Iron supplementation during pregnancy: versions and contraversions

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Iron deficiency status is one of the most common pregnancy complications in many countries of the world and requires timely diagnosis, prevention and treatment. The article describes the current understanding of etiology, pathogenesis, clinic and diagnosis of clinical manifestations and diagnostics of iron deficiency status during pregnancy. Particular attention is paid to the regulation of iron homeostasis and screening of iron status during pregnancy. According to modern concepts, the initial iron status determines the U-shaped risk curve for pregnancy complications and the effects of iron supplementation. On the one hand, iron deficiency status has a negative impact on the development of pregnancy complications and fetal pathology. When iron deficiency anemia is detected in the first trimester of pregnancy, the association with adverse outcomes is more obvious, but this ratio usually weakens with a detected decrease in hemoglobin in the second or third trimester of pregnancy. On the other hand, several potential mechanisms have now been identified by which excessive iron supplementation or high iron status during pregnancy can have an adverse effect on pregnancy outcomes. The article shows the need for screening of iron status during pregnancy and rational ferroprophylaxis with a personalized approach. Recommendations for choice and use of iron supplements are provided with due account for clinical guidelines and modern evidence-based data. A review of international and domestic sources devoted to the range of problems is made, experience of credible clinical trials is generalized. The issues of dosage, bioavailability, safety of use during pregnancy and pharmaceutical compatibility of iron supplements are considered.