Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Oral iron supplementation after postpartum haemorrhage. Oral iron supplementation, either alone or in combination with folic acid supplementation, may be provided to postpartum women for 6–12 weeks following delivery for reducing the risk of anaemia in settings where gestational anaemia is of public health concern
Context specific recommendation
Only in specific contexts
Notes and Remarks
- This recommendation is applicable to all postpartum women, irrespective of their lactation status.
- For ease of implementation and continuity of care, postpartum supplementation should begin as early as possible after birth; the iron supplementation regimen (e.g. dose and whether consumed daily or weekly) should follow that used during pregnancy (3); alternatively, it should start with that planned for menstruating women (61).
- Women should receive counselling on why and how to take iron and folic acid supplements. They should be informed of the common side-effects and be advised on how to manage them (e.g. take with meals or at bedtime) (60).
- Once menses have returned, women should receive supplementation in accordance with the country’s policy or WHO guidance on iron and folic acid supplementation for menstruating women (61).
- In cases in which a woman is diagnosed with anaemia (62), she should be treated in accordance with the country’s policy or the WHO recommendation of daily iron (120 mg of elemental iron plus 400 μg folic acid) supplements until haemoglobin concentrations rise to normal (60, 63).
- In malaria endemic areas, provision of iron and folic acid supplements should be implemented in conjunction with measures to prevent, diagnose and treat malaria (64, 65). In areas using sulfadoxine– pyrimethamine, high doses of folic acid should be avoided because they may interfere with the efficacy of this antimalarial drug (66, 67).
- An iron and folic acid supplementation programme should ideally form part of an integrated programme for postnatal care (68) that promotes exclusive breastfeeding in the first 6 months and continued breastfeeding, screening of all women for anaemia at postpartum visits, use of complementary measures to control and prevent anaemia, and a referral system to manage cases of severe anaemia. Particular attention should be given to identifying potential barriers to equitable access to health care, including postnatal care, suffered by population groups most vulnerable to iron deficiency and iron-deficiency anaemia, such as women in rural areas, women in low-income groups, women from racial or ethnic groups discriminated against, or women in settings where prevailing gender norms greatly disempower them over their body and health. Country programmes should be culturally appropriate to the target populations, so that the intervention is accepted, adopted and sustained.
- Oral supplements are available in capsules or tablets (soluble, dissolvable and modified-release tablets) (69). A strong quality assurance process is important to guarantee that supplements are manufactured, packaged and stored in a controlled and uncontaminated environment (37). Distributers and women should monitor the expiration dates of the supplements to ensure that they are not provided or taken after their expiration date.
- Iron supplements are prepared using several iron compounds, primarily containing ferrous compounds (e.g. fumarate, gluconate, sulfate) that are better absorbed then ferric iron (70). The WHO Essential Medicines List specifies that iron supplements should contain a ferrous salt (71).
- In all settings, breastfeeding mothers should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet (one that includes meat, fish, poultry and legumes when available and culturally appropriate), and to refer to guidelines on healthy eating during breastfeeding (72).
- An efficient system for the routine collection of relevant data, including therapeutic adherence and measures of programme performance, is critical to ensure that supplementation programmes are effective and sustained. Monitoring is key to identifying barriers that might be maintaining unequal access to postnatal care, including iron and folic acid supplementation, thus preserving health inequities. Sustained implementation and scale-up greatly benefit from appropriate monitoring mechanisms.