Guideline - WHO

1 WHO | GuidelineDaily iron and folic acid supplementation in pregnant womeniGuideline: Daily iron and folic acid supplementation in pregnant women WHO | GuidelineDaily iron and folic acid supplementation in pregnant womenIIWHO Library Cataloguing-in-Publication DataGuideline: Daily iron and folic acid supplementation in pregnant administration and dosage. 2. Folic acid administration and dosage. , iron -deficiency prevention and control. nutrition. supplements. Health 978 92 4 150199 6 (NLM classification: WD 110) World Health Organization 2012 All rights reserved.

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4 However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Design and layout: Alberto MarchWHO. Guideline : Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, citationWHO | GuidelineDaily iron and folic acid supplementation in pregnant womenIIIC ontentsAcknowledgements ivFinancial support ivSummary 1 Scope and purpose 2 Background 2 Summary of evidence 3 Recommendation 4 Remarks 5 Implications for future research 6 Dissemination, adaptation and implementation 6 Dissemination Adaptation and implementation Monitoring and evaluation of Guideline implementation Guideline development process 7 Advisory groups Scope of the Guideline .

5 Evidence appraisal and decision-makingManagement of conflicts of interest 10 Plans for updating the Guideline 10 References 11 GRADE Summary of findings tables 13 Summary of the considerations by the Nutrition Guidance Expert 17 Advisory Group for determining the strength of the recommendation WHO Steering Committee for Nutrition guidelines Development 18 Nutrition Guidance Expert Advisory Group Micronutrients, WHO Secretariat and external resource experts 19 External Experts and Stakeholders Panel Micronutrients 23 Questions in Population, Intervention, Control, Outcomes (PICO)

6 Format 27 Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 WHO | GuidelineDaily iron and folic acid supplementation in pregnant womenIVThis Guideline was coordinated by Dr Luz Maria De-Regil under the supervision of Dr Juan Pablo Pe a-Rosas, with technical input from Dr Metin Gulmezoglu, Dr Jose Martines, Dr Matthews Mathai and Dr Lisa Rogers. Thanks are due to the staff at the guidelines Review Committee Secretariat for their support throughout the process. Thanks are also due to Dr Davina Ghersi for her technical advice and assistance in the preparation of the technical consultations for this Guideline and Mr Issa T.

7 Matta and Mrs Chantal Streijffert Garon from the World Health Organization (WHO) Office of the Legal Counsel for their support in the management of conflicts of interest procedures. Ms Grace Rob and Mrs Paule Pillard from the Micronutrients Unit, Department of Nutrition for Health and Development, provided logistic support. WHO gratefully acknowledges the technical input of the members of the Nutrition Steering Committee and the Nutrition Guidance Expert Advisory Group, especially the chairs of the meetings, Dr Janet King, Dr Rebecca Stoltzfus and Dr Rafael Flores-Ayala.

8 WHO is also grateful to the Cochrane Pregnancy and Childbirth Group staff for their support during the development of the systematic review used to inform this Guideline . WHO thanks the Government of Luxembourg for providing financial support for this supportWHO | GuidelineDaily iron and folic acid supplementation in pregnant women1 Daily iron and folic acid supplementation in pregnant womenIt is estimated that of pregnant women worldwide are anaemic. At least half of this anaemia burden is assumed to be due to iron deficiency. Member States have requested guidance from the World Health Organization (WHO) on the effectiveness and safety of daily iron and folic acid supplementation in pregnant women as a public health measure to improve pregnancy outcomes in support of their efforts to achieve the Millennium Development Goals.

9 WHO developed the present evidence-informed recommendations using the procedures outlined in the WHO handbook for Guideline development. The steps in this process included: (i) identification of priority questions and outcomes; (ii) retrieval of the evidence; (iii) assessment and synthesis of the evidence; (iv) formulation of recommendations, including research priorities; and (v) planning for dissemination, implementation, impact evaluation and updating of the Guideline . The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed to prepare evidence profiles related to preselected topics, based on up-to-date systematic reviews.

10 The Guideline advisory group for nutrition interventions, the Nutrition Guidance Expert Advisory Group, comprises content experts, methodologists, representatives of potential stakeholders and consumers. These experts participated in several WHO technical consultations concerning this Guideline , held in Geneva, Switzerland, and in Amman, Jordan, in 2010 and 2011. Members of the External Experts and Stakeholders Panel were identified through a public call for comments, and this panel was involved throughout the Guideline development process. Guideline advisory group members voted on the strength of the recommendation, taking into consideration: (i) desirable and undesirable effects of this intervention; (ii) the quality of the available evidence; (iii) values and preferences related to the intervention in different settings; and (iv) the cost of options available to health-care workers in different settings.