Antenatal iron supplementation and serum non-transferrin bound iron in Kenyan women: a randomized placebo-controlled trial

M.N. Mwangi, J.M. Roth, A.M. Mwangi, H.F.J. Savelkoul, R.C. Hider, P.F. Mens, J.C.M. Verhoef

Research output: Contribution to journalAbstractAcademic


Introduction: Supplementation with ferrous iron can lead to increased
rates of malaria, possibly through the transient production of
non-transferrin bound iron (NTBI). Evidence that iron supplementation
can lead to NTBI production is mostly derived from small, mostly
non-randomized studies using volunteers with adequate iron status
and without infections or inflammation, and using NTBI quantitation
methods with inherent limitations. Little is known about factors that
influence the magnitude of the serum NTBI response to iron ingestion.
Objectives: We measured the effect of ingestion of a single iron
supplement on serum NTBI concentrations in pregnant Kenyan women.
We also explored the influence of initial iron status, gravidity,
maternal age, Plasmodium infection, HIV infection, α+-thalassemia
genotype on the NTBI response.
Method / Design: Rural Kenyan women with singleton pregnancies,
gestational age 13─23 weeks and hemoglobin concentration
≥90g/L were randomized to supplementation with iron (60mg as
ferrous fumarate) versus placebo. Approximately 1.5h after ingesting
the first supplement, participants were offered an optional nonstandardized
lunch meal. Blood was collected at baseline and after
3hours. Serum NTBI concentrations were determined using a novel,
flow cytometry-based assay.
Results: 379 women participated. Compliance was 100%. NTBI
concentrations after 3 hours were similar between groups (mean for
both: 0.18 μmol/L; difference, 95%CI: 0.01μmol/L, –0.03μmol/L to
0.05μmol/L). NTBI was present in 40.9% and 46.1% of women in iron
versus placebo groups (difference: 5.3%, –15.0% to 4.7%). We found
no evidence of effect modification by any of the baseline factors investigated.
Conclusions: There was no evidence that oral iron supplementation
led to NTBI production when the supplement was given with
food to women in their second trimester of pregnancy. These results
cannot be extrapolated to pregnant women who ingest supplements
without food, or to those in their third trimester of pregnancy
Original languageEnglish
Pages (from-to)341
Number of pages1
JournalAnnals of Nutrition & Metabolism
Issue numberSuppl.1
Publication statusPublished - 2015
Event12th European Nutrition Conference (FENS) - Berlin, Germany
Duration: 20 Oct 201523 Oct 2015


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