- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05385042
Iron and Immune Response to Vaccine (IRONMUM) (IRONMUM)
Iron Supplementation and Immune Responses to Maternal Vaccination in Pregnant Women
Study Overview
Status
Conditions
Detailed Description
This is a prospective interventional open label cohort study with an exploratory framework. After assessment of gestation by routine ultrasound, women will be invited to participate if they have a viable, singleton pregnancy with a gestation < 28 weeks. Consenting pregnant women will be enrolled at first antenatal clinic [7] visit and receive tetanus and diphtheria immunisation after confirmation of vaccination history, and SARS-CoV-2 immunisation (first dose if indicated). All women will be classified as non-anaemic or anaemic based on haematocrit (Haematocrit<33% in first trimester (defined <14 weeks) and Haematocrit <30% in 2nd trimester (defined 14 to <28 weeks)). Women will be assigned to groups and receive prophylactic (non-anaemic) or treatment (anaemic) doses of nutritional supplements, respectively, as per routine practice. These supplements will be provided daily for 3 months (12 weeks) and women will be followed up at day 7, 1 month (day 28), 2 and 3 months. There after they will follow routine antenatal care until birth when a cord blood sample will be taken. Mother and infant blood samples will be taken at the 2 months post-partum visit when the newborn attends for routine vaccinations of the expanded program of immunisation. Immunological and haematological responses will be measured by venous blood sampling and finger-prick sampling (routine at the clinics) at study visits; as will adverse events in relation to nutritional supplements by monthly questions using a checklist of common reactions to oral iron. The Adherence Starts with Knowledge (ASK-12) instrument has been modified and used in this population and will be compared to the Haematocrit levels, the pill count and adverse events, as a measure of adherence.
IRONMUM study is funded by Procter and Gamble. The grant reference number is Thailand-UK-IRONMUM-2021-01.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Germana Bancone, Dr.
- Phone Number: +66 (0) 84 921 3818
- Email: germana@tropmedres.ac
Study Contact Backup
- Name: Rose McGready, Prof.
- Phone Number: +66 (0) 81 785 3585
- Email: rose@shoklo-unit.com
Study Locations
-
-
Tak
-
Mae Sot, Tak, Thailand, 63110
- Shoklo Malaria Research Unit (SMRU)
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Viable singleton pregnancy<28 weeks confirmed by ultrasound
- 18 years and older
- Willingness and ability to comply with the study protocol for the duration of the study
- Can understand information about the study and provide consent
Exclusion Criteria:
- Any diphtheria-tetanus vaccine within the previous 2 years
- History of allergic reaction to diphtheria-tetanus or COVID-19 vaccine
- Haematocrit <21% or Haematocrit >50%
Known severe haemoglobinopathy (HbE/beta-thalassaemia syndrome, beta-thalassaemia major or HbH syndrome)* or G6PD deficiency
* Iron supplementation is safe in pregnant women with haemoglobin E, alpha-thalassemia 1, or beta-thalassemia carriers.
- HIV-positive
- Slide confirmed presence of malaria
- Fever (defined at >37.5°C)
- Symptoms of COVID (these women will be PCR tested as routine in clinic)
- Known severe medical or obstetric complication e.g. valvular heart disease, placenta praevia
- Known or clinical vitB12 deficiency as indicated by megaloblastic anaemia (pernicious anaemia or clinical symptoms)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Non-anaemic pregnant women
50 pregnant women who have normal haematocrit (not anaemic) at 12 weeks.
|
Prophylactic dietary supplements: 1 capsule of Sangobion + separate Thiamine Hydrochloride tablet 100mg per day for 12 weeks. Then non-anaemic pregnant women will continue with prophylactic nutritional supplements until delivery. |
Other: Anaemic pregnant women
100 pregnant women who have haematocrit below 33% (equates to Hb 11g/dL) in first trimester (<14 weeks gestation) and below 30% (equates to Hb 10g/dL).
|
Treatment dietary supplements: 3 capsules of Sangobion + separate Thiamine Hydrochloride tablet 100mg, Vit B12 100mcg per day for 12 weeks. If experience a therapeutic increase of 3% Haematocrit within 28 days (responders), they will continue with prophylactic nutritional supplements until delivery. If no affect in Haematocrit level within 28 days (non-responders; defined by trimester of diagnosis), they will be investigated for their serum ferritin and if this is low (<15ng/mL) intravenous (iv) iron supplement (Venofer®) will be provided. The dose will be calculated for the individual concerned (required iron dose (mg) = (2.4 x (target Hb of 11g/dL (Ht 33%) x pre-pregnancy weight (kg) +1000mg for replenishment of stores). Doses will be administered by slow iv infusion 200 mg per dose (maximum of 3 doses per week). Following treatment they will continue with prophylactic nutritional supplements. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Antibody responses to maternal vaccine
Time Frame: change from baseline before immunisation and at 7-days and 28-days after immunisation, and at 2 months post-partum in mother and infant.
|
Antibody responses to diphtheria-tetanus and SARS-CoV-2 immunisation, measured by ELISA.
|
change from baseline before immunisation and at 7-days and 28-days after immunisation, and at 2 months post-partum in mother and infant.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cellular Immune response post-immunisation measured by Mass Cytometry (plasma cells and circulating T-follicular helper cells).
Time Frame: 7-days after immunisation
|
7-days after immunisation
|
|
Profile of the circulating immune system components over the course of pregnancy measured by CyTOF
Time Frame: change from before immunisation, 7-days and 28-days after immunization and until 2 months post-partum in mother and infant
|
change from before immunisation, 7-days and 28-days after immunization and until 2 months post-partum in mother and infant
|
|
Haematological, iron and inflammatory parameters including: Hb, MCV, haematocrit serum iron, ferritin, TSAT, hepcidin, CRP, G6PD, Hb typing.
Time Frame: change from before immunisation, 7-days and 28-days after immunization and at 2 months post-partum in mother and infant
|
change from before immunisation, 7-days and 28-days after immunization and at 2 months post-partum in mother and infant
|
|
Haematocrit from baseline if anaemic at baseline according to trimester of gestation
Time Frame: change from baseline and month 1,2 and 3, and delivery
|
change from baseline and month 1,2 and 3, and delivery
|
|
Modified Adherence Starts with Knowledge (ASK-12) questionnaire including pill count.
Time Frame: Month 1,2 and 3
|
ASK-12 scores can range from 12-60, with higher scores representing greater barriers to adherence]
|
Month 1,2 and 3
|
To monitor safety of iron supplements
Time Frame: change from baseline and month 1,2 and 3
|
Monitor adverse events in mother and neonate - gastrointestinal (e.g.
constipation, diarrhea, infection)
|
change from baseline and month 1,2 and 3
|
Other Outcome Measures
Outcome Measure |
Time Frame |
---|---|
To assess if the amount of betel nut consumption relates to Haematocrit response
Time Frame: change from baseline and month 1,2 and 3
|
change from baseline and month 1,2 and 3
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Hal Drakesmith, Dr., MRC Human Immunology Unit, John Radcliffe Hospital, University of Oxford, OX3 9DS UK
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HCR22001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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