Ferrodeficiency and pregnancy: what to do and when to begin?

Abstract

In September 2021, an online webinar took place on the most common nutritional deficiency in the world – iron deficiency. According to the WHO recommendations, women should definitely receive iron and folic acid, starting with the stage of pregravid preparation, during pregnancy and lactation. Other trace elements and vitamins during pregnancy must be substantiated by evidence of their deficiency. WHO recommendations (2017) for antenatal care indicate that daily oral iron supplementation 30–60 mg and folic acid 400 µg in pregnant women can reduce the incidence of postpartum sepsis, preterm birth and low birth weight. Daily iron supplementation 60 mg should be preferred in regions where the prevalence of anemia in pregnant women ≥ 40%. In the first and third trimesters anemia is diagnosed by Hb level < 110 g/l, in the second trimester by Hb level < 105 g/l. If anemia is detected the iron dose is doubled until Hb reaches ≥ 110 g/l, after which the prophylactic dose is resumed. Iron supplements 120 mg once a week and folic acid 2800 µg once a week are recommended if daily intake of iron supplements is not possible due to side effects, and the prevalence of anemia in pregnant women does not exceed 20%.Modern Lipofer® technology in the development of liposomal iron delivery (when iron transported by liposomes) solved the problem of low bioavailability and poor tolerance, which is inherent in most ferrum drugs. As a result, iron trapped in liposomes (liposomal iron) does not come into contact with the mucous membranes of the gastrointestinal tract, but binds to chylomicrons, which enter the blood through the lymph, where iron is freed from the liposome. This way of absorption reduces iron loss, allows using of smaller doses and helps to avoid side effects.