Bradford mums are taking part in new research to investigate if taking iron during pregnancy can prevent anaemia, reducing risk of stillbirth, post-partum haemorrhage and postnatal depression.
The PANDA (Primary prevention of maternal ANaemia to avoid preterm Delivery and other Adverse outcomes) trial – which Bradford Teaching Hospitals NHS Foundation Trust is participating in – is set to investigate if routinely taking iron supplements during pregnancy can prevent anaemia, reducing the risk of stillbirth, pre-term birth, postnatal depression, haemorrhage after delivery and the need for blood transfusions.
Around one in three pregnant women will develop anaemia and need treatment with oral iron supplements (iron tablets). The trial will investigate if taking iron supplements preventatively, even before a mother has developed anaemia, is beneficial to both mother and baby and will reduce the symptoms and outcomes that go with low iron in pregnancy. This study is being led by NHS Blood and Transplant (NHSBT) and the University of Oxford and funded by the National Institute for Health and Care Research (NIHR).
Bradford Teaching Hospitals’ maternity unit at the Bradford Royal Infirmary is one of a number of participating NHS trusts where pregnant women can take part in the research trial.
Mothers with anaemia experience symptoms including extreme fatigue, weakness and poor concentration and may be at higher risk of infection, premature birth, bleeding after delivery and having babies of low birth weight. It is thought there may also be a link between anaemia and postnatal depression and there are studies that suggest the babies of mothers with iron-deficiency and anaemia may show developmental difficulties in childhood. Anaemia may have an impact on a range of problems in mothers and infants and affect survival (morbidity and mortality). The PANDA trial will identify if these problems can be safely addressed using supplements of oral iron, as we do not know this.
The trial is now open to women who are in the first 16 weeks of pregnancy. Those who join will be given either iron supplements or placebo tablets, to take every day throughout their pregnancy and until six weeks after birth.
Researchers will assess several factors within both groups, including the numbers of pre-term births, stillbirths, neonatal deaths and babies deemed small for their gestational age, as well as the proportion of women developing anaemia during pregnancy, any changes in red cell counts in the blood during pregnancy, any changes in red cell counts in the blood during pregnancy and the proportion of women with bleeding after giving birth.
Longer term, the study will also link with other organisations to collect data to understand the effects of giving iron supplements during pregnancy on a child’s development – we know that iron plays an important role in a baby’s neurodevelopment.
Earlier research has already been done as a part of the study, to find out the best dose of iron to offer to non-anaemic pregnant women, balancing likely effectiveness with side effects.
Co-Chief Investigator Professor Simon Stanworth, Consultant Haematologist for NHS Blood and Transplant and University of Oxford, said:
“The PANDA trial addresses the very common problem of anaemia in pregnancy. We need to know whether taking a single tablet of iron throughout pregnancy has a benefit for both mother and infant – if it does, there is the real potential to change practice and improve outcomes in maternity. This study is a prime example of the world class research being carried out by both NHS Blood and Transplant and our partners and it is great to see recruitment starting at so many maternity hospitals, along with the interest this study has generated nationally.”
Natalie Higham-James, 31, a University Researcher and mum of two from Manchester, had anaemia in her second pregnancy, in 2024. She said:
“Whilst neither of my pregnancies had been straightforward, I assumed my second seemed so much harder day-to-day because I was also juggling a toddler and had been struggling with gestational diabetes and severe acid reflux. I felt exhausted all the time and was unable to do the most basic tasks like play with my three-year-old, take the dog for a walk and some days even walk up the stairs without having to stop for breath. I was utterly miserable and desperate for my baby to just get here.
“It was during blood tests for my dietary issues that my iron levels were checked and found to be dangerously low, so at 37 weeks I was diagnosed with severe anaemia and I had to undergo two iron infusions. I was told that without, there was an increased risk of me haemorrhaging during birth – not something any late term pregnant woman wants to hear. The difference in energy I felt after the infusions was remarkable. Had the anaemia been spotted earlier or prevented from the outset, I believe I would’ve had a much easier pregnancy, both physically and mentally.
“The PANDA study is really important – we need to be looking at ways to prevent anaemia rather than just treat it, often too late, so that women can feel their best throughout pregnancy. Being pregnant is difficult enough, so anything that’s going to help ensure that both mother and baby are at their best, is well worth exploring.”
Professor David Churchill, Lead Consultant Obstetrician at The Royal Wolverhampton NHS Trust and Obstetrics lead on the PANDA trial, explained:
“Any obstetrician is always looking to reduce the risks of preterm birth, growth insufficiency in babies and stillbirths. To think that a simple and cheap intervention, like a single iron tablet a day, could have such a big impact for thousands of women and their babies is remarkable. It is testament to how important it is to carry out this trial and finally come to a definitive answer.”
Joanne Murray, Public Co-Investigator on the PANDA trial, working to ensure women’s perspectives are fed into all aspects of the research, concluded:
“After suffering anaemia in my first pregnancy, I felt compelled to work with the PANDA team to support the development of new guidelines to make avoiding anaemia standard practice for pregnant women. I believe this study will be a major step towards ensuring fewer pregnancies are affected.”
The PANDA study is now open to women across the UK at all *participating hospitals, who are under 16 weeks pregnant with a single baby. Women can ask their healthcare professional for more information or ask about taking part.
Further information can be found here: PANDA – Clinical Trials Unit – NHS Blood and Transplant
*Participating hospitals include: United Lincolnshire Hospitals NHS Trust – Lincoln County Hospital/Pilgrim, Royal Wolverhampton NHS Trust – New Cross Hospital, County Durham and Darlington NHS FT – Darlington Memorial hospital & University Hospital of North Durham, Oxford University Hospitals NHS Foundation Trust – John Radcliffe, Milton Keynes University Hospital NHS Foundation Trust – Milton Keynes University Hospital, Barts Health NHS Trust – Royal London Hospital & Whipps Cross, Nottingham University Hospitals NHS Trust – Queen’s Medical Centre, Leeds Teaching Hospitals NHS Trust – St James’ & Leeds General Infirmary, Shrewsbury and Telford Hospital Trust – Princess Royal Hospital, Sherwood Forest Hospitals NHS Foundation Trust – King’s Mill Hospital, Sheffield Teaching Hospitals NHS Foundation Trust – Jessop Wing, Royal Berkshire NHS Foundation Trust – Royal Berkshire, Mid Cheshire Hospitals Foundation Trust – Leighton Hospital, Norfolk and Norwich University Hospital – NNUH, Bradford Teaching Hospitals NHS Foundation Trust – Bradford Royal Infirmary, Chelsea and Westminster Hospital NHS Foundation Trust – Chelsea and Westminster & West Middlesex Hospital, South Tees Hospitals Foundation Trust – James Cook, King’s College Hospital NHS Foundation Trust – King’s College Hospital / Princess Royal University Hospital, Northampton General Hospital NHS Trust – Northampton General Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust – York Hospital, Blackpool Teaching Hospitals NHS Foundation Trust – Blackpool Victoria infirmary, East Cheshire NHS Trust – Macclesfield District General Hospital, East Cheshire NHS Trust – Macclesfield District General Hospital, Whittington Health NHS Trust – The Whittington Hospital.