can Serum Iron Concentrations in Early Healthy Pregnancy Be a Risk Marker of Pregnancy-Induced Hypertension? Journal of Nutrients. 2019;11. http://dx.doi.org/10.3390/nu11051086
Maaita M. Perception of iron deficiency anemia (IDA) and compliance of iron supplements among pregnant women admitted to the labor ward at King Hussein Medical Center,. Journal of the Royal Medical Services. 2018;25(2). http://dx.doi.org/10.12816/0049829
Milman N. Iron in Pregnancy – How Do We Secure an Appropriate Iron Status in the Mother and Child ? Journal Annals of Nutrition and Metabolism. 2011;50–4. http://dx.doi.org/10.1159/000332129
Rajoria L, Dalia Y, Sharma A, Agrawal M, Chaturvedi H. Comparative study of daily vs intermittent iron supplementation in pregnant women. International Journal of Clinical Obstetrics and Gynecology. 2018;2(1):25–8. https://www.gynaecologyjournal.com
Shankar H, Kumar N, Sandhir R, Mittal S. Weekly iron folic acid supplementation plays a differential role in maintaining iron markers level in non-anaemic and anaemic primigravida : A randomized controlled study. Saudi Journal of Biology Science. 2016;23(6):724–30. http://dx.doi.org/10.1016/j.sjbs.2015.09.007
Suhartati S, Rahmawaty L, Hestiyana N. The Relationship of Anemia in Pregnant Women with the Incidence of Low Birth Weight Babies in the Work Area of the Tanta Health Center, Tabalong Regency in 2016. Journal of the Dynamics of Midwifery and Nursing Health. 2017;8(1).
https://ojs.dinamikakesehatan.unism.ac.id
Susiloningtyas I. Provision Of Iron (Fe) In Pregnancy. Unissula Journal. 2012; 50. http://jurnal.unissula.ac.idd
Utari DM, Achadi EL, Pujonarti SA, Salimar. Impact of Weekly Versus Daily Iron-folic Acid Supplementation for Pregnant Women with Anemia on Hemoglobin Levels , Clinical Symptoms and Subjective Complaints. Pakistan Journal of Nutrients. 2017;16(6). http://dx.doi.org/10.3923/pjn.2017.463.469
Vernissa V, Andrajati R, Study P, Science M, Faculty K, University F, et al. The Effectiveness of Leaflets and Counseling on Compliance with Taking Iron Tablets and Hemoglobin Levels of Pregnant Women with Anemia at Public Health Centers in Bogor Regency. Research and Development Media. 2017;4:229–36. http://dx.doi.org/10.22435/mpk.v27i4.6628.229-236
World Health Organization. Guideline : Daily iron and folic acid supplementation in pregnant women. Geneva: WHO; 2012.
World Health Organization. Guideline : Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: WHO; 2012.
Yaznil MR, Lubis MP, Lumbanraja SN, Barus MNG, Sakina A, Sarirah M. Side Effects of Daily Versus Weekly Iron Supplementation in Pregnant Women. Journal of the Bahrain Medical Society. 2019;31(1):17–22. https://repository.usu.ac.id
Zhuang T, Han H, Yang Z. Iron, Oxidative Stress and Gestational Diabetes. Journal of Nutrients. 2014;6:3968–80. http://dx.doi.org/10.3390/nu6093968