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Abstract Background Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, thus supplements are recommended. Adherence to current tablet-based supplements is documented to be poor. Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence. However, before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy, the bioavailability of the iron needs to be determined. Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women. Methods Eighteen healthy pregnant women (24 – 32 weeks gestation) were randomized to receive the supplements in a crossover design. Following ingestion of each supplement, the changes (over baseline) in serum iron and folate over 8 hours were determined. The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid. Results Overall absorption of iron from the powdered supplement was significantly lower than the tablet (p = 0.003). There was no difference in the overall absorption of folic acid between supplements. Based on the differences in the area under the curve and doses, the relative bioavailability of iron from powdered supplement was lower than from the tablet (0.22). Conclusion The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports. However, since pills and capsules are known to be poorly accepted by some women during pregnancy, it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose. Trial Registration ClinicalTrials.gov NCT00789490

Presents a response by S. H. Zlotkin to a letter to the editor about his article "Micronutrient Sprinkles to Control Childhood Anaemia," in a 2005 issue of "PLoS Medicine."

Competing Interests: Declaration of Conflicting Interests:With the exception of Mr. Barnes, all authors received consulting fees related to the preparation of this article. Dr. Tsuyuki has received consulting or speaking fees from Emergent BioSolutions, Sanofi and Shoppers Drug Mart. He has received investigator-initiated research grants from Merck and Sanofi in the past 5 years. He is the president of SMHEART CONSULTING, Inc. Mr. Barnes reports ownership of a community-based, ambulatory, addiction-focused pharmacy where naloxone is dispensed. He receives commercial terms and training fees for the professional dispensing of naloxone. The other authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Unlabelled: Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in India. Sprinkles is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia., Objective: We aimed to determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops., Setting: Twenty two villages of Vadu Rural Health Program, KEM Hospital, Pune., Design: Double blind clustered randomized community-based trial., Subjects: Children (n=432) aged 6 to 18 mo age with Hb between 70 to 100 g/L were enrolled., Methods: Selected villages were randomized into 5 groups: Sprinkles 12.5, 20 or 30 mg ferrous fumarate, Sprinkles 20 mg micronized ferric pyrophosphate or drops 20 mg ferrous glycine sulphate (DROPS) for 8 weeks. Household socio-demographic information was collected at baseline. Side effects and compliance were monitored through weekly visits. Hemoglobin was estimated at baseline, 3 and 8 weeks. Ferritin was assessed at baseline and 8 weeks., Results: Baseline characteristics were similar across all groups. Hemoglobin increased significantly (P<0.0001) in all groups at 8 weeks with no difference between groups. Ferritin increased (P<0.0001) significantly in all groups with no difference across the groups. Compliance (overall range: 42 to 62 %) was lowest for DROPS. Side effects were significantly higher among DROPS compared to Sprinkles (p>0.05)., Conclusions: Sprinkles 12.5 mg FF dose is as efficacious as higher doses of iron in Sprinkles or DROPS in increasing hemoglobin. Sprinkles FF 12.5 mg is recommended as it has fewer reported side effects and better compliance compared to DROPS.