@article{Brabin2017-um,

title = {Effects of long-term weekly iron and folic acid supplementation  on lower genital tract infection - a double blind, randomised  controlled trial in Burkina Faso},

author = {Loretta Brabin and Stephen A Roberts and Sabine Gies and Andrew Nelson and Salou Diallo and Christopher J Stewart and Adama Kazienga and Julia Birtles and Sayouba Ouedraogo and Yves Claeys and Halidou Tinto and Umberto d'Alessandro and E Brian Faragher and Bernard Brabin},

doi = {10.1186/s12916-017-0967-5},

issn = {1741-7015},

year  = {2017},

date = {2017-11-01},

urldate = {2017-11-01},

journal = {BMC Med.},

volume = {15},

number = {1},

pages = {206},

abstract = {BACKGROUND: Provision of routine iron supplements to prevent 

 anaemia could increase the risk for lower genital tract 

 infections as virulence of some pathogens depends on iron 

 availability. This trial in Burkina Faso assessed whether weekly 

 periconceptional iron supplementation increased the risk of lower 

 genital tract infection in young non-pregnant and pregnant women. 

 METHODS: Genital tract infections were assessed within a double 

 blind, controlled, non-inferiority trial of malaria risk among 

 nulliparous women, randomised to receive either iron and folic 

 acid or folic acid alone, weekly, under direct observation for 18 

 months. Women conceiving during this period entered the pregnancy 

 cohort. End assessment (FIN) for women remaining non-pregnant was 

 at 18 months. For the pregnancy cohort, end assessment was at the 

 first scheduled antenatal visit (ANC1). Infection markers 

 included Nugent scores for abnormal flora and bacterial vaginosis 

 (BV), T. vaginalis PCR, vaginal microbiota, reported signs and 

 symptoms, and antibiotic and anti-fungal prescriptions. Iron 

 biomarkers were assessed at baseline, FIN and ANC1. Analysis 

 compared outcomes by intention to treat and in iron 

 replete/deficient categories. RESULTS: A total of 1954 women 

 (mean 16.8 years) were followed and 478 (24.5%) became pregnant. 

 Median supplement adherence was 79% (IQR 59-90%). Baseline BV 

 prevalence was 12.3%. At FIN and ANC1 prevalence was 12.8% and 

 7.0%, respectively (P \< 0.011). T. vaginalis prevalence was 

 4.9% at FIN and 12.9% at ANC1 (P \< 0.001). BV and T. vaginalis 

 prevalence and microbiota profiles did not differ at trial 

 end-points. Iron-supplemented non-pregnant women received more antibiotic treatments for non-genital infections (P = 0.014; mainly gastrointestinal infections (P = 0.005), anti-fungal treatments for genital infections (P = 0.014) and analgesics (P = 

 0.008). Weekly iron did not significantly reduce iron deficiency 

 prevalence. At baseline, iron-deficient women were more likely to have normal vaginal flora (P = 0.016). CONCLUSIONS: 

 Periconceptional weekly iron supplementation of young women did 

 not increase the risk of lower genital tract infections but did 

 increase general morbidity in the non-pregnant cohort. Unabsorbed 

 gut iron due to malaria could induce enteric infections, 

 accounting for the increased administration of antibiotics and 

 antifungals in the iron-supplemented arm. This finding reinforces 

 concerns about routine iron supplementation in highly malarious 

 areas. TRIAL REGISTRATION: Trial registration number NCT01210040 

 . Registered with Clinicaltrials.gov on 27 September 2010.},

keywords = {Adolescents; Antibiotics; Burkina Faso; Iron; Lower genital tract   infection},

pubstate = {published},

tppubtype = {article}

}