Provision of Iron and Folic Acid Supplementations for Pregnant Women in Public and Private Sectors of Tabriz, Iran

Document Type: Original Article


1 National Public Health Management Center (NPMC) and Department of Social Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran

3 Physician, Researcher, Tabriz University of Medical Sciences, Tabriz, Iran

4 Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Science, Tabriz, Iran

5 Students Research Committee, Medical Faculty, Tabriz University of Medical Science Tabriz, Iran

6 Medical philosophy and history research center, Tabriz University of Medical Science, Tabriz, Iran


Background: This study aimed to investigate different methods used to provide necessary supplementations for pregnant women and obtain reliable data about the general status of health promotion during pregnancy.
Methods: This descriptive, cross-sectional study was conducted on 401 pregnant women referring to different women’s hospitals of Tabriz, including Alzahra, Taleghani, 29-Bahman, Zakariya, Shafa, and Shams from March 2011 to September 2013. Subjects were selected using simple random sampling and had prior experience of childbirth.
Results: In this study, prenatal care was provided for all the pregnant women at public (55.8%) and private sectors (44.2%). Iron supplementation used by the subjects included ferrous sulfate (150 mg) + folic acid (0.5 mg) (20.2%), regular-release ferrous sulfate (325 mg) (70.4%), folic acid (0.1 mg) + ferrous sulfate (200 mg) (6.5%), and vitamin B12 (15 mg) + ferrous fumarate (350 mg)+ vitamin C (150 mg) + folic acid (1 mg) (1.6%). Supplementations were provided before (56.7%) or after (43.3%) the onset of pregnancy. In total, 40.9% of the subjects received family planning care, 44.7% of whom referred to medical centers, 34.6% referred to health houses, 12.3% consulted gynecologists, 2.8% consulted midwives and 5% received traditional care.
Conclusion: According to the results of this study, general status of iron and folic acid supplementation, their provision and average use of these substances were suboptimal. However, status, provision and use of iron were significantly more efficient than folic acid.


1.   Organization WH. The World Health Report 2005. Make every mother and child count. Geneva: World Health Organization; 2005.

2.   Vollset SE, Clarke R, Lewington S, Ebbing M, Halsey J, Lonn E, et al. Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50 000 individuals. The Lancet. 2013; 381(9871):1029-36.

3.   Kelly D, O'Dowd T, Reulbach U. Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study. Br J Gen Pract. 2012; 62(600):e466-e72.

4.   Organization WH. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.

5.   McNulty B, McNulty H, Marshall B, Ward M, Molloy AM, Scott JM, et al. Impact of continuing folic acid after the first trimester of pregnancy: findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters. Am J Clin Nutr. 2013; 98(1):92-8.

6.   Health Evidence Network. What is the effectiveness of antenatal care? J Health Serv Res Policy. 2005; 11(3):191.

7.   World Health Organization. Unit:3.5. Community Base Initiality. Egypt: Regional office for the Eastern Mediterranean; 2003.

8.   Sehhati-Shafaii F, Asadollahy M, Piri R, Naghavi-Behzad M, Farzollahpour F. Prevalence and risk factors of preterm labor in Health Educational Centers of Northwest Iran (2009-2010). Life Sci J. 2013; 10(3).

9.   Ghojazadeh M, Velayati A, Mallah F, Azami-Aghdash S, Mirnia K, Piri R, et al. Contributing death factors in very low-birth-weight infants by path method analysis. Niger Med J. 2014; 55(5):389-93.

10. Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. T Medscape J Med. 2008; 10(12):283.

11. Cordero AM, Crider KS, Rogers LM, Cannon MJ, Berry RJ. Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: world health organization guidelines. MMWR Morb Mortal Wkly Rep. 2015; 64(15):421-3.

12. Green NS. Folic acid supplementation and prevention of birth defects. J Nutr. 2002; 132(8 Suppl):2356S-60S.

13. Wilson RD, Johnson JA, Wyatt P, Allen V, Gagnon A, Langlois S, et al. Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2007; 29(12):1003-26.

14. Czeizel AE, Dudás I, Vereczkey A, Bánhidy F. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients. 2013; 5(11):4760-75.

15. Dastgiri S, Imani S, Kalankesh L, Barzegar M, Heidarzadeh M. Congenital anomalies in Iran: a cross-sectional study on 1574 cases in the North-West of country. Child Care Health Dev. 2007; 33(3):257-61.

16. Chang S, Zeng L, Brouwer ID, Kok FJ, Yan H. Effect of iron deficiency anemia in pregnancy on child mental development in rural China. Pediatrics. 2013; 131(3):e755-63.

17. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low-and middle-income countries. Blood. 2013; 121(14):2607-17.

18. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harbor perspectives in medicine. 2013; 3(7):pii:a011866.

19. Bank W. Main Report. Iran: Islamic Republic of Iran Health Sector Review. 2007;1.

20. Bestwick JP, Huttly WJ, Morris JK, Wald NJ. Prevention of neural tube defects: a cross-sectional study of the uptake of folic acid supplementation in nearly half a million women. PloS one. 2014; 9(2):e89354.

21. Vaidya A, Saville N, Shrestha BP, Costello AM, Manandhar DS, Osrin D. Effects of antenatal multiple micronutrient supplementation on children's weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet. 2008; 371(9611):492-9.

22. Mahaini R. Improving maternal health to achieve the Millennium Development Goals in the Eastern Mediterranean Region: a youth lens. East Mediterr Health J. 2008; (14 Suppl):S97-106

23. Kadivar MR, Massumi SJ, Moradi F, Shenavar B. Folic acid consumption in Fars province, southern Iran. J Res Health Sci. 2005; 5(2):11-4.

24. Bille C, Murray JC, Olsen SF. Folic acid and birth malformations. BMJ. 2007; 334(7591):433-4.