Oral Iron Supplementation is Most Appropriate
For a healthy 28-week primigravida with no complications, oral iron supplementation (Option C) is the most appropriate choice to contribute to her health and wellness. 1
Rationale for Iron Supplementation
All pregnant women should take 45-60 mg of elemental iron daily throughout pregnancy to support maternal health and optimal fetal development. 1 This recommendation is particularly important at 28 weeks gestation, when iron demands are at their peak and the risk of developing iron deficiency anemia is highest. 2
Key Benefits of Iron Supplementation
Iron supplementation during pregnancy consistently increases serum ferritin and hemoglobin levels while reducing the prevalence of iron deficiency anemia. 3
Prophylactic iron supplementation likely results in a large reduction in maternal anemia during pregnancy (NNT = 10), with higher hemoglobin levels (mean difference 6.95 g/L) and ferritin levels (mean difference 12.22 ng/ml) compared to no supplementation. 4
Iron deficiency anemia during pregnancy increases the risk of preterm birth, low birth weight, and postpartum hemorrhage. 2, 5
Adequate iron supply is essential for normal fetal brain development and cognitive abilities of the newborn, with children born to iron-deficient mothers starting life with iron deficiency. 5
Recommended Dosing at 28 Weeks
The standard dose is 30-60 mg of elemental iron daily during the second and third trimesters. 1, 6
Low daily doses of iron (30 mg elemental iron) improve women's iron status and protect infants from iron-deficiency anemia, and may improve birth weight even in non-anemic women. 6
Iron supplements should ideally be taken at bedtime or between meals to ensure optimum absorption. 3
Why Not the Other Options?
Tdap Vaccine (Option B)
While Tdap vaccination is important during pregnancy, it is typically recommended between 27-36 weeks gestation and represents a one-time intervention rather than ongoing supplementation for maternal and fetal health throughout the remainder of pregnancy. [@General Medicine Knowledge@]
Influenza Vaccine (Option A)
Influenza vaccination is recommended for all pregnant women during flu season, but this is a seasonal and one-time intervention, not a continuous health maintenance measure like iron supplementation. [@General Medicine Knowledge@]
Calcium Supplements (Option D - if this refers to calcium rather than GBS prophylaxis)
Calcium supplementation (1200-1500 mg daily) is recommended during pregnancy, but it is typically part of a comprehensive prenatal vitamin regimen that should already include iron. 1 At 28 weeks with everything normal, iron deficiency prevention takes priority as a specific intervention.
Critical Considerations
Calcium can inhibit iron absorption, so if both supplements are given, they should be taken at different times of day. 1
Higher iron dosages above 100 mg/day are not recommended due to potential negative effects on mineral absorption, oxidative stress, and adverse gastrointestinal symptoms. 3, 6
The harms of iron supplementation are generally minor (gastrointestinal symptoms, darkening of stool), while the benefits for preventing maternal anemia and supporting fetal development are substantial. 2