Iron Deficiency In Pregnant Women Research Articles

Factors associated with iron deficiency in pregnant women seen at a public prenatal care service

OBJECTIVE: This study aimed to determine the frequency of iron deficiency and its association with socioeconomic, obstetric, and nutritional factors in pregnant women. METHODS: This cross-sectional study included women on the second trimester of pregnancy seen at a public prenatal care facility of Cuiabá, Mato Grosso, Brazil from May 2008 to May 2009. Socioeconomic, nutritional, and obstetric data were compared with markers of iron stores. RESULTS: During the study period, 146 pregnant women met the inclusion criteria. The frequency of anemia characterized by abnormal hemoglobin level, hematocrit, and mean corpuscular volume varied from 3% to 5%. However, 11% of the women had high transferrin levels and 39% had low ferritin levels. Before pregnancy, 21% of the women were underweight and 29% were overweight or obese. During pregnancy, the percentage of overweight or obese women rose to 40%. History of miscarriages, higher gestational age, and excess weight before pregnancy were associated with markers of iron stores at abnormal levels. Consumption of specific food groups was not associated with abnormal marker levels. CONCLUSION: Serum ferritin was the most sensitive indicator of iron deficiency. Excess weight and anemia were concomitant.

Vitamin a and iron deficiency in pregnant women, lactating mothers and their infants in Adamawa State, Nigeria: a prospective cohort study

Vitamin a and iron deficiency in pregnant women, lactating mothers and their infants in Adamawa State, Nigeria: a prospective cohort study

Vitamin A and Iron Deficiency in Pregnant Women, Lactating Mothers and Their Infants in Adamawa State, Nigeria: A Prospective Cohort Study

We determined the breast-feeding patterns, Vitamin A and Iron supplement intake between various age groups of pregnant women in Adamawa state, Nigeria. Of the 161 pregnant women screened for this study, 73% were from Njoboliyo (NJ) (n=118) while 27% from GD Chanrai Memorial hospital (CMH) (n=43). Of the 161 women from the two study sites, women within the 15-24 age brackets had the highest number of study participants (65) 40%. Two-thirds of the study participants take supplements of Iron and Vitamin A (68%) in both study sites, while (22%) in Njoboliyo and (20%) in CMH breast-feed their infants for more than 6months. The intake of iron and vitamin A was observed to be higher in women of age 25-34, but it was statistical not significant (P=0.12, DF=3, X 2 =0.65). Comparing breast-feeding patterns irrespective of age, we observed that 94.1% of the pregnant mothers breast-feed their infants as opposed to the 5.9% that do not breast-feed, but the pattern showed no significant relationship when compared across the various age groups (P=0.62, DF=3, X

Impact of Prophylactic Iron Supplementation in Healthy Pregnant Women on Maternal Iron Status and Birth Outcome

In spite of the beneficial effect of iron supplementation in iron-deficient pregnant women, iron supplementation may not be needed for women who are iron replete or not anemic. Moreover, the theoretical possibility of adverse effects, such as oxidative damage,from administration of iron supplements during pregnancy has been raised. To determine the effect of prophylactic iron supplementation on iron status and birth outcomes among nonanemic pregnant women. METHODS. A randomized, triple-blind clinical trial was conducted. One hundred forty-eight nonanemic pregnant women with hemoglobin > 110 g/L, serum ferritin > 12 microg/L, and gestational age < 20 weeks were randomly assigned to receive either ferrous sulfate (60 mg elemental iron) (n = 70) or placebo (n = 78) until delivery. Hemoglobin concentration and serum ferritin were measured by electronic counter and radioimmunoassay, respectively. Data were analyzed by independent t-tests, ANCOVA, and repeated measures. At delivery, the incidence of iron deficiency was significantly lower in the iron than in the placebo group. There were no significant differences between the two groups in maternal hemoglobin and ferritin concentrations at delivery or in the infant's birthweight, birth length, or length of gestation. Iron supplementation during pregnancy in nonanemic women with low serum ferritin may have benefits beyond the prevention of iron-deficiency anemia.

Efficacy and safety of oral iron(III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study

Objective: To evaluate the efficacy and safety of iron(III) polymaltose complex (Maltofer®) versus ferrous sulfate in iron-deficient pregnant women using recommended doses. Methods: An exploratory, open-label, randomized, controlled, multicenter study was undertaken in 80 pregnant women with iron-deficiency anemia (hemoglobin ≤ 10.5 g/dL, serum ferritin ≤ 15 ng/mL and mean corpuscular volume < 80 fL). Patients were randomized 1:1 to oral iron(III) polymaltose complex or ferrous sulfate (each 100 mg iron twice daily) for 90 days. Results: The primary endpoint, change in hemoglobin from baseline to days 60 and 90, did not differ significantly between treatment groups. The mean (SD) change to day 90 was 2.16 (0.67) g/dL in the iron(III) polymaltose complex group and 1.93 (0.97) g/dL in the ferrous sulfate group (n.s). Mean serum ferritin at day 90 was 179 (38) ng/mL and 157 (34) ng/mL with iron(III) polymaltose complex and ferrous sulfate, respectively (p = 0.014). Adverse events were significantly less frequent in the iron(III) polymaltose group, occurring in 12/41 (29.3%) patients, than in the ferrous sulfate group (22/39 [56.4%]) (p = 0.015). Conclusions: Oral iron(III) polymaltose complex offers at least equivalent efficacy and a superior safety profile compared to ferrous sulfate for the treatment of iron-deficiency anemia during pregnancy.

Fermented soyabean and vitamin C-rich fruit: a possibility to circumvent the further decrease of iron status among iron-deficient pregnant women in Indonesia

Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake. We assessed the effect of supplementary food consisting of fermented soyabean (tempeh) and vitamin C-rich fruit consumed during pregnancy on maternal iron deficiency (ID). Pregnant women were randomly allocated by village into optimized diet and control groups. Supplementary food was given 6 d/week at home. The average weekly food provided comprised 600 g of tempeh, 30 g of meat, 350 g of guava, 300 g of papaya and 100 g of orange. Hb, ferritin and transferrin receptor (TfR) concentrations were measured at 12-20 and at 32-36 weeks of gestation. Thirty-nine villages in Indonesia. Pregnant women (12-20 weeks of gestation, n 252). At baseline, mean Hb, ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups. At near term, mean Hb, ferritin and body Fe decreased, whereas mean TfR increased significantly in both groups. The mean changes in Fe status were similar in both groups. In Fe-deficient women, consumption of an optimized diet was associated with smaller decreases in Hb (1·02 (95% CI 0·98, 1·07) g/l; P = 0·058), ferritin (1·42 (95% CI 1·16, 1·75) μg/l; P = 0·046) and body Fe (2·57 (95% CI 1·71, 3·43) mg/kg; P = 0·073) concentrations, compared with a state of no intervention. Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women. Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID.

Evaluation of Oxidative Stress and Antioxidant Status in Pregnant Anemic Women

The present study was conducted to investigate the oxidant-antioxidant status in iron deficient pregnant anemic women. One hundred thirty pregnant women with iron deficiency anemia (IDA) were divided into three groups, namely mild (50), moderate (50) and severe (30) anemic along with pregnant healthy women as controls (50). The complete blood count, plasma lipid peroxidation products, enzymatic and non-enzymatic antioxidants were measured according to respective protocols. The levels of complete blood count, iron, ferritin along with antioxidant enzymes namely catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase and reduced glutathione were significantly reduced in all IDA groups. However, the level of oxidized glutathione, lipid peroxides, protein carbonyls, conjugated dienes were found significantly increased in all anemic patients. Antioxidant vitamins, namely C, E and A were also found significantly decreased in IDA patients. On the basis of our results, it may be concluded that IDA tends to increase the pro-oxidant components, which may result in various complications including peroxidation of vital body molecules resulting in increased risk for pregnant women as well as fetus.

Erratum

European Journal of HaematologyVolume 80, Issue 1 p. 92-92 Free Access Erratum This article corrects the following: Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term Mari Ervasti, Sanna Kotisaari, Seppo Heinonen, Kari Punnonen, Volume 79Issue 6European Journal of Haematology pages: 539-545 First Published online: September 15, 2007 First published: 13 December 2007 https://doi.org/10.1111/j.1600-0609.2007.01002.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat The article by Ervasti et al. (1) was found to contain a few errors. In the text on page 541 and in Tables 1 and 2, the correct number of pregnant women in the non-iron deficient study group (TfSat >11%) is 167 instead of 67. In Table 2, the correct percentage of gestational diabetes mellitus (GDM) in the iron deficient group (TfSat ≤11%) is 16% instead of 6%. The correct version of Table 2 is printed below. Table 2. Clinical characteristics of pregnant women with and without iron deficiency Variable TfSat ≤ 11%, n = 31Mean ± SD TfSat > 11%, n = 167Mean ± SD P-value Maternal age 28.1 ± 4.8 28.9 ± 5.5 0.54 Duration of pregnancy 40 + 2 ± 1 + 0 40 + 2 ± 1 + 0 0.96 Number of previous pregnancies 1.35 ± 1.36 1.31 ± 1.42 0.70 Prepregnancy weight (kg) 67.1 ± 14.3 67.9 ± 13.0 0.53 GDM 16% 11% 0.46 Pre-eclampsia 0% 3% 0.33 Smoking 13% 11% 0.81 P-value is the difference between the groups calculated with Mann–Whitney U test for continuing variables, or Chi-Square test for categorical variables. GDM, gestational diabetes mellitus. Reference 1 Ervasti M, Kotisaari S, Heinonen S, Punnonen K. Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term. Eur J Haematol 2007; 79: 539– 45. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume80, Issue1January 2008Pages 92-92 ReferencesRelatedInformation

Use of advanced red blood cell and reticulocyte indices improves the accuracy in diagnosing iron deficiency in pregnant women at term

Detection of iron deficiency during pregnancy with hemoglobin (Hb) and serum measurements is insignificant as the measurements may be affected by e.g. hemodilution or accelerated erythropoiesis. This study tests whether cell indices will give a more reliable measure of iron deficiency in pregnant women at term. The population was 202 pregnant women. Using the ADVIA 120 hematology system, Hb, mean cell volume (MCV), percentage of hypochromic red blood cells (%HYPOm) and reticulocytes (%HYPOr), and cellular hemoglobin in reticulocytes (CHr) were tested. Additionally, transferrin saturation (TfSat), ferritin, and transferrin receptor (TfR) were analyzed. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were used as statistical methods. When TfSat (< or = 11%) was used as the reference test for iron deficiency, %HYPOm and CHr had a sensitivity of 58.1% and 80.7%, while the specificities were 82.6% and 71.3%, respectively. Additionally, the AUC values were %HYPOr 0.80, CHr 0.79, ferritin 0.77, %HYPOm 0.75, TfR 0.67, MCV 0.63 and Hb 0.64. The results provided by the cell indices alone (%HYPOm or CHr) were in good agreement with the results based on the usage of a combination of three commonly used tests (Hb, MCV, ferritin). This study suggests that the most practical way to diagnose iron deficiency in pregnant women at term is to use cell indices such as CHr and %HYPOm provided by the automated hematological analyzer. Further studies are needed to determine the usefulness of the cell indices in diagnosing iron deficiency longitudinally during the course of pregnancy.

Effect of Iron Supplementation during Pregnancy on Birthweight: Evidence from Zimbabwe

Iron deficiency in pregnant women has been shown to reduce the oxygen supply to the fetus, cause intrauterine growth retardation, and increase the risk of premature delivery and reduced birthweight. Yet the effects of iron supplementation programs on pregnancy outcomes are not well documented for developing countries. To examine the relation between iron supplementation of mothers during pregnancy and children's birthweight using data from a national population-based survey in Zimbabwe. The analysis uses information on 3559 births during the five years preceding the 1999 Zimbabwe Demographic and Health Survey. The effect of iron supplementation during pregnancy on birthweight was estimated by multiple regression, controlling for potential confounding effects of prenatal care, child's sex and birth order, mother's education and nutritional status (measured by body-mass index), household living standard, smoke exposure, and other variables. Babies born to mothers who received iron supplementation during pregnancy were 103 g heavier (95% confidence interval, 42-164; p = .001), on average, than babies born to mothers who did not receive iron supplementation during pregnancy. The difference was 64 g (95% confidence interval, 2-125; p = .043) for children whose birthweights were taken from health cards and 163 g (95% confidence interval, 44-281; p = .008) for children whose birthweights were reported by their mothers. Iron supplementation during pregnancy is associated with significantly higher birthweight, independent of other pregnancy care factors, mother's nutritional status, smoke exposure, and a number of demographic and socioeconomic factors. Prenatal iron supplementation programs can improve pregnancy outcomes and promote child survival in developing countries.

The multiple vitamin status of Chinese pregnant women with anemia and nonanemia in the last trimester.

Iron-deficiency or anemia in pregnancy is a major public health problem in China. This cross-sectional study was carried out to observe the association between iron status and multiple vitamin levels of Chinese pregnant women in the third trimester. We measured iron, ascorbic acid, retinol, folate and vitamin B12 in serum, and riboflavin in urine specimens of 1,163 pregnant women in four sites throughout rural and city areas in China. Based on hemoglobin concentrations (Hb), the subjects were divided into an anemia group with Hb < 110 g/L or Hb < or = 100 g/L as severe anemia group, and nonanemia group with Hb > or = 110 g/L. Results showed that 41.58% of the population with serum iron < 700 microg/L and 51.04% of the population with ferritin < 12 microg/L in the anemia group, percentages that were much higher than those in the nonanemia group. Relationships between five vitamins and hemoglobin concentrations of all subjects were observed. There was a lower level of serum ascorbic acid (291.05 microg/dL) in the Hb < or = 100 g/L group than in the Hb > or = 120 g/L group (487.79 microg/dL) (p < 0.001). Serum levels of vitamin B12 and folate were 445.67 pg/mL and 5.94 ng/mL in the Hb < or = 100 g/L group, whose levels were much lower than the levels of 502.01 pg/mL (p < 0.012) and 8.07 ng/mL (p < 0.010) respectively in the Hb > or = 120 g/L group. Further, cross-sectional analysis showed positive correlations between abnormal hematological results and prevalences of vitamin deficiencies. The subjects with iron-deficiency anemia had much higher rates of vitamin C, folate and vitamin B12 deficiencies than those in the nonanemic subjects, and especially in the deficient rates of ascorbic acid and folate in the anemia (Hb < 110 g/L) group, which reached 64.04% and 22.70% respectively. Moreover, we observed that the decreasing trends of hemoglobin concentrations were accompanied by the decreases of serum levels of vitamin A, ascorbic acid, folate and vitamin B12. In conclusion, multiple vitamin deficiencies, especially ascorbic acid, retinol and folic acid, may be associated with anemia or iron deficiency in pregnant women in the last trimester. The study suggested that anemic pregnant women in China should be supplemented with iron and multiple vitamins simultaneously.

Iron Supplementation: Overcoming Technical and Practical Barriers

Iron supplementation is probably the best available option to effectively address iron deficiency in pregnant women and young children because it can be targeted specifically to these high-risk groups. However, technical and practical barriers exist: limited information on the effectiveness of supplementation interventions, side effects that affect compliance, and supply/distribution constraints. An innovative approach to addressing these constraints is the use of sprinkles of powdered, microencapsulated ferrous fumarate that can be added directly to any semi-liquid food without changing their taste or consistency. This technique has been tested in initial trials in Ghana and found to be as effective as iron drops. Another approach to improve the effectiveness of iron interventions is through information, education and communication (IEC) programs. These interventions can help modify consumer behavior in some cases, but in some countries, geographic location, variations in language and population size can make the cost of IEC programs very high. IEC strategies in Indonesia aimed at increasing demand for iron supplements by systematic dissemination of specific messages, improving the quality and variety of tablets, increasing the availability and access to supplements by engaging the commercial sector, enrolling traditional birth attendants and other community volunteers in selling supplements. Key issues to be addressed include clarifying optimal starting points and duration of supplementation interventions--based on individual status or population prevalence, defining hemoglobin and ferritin cutoffs at which treatment should be instigated and evaluating the effectiveness of intermittent supplementation with multiple micronutrients.

Cord serum ferritin levels, fetal iron status, and neurodevelopmental outcomes: Correlations and confounding variables

Cord serum ferritin levels, fetal iron status, and neurodevelopmental outcomes: Correlations and confounding variables

Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany

Objective: To determine the prevalence and risk factors of iron deficiency in pregnancy, since iron supplements are not routine in Germany. Study design: Soluble transferrin receptor (sTfR), ferritin, hemoglobin (Hb), C-reactive protein (CRP) and leucocyte counts were determined in venous blood samples of 378 women before delivery; 191 of them filled in a questionnaire. Statistical analysis was performed using SPSS 9.0.1. Results: CRP and leucocyte count correlated significantly with ferritin values, while sTfR values were independent. Iron deficiency (sTfR >3.3 mg/dl) was found in 40.7% of pregnant women, and anemia (Hb<11.0 g/dl) in 13.6%. Non-German nationality, low educational level and young maternal age were significant risk factors for iron deficiency, while alcohol use in pregnancy, iron and folic acid supplements were protective. After adjusting for all other factors in a logistic regression equation, not taking any iron supplements in pregnancy (odd ratios (OR) 3.3 and 95% confidence interval (CI) 1.1–9.4), and young maternal age (OR 2.86 and 95% CI 1.1–7.7) remained significant risks. Conclusion: Iron deficiency in pregnant women in Germany is prevalent; it could be prevented by routine iron supplements.

Iron deficiency in pregnant women with PICA

Iron deficiency in pregnant women with PICA

Biological Mechanisms That Might Underlie Iron's Effects on Fetal Growth and Preterm Birth

A negative association between anemia and duration of gestation and low birth weight has been reported in the majority of studies, although a causal link remains to be proven. This paper explores potential biological mechanisms that might explain how anemia, iron deficiency or both could cause low birth weight and preterm delivery. The risk factors for preterm delivery and intrauterine growth retardation are quite similar, although relatively little is understood about the influence of maternal nutritional status on risk of preterm delivery. Several potential biological mechanisms were identified through which anemia or iron deficiency could affect pregnancy outcome. Anemia (by causing hypoxia) and iron deficiency (by increasing serum norepinephrine concentrations) can induce maternal and fetal stress, which stimulates the synthesis of corticotropin-releasing hormone (CRH). Elevated CRH concentrations are a major risk factor for preterm labor, pregnancy-induced hypertension and eclampsia, and premature rupture of the membranes. CRH also increases fetal cortisol production, and cortisol may inhibit longitudinal growth of the fetus. An alternative mechanism could be that iron deficiency increases oxidative damage to erythrocytes and the fetoplacental unit. Iron deficiency may also increase the risk of maternal infections, which can stimulate the production of CRH and are a major risk factor for preterm delivery. It would be useful to explore these potential biological mechanisms in randomized, controlled iron supplementation trials in anemic and iron-deficient pregnant women.

Consequences of Iron Deficiency in Pregnant Women

Pregnant women constitute a high-risk group for iron deficiency. This may be explained by the high iron requirements during gestation. Although iron deficiency is mainly a problem in developing countries, dietary iron intakes, even in developed countries, are too low to meet iron needs during pregnancy. Indeed, most pregnant women start their gestation with low or totally depleted iron stores. Existing data suggest that maternal iron deficiency, and particularly iron-deficiency anaemias, may be associated with detrimental effects on maternal and infant function, and particularly with a higher risk of preterm delivery and delivery of low birthweight neonates. Although further research on the consequences of maternal iron deficiency for maternal and infant health is warranted, current evidence suggests that a major effort is needed to prevent iron deficiency and anaemia during pregnancy.

Serum transferrin receptors in detection of iron deficiency in pregnancy.

A prospective hospital-based study was conducted to evaluate the efficacy of serum transferrin receptors in the detection of iron deficiency in pregnant women. The iron status of 100 pregnant women with single uncomplicated term pregnancies in the first stage of labor was established using standard laboratory measures. These included complete hemogram, red cell indices, serum iron, percent transferrin saturation, and serum ferritin. In addition, serum transferrin receptor (STFR) was estimated. The results of 81 women with complete laboratory profiles were analyzed. Thirty-five (43.2%) women were anemic (hemoglobin <11 g/dl). Hemoglobin (Hb) showed a significant correlation with MCH, MCHC, serum iron, and percent transferrin saturation, suggesting that the anemia was likely to be due to iron deficiency. The mean STFR level was 18.05+/-9.9 mg/l in the anemic women and was significantly raised (p<0.001) compared with that of the nonanemic women. STFR correlated significantly with Hb (p<0.001), MCH (p<0.05), MCHC (p<0.01), serum iron (p<0.01), and percent transferrin saturation (p<0.01) and also showed a highly significant correlation with the degree of anemia. Serum ferritin in these women did not correlate with Hb, and only 54.4% of the women had levels <12 ng/ml, which does not reflect the true prevalence of iron deficiency. Serum transferrin receptor estimation is thus a useful measure for detecting iron deficiency in pregnancy.

Iron deficiency in pregnant women in Ibarapa District of Western Nigeria.

Ninety-nine pregnant women with anaemia (haematocrit less than 0.30) were detected by antenatal screening in Ibarapa District. Studies on 23 anaemic women and 17 non-anaemic women from the same clinic on the same day showed that eight out of 23 anaemic women had a transferrin saturation of less than 15%. The mean level (19.5%) for the anaemic patients was significantly less than that found in the nonanaemic controls; mean 33.0% (P less than 0.01). Bone marrow studies on 32 anaemic women revealed megaloblastic change and absent iron in 27 of the 32 patients. In a trial of parenteral iron treatment in 66 patients the mean haematocrit of Imferon treated patients rose from 0.27 to 0.32 in 6 weeks but remained at 0.28 or less in the controls. There was a significant difference between the iron-treated group and the comparable group receiving no imferon (P less than 0.001 at 6 weeks). The method of using parenteral iron treatment to make a diagnosis of iron deficiency anaemia is discussed together with the possible advantages and disadvantages of giving iron.