Iron supplementation during pregnancy in Sweden:: to what extent is the national recommendation followed?

Background. While there has been a worldwide trend to reduce the recommended amount of iron in prenatal supplements, this has still not been implemented in Sweden. It is likely that the current national recommendation of 100 mg of iron/day to all pregnant women provides a larger amount of iron than warranted and results in increased occurrence of side-effects and reduced compliance. This may also reduce midwives' motivation to implement the recommendation. The aim of this study was to assess adherence to the current recommendation and to describe factors associated with prescription and use of iron supplements. Methods. A questionnaire capturing determinants for and use of prenatal iron supplementation was distributed to newly delivered women and midwives in five regions of Sweden. In addition, an inquiry about implementation of the recommendation was sent to all senior obstetricians in charge of antenatal care. Results. Most (79%) of the senior obstetricians indicated adherence to the national recommendation. A lower percentage of midwives (41%) and a further lower proportion of pregnant women (28%) did so. Despite limited compliance to the recommendation, the majority of pregnant women had used some type of iron-containing supplement. Side-effects of supplements, perceived need and advice from midwives influenced their use. Many midwives preferred and practiced a selective supplementation strategy. Conclusions. The current recommendation is not practiced. Side-effects and perceptions that the amount of iron is larger than necessary contribute to its limited use. A revision is needed to address the amount of iron required and strategies to ensure good adherence.