New trial investigates if taking iron during pregnancy can prevent anaemia

A new trial is set to investigate if routinely taking iron supplements during pregnancy can prevent anaemia, reducing the risk of stillbirth, pre-term birth, postnatal depression, haemorrhage after delivery and the need for blood transfusions.

Around one in three pregnant women will develop anaemia and need treatment with iron tablets.

The PANDA (Primary prevention of maternal ANaemia to avoid preterm Delivery and other Adverse outcomes) trial will investigate if taking iron supplements preventatively, even before a mother has developed anaemia, is beneficial to both mother and baby and will reduce the symptoms and outcomes that go with low iron in pregnancy.

This study is being led by NHS Blood and Transplant (NHSBT) and the University of Oxford and funded by the National Institute for Health and Care Research (NIHR). Oxford University Hospitals is one of the NHS trusts taking part in the study.

Mothers with anaemia experience symptoms including extreme fatigue, weakness and poor concentration and may be at higher risk of infection, premature birth, bleeding after delivery and having babies of low birth weight.

It is thought there may also be a link between anaemia and postnatal depression and there are studies that suggest the babies of mothers with iron-deficiency and anaemia may show developmental difficulties in childhood, as well as a range of other problems in mothers and infants. The PANDA trial will identify if these problems can be safely addressed using supplements of oral iron, as we do not know this.

The trial is now open to women who are in the first 16 weeks of pregnancy. Those who join will be given either iron supplements or placebo tablets, to take every day throughout their pregnancy and until six weeks after birth.

Researchers will assess several factors within both groups, including the numbers of pre-term births, stillbirths, neonatal deaths and babies deemed small for their gestational age, as well as the proportion of women developing anaemia during pregnancy, any changes in red cell counts in the blood during pregnancy, any changes in red cell counts in the blood during pregnancy and the proportion of women with bleeding after giving birth.

Longer term, the study will also link with other organisations to collect data to understand the effects of giving iron supplements during pregnancy on a child’s development; it is known that iron plays an important role in a baby’s neurodevelopment.

Earlier research has already been done as a part of the study, to find out the best dose of iron to offer to non-anaemic pregnant women, balancing likely effectiveness with side effects.

Co-Chief Investigator Professor Simon Stanworth, Consultant Haematologist for NHS Blood and Transplant and University of Oxford, says: "The PANDA trial addresses the very common problem of anaemia in pregnancy. We need to know whether taking a single tablet of iron throughout pregnancy has a benefit for both mother and infant – if it does, there is the real potential to change practice and improve outcomes in maternity.

"This study is a prime example of the world class research being carried out by both NHS Blood and Transplant and our partners and it is great to see recruitment starting at so many maternity hospitals, along with the interest this study has generated nationally."