The iron-rich bread (2.2 mg iron per 50 g slice) used in the study was developed using Eragrostis tef flour, naturally rich in iron. Iron deficiency is prevalent in pregnancy and compliance with supplements can be low. In this double-blind, randomized trial 34 Caucasian, primiparous antenatal patients were randomized to receive intervention bread or a placebo for 6 weeks. Women consumed on an average of 2.3 slices per day, providing a total of 5.0 mg iron. Using World Health Organisation (2001) haemoglobin cut-offs, 12% of participants eating the iron-rich bread were iron deficient by the end of the study compared with 27% in the control group. For other markers of iron status, these were improved in the placebo versus the treatment group. For example, a significant decline in serum iron and transferrin saturation was not observed in this group. Findings demonstrate that other modes of delivery, i.e. food fortification, may be needed to generate 'physiological effects', or further measures are taken to improve intervention compliance.