Abstract
A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.
Highlights
Anemia with a hemoglobin (Hb) concentration no lower than 10 g/dL at term, occurs in most pregnancies, and in the majority of cases reflects a physiologic process rather than a deficiency state or underlying hematologic disorder [1]
The effects of iron deficiency (ID) on red cell production occur in the context of what is usually called the physiologic anemia of pregnancy
The “gold standard” for ID is the absence of stainable reticuloendothelial iron on a bone marrow specimen, in clinical practice it is usually defined by surrogate laboratory markers such as a low serum ferritin or a decreased percentage of transferrin saturation by iron [31]
Summary
Anemia with a hemoglobin (Hb) concentration no lower than 10 g/dL at term, occurs in most pregnancies, and in the majority of cases reflects a physiologic process (discussed below) rather than a deficiency state or underlying hematologic disorder [1]. Anemia is a major contributor to maternal and fetal morbidity and mortality, in less developed countries [2,3,4,5,6]. Of the pathologic causes of anemia in pregnancy, anemia due to iron deficiency (IDA) is the most common, in more developed countries, where contributions from other anemia-producing disorders such as malaria or hemoglobinopathies are less significant [7,8,9]. In preparing for this review, PubMed searches using the terms “pregnancy” and “iron deficiency” were performed. 71 reports, reviews, or studies new to the author were identified through this process
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