Hepcidin-guided screen-and-treat interventions against iron-deficiency anaemia in pregnancy: a randomised controlled trial in The Gambia

Publication date: November 2019Source: The Lancet Global Health, Volume 7, Issue 11Author(s): Amat Bah, Abdul Khalie Muhammad, Rita Wegmuller, Hans Verhoef, Morgan M Goheen, Saikou Sanyang, Ebrima Danso, Ebrima A Sise, Sant-Rayn Pasricha, Andrew E Armitage, Hal Drakesmith, James H Cross, Sophie E Moore, Carla Cerami, Andrew M PrenticeSummaryBackgroundWHO recommends daily iron supplementation for pregnant women, but adherence is poor because of side-effects, effectiveness is low, and there are concerns about possible harm. The iron-regulatory hormone hepcidin can signal when an individual is ready-and-safe to receive iron. We tested whether a hepcidin-guided screen-and-treat approach to combat iron-deficiency anaemia could achieve equivalent efficacy to universal administration, but with lower exposure to iron.MethodsWe did a three-arm, randomised, double-blind, non-inferiority trial in 19 rural communities in the Jarra West and Kiang East districts of The Gambia. Eligible participants were pregnant women aged 18–45 years at between 14 weeks and 22 weeks of gestation. We randomly allocated women to either WHO's recommended regimen (ie, a daily UN University, UNICEF, and WHO international multiple-micronutrient preparation [UNIMMAP] containing 60 mg iron), a 60 mg screen-and-treat approach (ie, daily UNIMMAP containing 60 mg iron for 7 days if weekly hepcidin was <2·5 μg/L or UNIMMAP without iron if hepcidin was ≥2·5 μg/L), or a 30 mg screen-and-treat approach (ie, ...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research