Abstract
BackgroundIron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country.MethodsWithin a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26–28 weeks’ gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 μg/L (iron sufficiency), 15 to < 30 μg/L (modest iron depletion) and < 15 μg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion.ResultsThe median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9–30.6) μg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15–4.84), Malay (2.05; 1.30–3.24) and Indian (1.98; 1.14–3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13–2.38), multiparity (1.73; 1.23–2.44) and lack of iron-containing supplementation (3.37; 1.25–8.53) were associated with increased odds of modest and severe iron depletion.ConclusionsNearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy.Trial registrationNCT01174875. Registered 1 July 2010 (retrospectively registered).
Highlights
Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide
The extra iron requirements during pregnancy are considered to be met through cessation of menstrual losses, increased intestinal absorption and mobilisation of maternal iron stores [8]
Compared to women with iron sufficiency, those with modest iron depletion were more likely to belong to the Malay (27.6 versus 21.7%; P < 0.001) or Indian (21.8 versus 13.6%; P < 0.001) ethnic groups, to attain university education (36.5 versus 29.5%; P = 0.043), to be multiparous (60.0 versus 51.2%; P = 0.013), less likely to have taken iron-containing supplements during pregnancy (85.5 versus 93.4%; P = 0.001) and had higher plasma soluble transferrin receptor (sTfR) concentration
Summary
Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country. Iron deficiency is the most prevalent global nutrient deficiency and the most common cause of anaemia worldwide [1, 2]. A large proportion of pre-pregnant women or those of reproductive age have low iron stores [9, 10], predisposing them to an increased risk of iron deficiency when becoming pregnant [8]. In Singapore, a developed country, one in five non-pregnant women of reproductive age were found to be anaemic [11]
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