Use and Adherence to Oral-Iron during Pregnancy
Research type
Research Study
Full title
USE AND ADHERENCE TO ORAL-IRON DURING PREGNANCY: EXPLORING THE DRIVERS OF BEHAVIOUR AND DEVELOPING A BEHAVIOURAL INTERVENTION
IRAS ID
282656
Contact name
Simon Stanworth
Contact email
Sponsor organisation
NHS Blood and Transplant
Clinicaltrials.gov Identifier
NIHR200869, FUNDER Number
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
Research Summary
Around a third of UK pregnant women develop anaemia (reduced numbers of red blood cells) caused by lack of iron. Anaemia may mean that women experience general health problems such as excessive tiredness. Severe anaemia during pregnancy might increase the risk of a baby being stillborn, born early, or born small (with a low birthweight). It may also increase the risk of blood loss during childbirth and affect a baby’s development. We know that treating anaemia after it develops does not reduce all the risks.
This study is the first part (out of five parts) of an NIHR-funded programme of research named PANDA (Primary prevention of maternal ANaemia to avoid preterm Delivery and other Adverse outcomes). The overall aim of this programme of research is to find out whether we can prevent anaemia in the first place by giving iron tablets. In this study we first want to find out what women think about anaemia and why women do (or do not) take iron tablets during pregnancy. We also want to find out how the healthcare professionals (e.g. midwives, obstetricians, and General Practitioners) are managing and treating anaemia during pregnancy. The findings of this study will help us to support women to take iron supplements regularly and will inform the other parts of the PANDA research programme.
Summary of results
The findings described here are from a study called: Use and adherence to oral iron during pregnancy: Exploring the drivers of behaviour and developing a behavioural intervention. This study is part of a larger research project called PANDA (Primary prevention of maternal ANaemia to avoid preterm Delivery and other Adverse outcomes), which is funded by the National Institute for Health Research (NIHR) and sponsored by NJS Blood and Transplant (NHSBT). PANDA is focused on the use of oral iron supplements during pregnancy. Currently, women diagnosed with anaemia during pregnancy are given oral iron supplements to treat it. We want to understand whether giving oral iron supplements to all pregnant women (even those without anaemia) will help to stop anaemia from developing (otherwise called prevention of anaemia). In the larger research project, we will be testing whether giving women oral iron supplements during pregnancy helps to prevent anaemia from developing.
For the study Use and adherence to oral iron during pregnancy: Exploring the drivers of behaviour and developing a behavioural intervention, we wanted to achieve the following aims:
a) To understand pregnant women’s views on what factors help or stop them from deciding to take, and continuing to use oral iron supplements during pregnancy that are recommended for the prevention of anaemia
b) To understand how clinicians support pregnant women with anaemia currently and their thoughts on giving oral iron supplements during pregnancy for the prevention of anaemia
c) To develop potential strategies to support decision making and use of oral iron supplementals as recommended during pregnancy
Twenty seven pregnant women (13 who had a diagnosis of anaemia and 14 who did not have a diagnosis of anaemia) took part in interviews. These women were attending antenatal appointments in England NHS clinics during 2020. Women talked about their experiences of taking medicines and supplements during pregnancy. Women who were taking oral iron supplements spoke about their experiences of taking these. Women also talked about their views on taking oral iron supplements during pregnancy to prevent anaemia from developing, rather than only taking the supplements to treat anaemia.Findings from interviews showed that understanding about anaemia, discussing anaemia with others (like friends and doctors) and how important anaemia was viewed compared to other aspects of health in pregnancy influenced the decision to start taking oral iron supplements. Forgetting to take supplements, using reminder strategies to help take supplements, confidence to take supplements as recommended, and women identifying as responsible for baby’s health were factors that were viewed to influence taking oral iron supplements as recommended.
Findings from the interviews were used to develop strategies to support women in deciding whether or not to take oral iron during pregnancy and to help women take oral iron supplements as recommended during pregnancy. These strategies included: giving information on the purpose of the PANDA dosing trial (the next stage of the PANDA project), giving information about anaemia and oral iron supplements in videos from healthcare professionals and providing support to women to set up their own ways to take oral iron supplements as recommended (e.g. monitoring their use of oral iron supplements, using reminders, building taking the supplement into a routine).
These strategies were presented in a workshop in Spring 2021 to three healthcare professionals, two behavioural scientists and nine pregnant women representatives to understand which of these strategies were thought to be acceptable and able to be delivered within the NHS. Each of the strategies presented were generally viewed to be acceptable and likely to be usable in an NHS setting. The timing of using strategies providing women with information about anaemia and oral iron supplements was discussed as being important to consider. Women are given a lot of information early on in their pregnancy journey and so it would be important not to overwhelm them with too much. Workshop attendees also said that the diversity of those included in materials (e.g. healthcare professionals involved in videos giving information), as well as different languages materials could be produced in was important. Changes to strategies were suggested including the use of an app to deliver the strategies and having more pictures/strategies being more visual rather than lots of text.
Throughout this study, two members of the public (both of whom had knowledge and/or lived experience of pregnancy and anaemia during pregnancy) were involved in supporting the study. They were involved in designing the study, developing study materials like information sheets and interview questions, as well as supporting the research team to interpret and understand findings from interviews.
The findings from this study have helped to develop a full package of strategies to help women in deciding to take oral iron during pregnancy and to help them take it as recommended. These strategies are being used in other studies within PANDA. One study is called a dosing trial and is exploring how much (what dose) of oral iron supplements is best to give women in order to reduce the chance of them developing anaemia during pregnancy.
You can learn more about this study from our study website here: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbbSnkJ-2BLtEwCbbV4w7rOzFJfT1KpWj5zpPWScb20uq95CaUK4-2FyDUElmxAAQynDfNvjWglpWP1AHqCmEANzm7STv2YG7BSjdbn5fVnVl3rlIoQJ-2FhgOqBwpo-2F1r-2FjeXWcw-3D-3D3yAw_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YJL4UCml-2FQ0RrmPlSPW9OObmZ8oZ4lvwBfL7rWAkSSrow7JuOXgQBWoqhvmz46lIb94FZCtniqQSRmV22xfoz69HiXT6jyw4ZweIliYrGSgPoGlhX3BG0MKbbe4EZdLjFfhaQYIHDQ6zBtEt6lsgleC4vYB-2B54d0ydhG5gRvNM-2BUQ-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7Cf130c11f17da43dc2c8108da97fdad66%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637989413028677825%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=LSsc7SqjRxMj8Eb3h1jHR8QhljGC1%2BjYE5T2OXwptos%3D&reserved=0
REC name
Wales REC 1
REC reference
20/WA/0137
Date of REC Opinion
29 May 2020
REC opinion
Further Information Favourable Opinion