Vitamins and Iron Preparations

25 Vitamins and Iron Preparations



Vitamins


Vitamins are factors in food necessary for growth and reproduction of living tissues. Some vitamins are fat soluble and others are water soluble. Those of interest to the midwife are vitamins C, B12, K and folic acid, and are usually present in the diet.


Supplements of vitamins C and K are rare, but B12 and folic acid supplements are increasing. More recently, vitamin D has been in the spotlight with the re-emergence of neonatal rickets and reduced mineralization within the bones of children within certain populations. National Institute for Health and Clinical Excellence (NICE) guidelines were updated in 2008 to add advice for specific populations.


Other elements present in food are minerals.


The student should be aware of:



image the importance of good nutrition in women of childbearing age


image what is considered malnutrition by the World Health Organization (WHO)


image the prevalence of malnutrition in local populations


image the sequelae to mother and fetus of malnutrition


image the foods that are part of a well balanced healthy diet


image current recommendations for supplementation for specific populations (NICE, 2008).



Iron Preparations


Iron (Fe) is a metallic element and a constituent of the haemoglobin molecule that is necessary to carry oxygen around the body via the blood.


Vitamin C, and to a lesser extent folic acid, are involved in Fe absorption. In theory, the haemoglobin (Hb) concentration in the blood should increase by 2 g/100 mL, or 20 g/L, over 3–4 weeks of supplementation.


The student should be aware of:



image WHO guidelines for diagnosis of anaemia


image the aetiology of and predisposing factors for anaemia


image the physiology and pathophysiology of anaemia in pregnancy


image the appropriateness and effectiveness of Fe preparations, both in anaemia and routinely in pregnancy


image the different kinds of anaemia and their prognosis


image the dietary sources of Fe, vitamin C and folic acid


image the sequelae of anaemia in the antenatal, intranatal and postnatal periods.


NB: Because of the risk of anaphylactic reaction and cardiopulmonary collapse, Fe injections should be carried out under strict medical supervision. Resuscitation, defibrillation facilities and adrenaline (ephedrine) must be immediately available. It is also recommended that the course of oral Fe should be stopped 48 hours before the IM course.


A test dose is recommended prior to the first full administration.



Other Fe compounds




Pregaday® (UCB Pharma Ltd) – ferrous fumarate (100 mg Fe) and folic acid (350 mcg) tablets (brown) – one tablet daily (BNF, 2011).




BP

Ferrous sulphate

Proprietary

Ferrous sulphate (Goldshield Group UK Limited)
(non-proprietary, see BNF for details)

Group

Fe salts

Uses/indications

Iron deficiency anaemia

Type of drug

POM, GSL

Presentation

Tablets (white coated)

Dosage

One tablet 200 mg/day in prophylaxis or mild anaemia
2–3 tablets 400–600 mg/daily in therapeutic doses

Route of admin

Oral

Contraindications

Diverticulitis, inflammatory bowel disease, anaemias other than iron deficiency, concurrent administration of parenteral iron

Side effects

Nausea, gastric irritation, epigastric pain, diarrhoea or constipation, iron overload, darkening of the stools

Interactions

Antacids – magnesium trisilicate reduces the absorption of Fe
Antibiotics – absorption of antibiotics can be reduced in the presence of Fe

Pharmacodynamic properties

Iron aids haemoglobin regeneration and the oxidative processes in tissues
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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Vitamins and Iron Preparations

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