Routine Iron Supplementation Research Articles

Associations of maternal serum ferritin levels across gestation with gestational diabetes mellitus: A longitudinal cohort study.

The longitudinal changes in maternal serum ferritin (SF) levels across gestation, which indirectly reflect iron supplementation, have not been extensively investigated in relation to gestational diabetes mellitus (GDM). We conducted a retrospective cohort study at a tertiary maternal hospital in Shanghai. Women with SF concentration measurements at 8.0-13.6 weeks' gestation (GW), 29.0-31.6 GW, and an oral glucose tolerance test (OGTT) at 24-28 GW were included. We utilized logistic regression analysis to assess GDM association with maternal SF levels and longitudinal changes. The study included 17 560 women, with 2160 (12.3%) participants diagnosed with GDM. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for GDM across increasing quartiles of SF concentrations at 8.0-13.6 GW were 1.00 (reference), 1.139 (95% CI: 1.012-1.283), 1.093 (95% CI: 0.969-1.233), and 1.248 (95% CI: 1.111-1.403). Similarly, at 29.0-31.6 GW, increasing quartiles of SF concentrations were associated with higher adjusted ORs for GDM: 1.00 (reference), 1.165 (95% CI: 1.029-1.320), 1.335 (95% CI: 1.184-1.505), and 1.428 (95% CI: 1.268-1.607). Pregnant women with higher SF levels (upper 25th percentile) at 8.0-13.6 GW had a reduced GDM risk if their SF levels decreased to the lower 25th percentile at 29.0-31.6 GW. Conversely, the subgroup with higher SF levels (upper 25th percentile) at both time points had the highest incidence rate of GDM (15.3%, 1.235 [95% CI: 1.087-1.404]). Maternal SF levels independently and positively associated with GDM risk during early and late gestational stages. Considering the increased GDM risk, routine iron supplementation for iron-replete women is questionable.

Iron status, anemia, and birth outcomes among pregnant women in urban Bloemfontein, South Africa: the NuEMI study

BackgroundDespite routine iron supplementation for pregnant women in South Africa, anaemia and iron deficiency (ID) in pregnancy remain a public health concern.ObjectiveTo determine the associations between iron status and birth outcomes of pregnant women attending antenatal clinic at a regional hospital in Bloemfontein.MethodsIn this cross-sectional study of 427 pregnant women, blood was taken to analyze biomarkers of anaemia (haemoglobin), iron status (ferritin and soluble transferrin receptor) and inflammation (C-reactive protein and α-1-acid glycoprotein). A questionnaire was used to collect information about birth outcomes (birth weight and gestational age at birth), HIV exposure, sociodemographics, iron supplement intake, and maternal dietary iron intake using a validated quantified food frequency questionnaire.ResultsThe median (Q1, Q3) weeks of gestation of participants was 32 (26, 36) at enrolment. Anaemia, iron deficiency (ID), ID anaemia (IDA) and ID erythropoiesis (IDE) were present in 42%, 31%, 19% and 9.8% of participants, respectively. Median (Q1, Q3) dietary and supplemental iron intake during pregnancy was 16.8 (12.7, 20.5) mg/d and 65 (65, 65) mg/d, respectively. The median (max-min) total iron intake (diet and supplements) was 81 (8.8-101.8) mg/d, with 88% of participants having a daily intake above the tolerable upper intake level of 45 mg/d. No significant associations of anaemia and iron status with low birth weight and prematurity were observed. However, infants born to participants in the third hemoglobin (Hb) quartile (Hb > 11.3–12.2 g/dL) had a shorter gestation by 1 week than those in the fourth Hb quartile (Hb > 12.2 g/dL) (p = 0.009). Compared to pregnant women without HIV, women with HIV had increased odds of being anaemic (OR:2.14, 95%CI: 1.41, 3.247), having ID (OR:2.19, 95%CI: 1.42, 3.37), IDA (OR:2.23, 95%CI: 1.36, 3.67), IDE (OR:2.22, 95%CI: 1.16, 4.22) and delivering prematurely (OR:2.39, 95%CI: 1.01, 5.64).ConclusionIn conclusion, anaemia, ID, and IDA were prevalent in this sample of pregnant women, despite the reported intake of prescribed iron supplements, with HIV-infected participants more likely to be iron deficient and anaemic. Research focusing on the best formulation and dosage of iron supplementation to enhance iron absorption and status, and compliance to supplementation is recommended, especially for those living with HIV infection.Graphical

Maintaining Normal Serum Ferritin Levels During Pregnancy: A Randomized Controlled Trial of Daily versus Weekly Ferrous Sulfate

Background: Serum ferritin is the most reliable indication of stored iron in pregnancy, offering a noninvasive way to detect iron deficiency anemia before it occurs. Therefore, this study aimed to determine serum ferritin levels among women receiving daily versus weekly iron supplementation, with a secondary focus on comparing the proportion developing iron deficiency anemia and compli-ance rates between the two groups.Methods: This non-blinded randomized control trial involved non-anaemic pregnant women attend-ing antenatal clinics at two Teaching Hospitals in Osun State. One hundred twenty-five subjects were recruited to receive 65mg in the control group, while another 125 subjects in the active group re-ceived three tablets (195mg) of ferrous sulfate (Fesulf) once weekly for 17 weeks from the 20th to 37th weeks of gestation. The primary outcome measure was comparing mean serum ferritin levels in both groups at 37 weeks.Results: Among the 240 subjects analyzed, the 37-week serum ferritin level was higher in the daily group (73.26±26.67μg/L) compared to the weekly group (63.04±30.71 μg/L), p value=0.006. Four (3.36%) and 10 (8.26%) of our subjects had Iron deficiency anaemia. Nine subjects (3.75%) reported dyspepsia as a side effect. Daily 65 mg of Felsulf proved more effective than weekly 195mg in main-taining normal blood ferritin levels during pregnancy.Conclusions: Daily iron supplementation with 65mg ferrous sulfate was more effective at main-taining adequate maternal iron concentration in this group of non-anaemic pregnant women. This dosage is recommended for routine iron supplementation in our environment.

The impact of iron supplementation on the preterm neonatal gut microbiome: A pilot study.

The gastrointestinal microbiome in preterm infants exhibits significant influence on optimal outcomes-with dysbiosis shown to substantially increase the risk of the life-threatening necrotizing enterocolitis. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurodevelopment. However, excess colonic iron exhibits potent oxidation capacity and alters the gut microbiome-potentially facilitating the proliferation of pathological bacterial strains. Breastfed preterm infants routinely receive iron supplementation starting 14 days after delivery and are highly vulnerable to morbidities associated with gastrointestinal dysbiosis. Therefore, we set out to determine if routine iron supplementation alters the preterm gut microbiome. After IRB approval, we collected stool specimens from 14 infants born <34 weeks gestation in the first, second, and fourth week of life to assess gut microbiome composition via 16S rRNA sequencing. We observed no significant differences in either phyla or key genera relative abundance between pre- and post-iron timepoints. We observed notable shifts in infant microbiome composition based on season of delivery. Though no obvious indication of iron-induced dysbiosis was observed in this unique study in the setting of prematurity, further investigation in a larger sample is warranted to fully understand iron's impact on the gastrointestinal milieu.

Anaemia at mid-pregnancy is associated with prehypertension in late pregnancy among urban women.

Antenatal iron deficiency and anaemia are associated with gestational hypertension and diabetes mellitus, but so are elevated iron stores and haemoglobin. In South Africa, pregnant women receive routine iron supplementation regardless of iron status. This study aimed to assess associations of antenatal iron status and anaemia with blood pressure in pregnant women in urban South Africa. Secondary to this, associations with heart rate, fasting glucose and glucose tolerance were also investigated. Johannesburg, South Africa. A total of 250 pregnant women, aged 27 (24-32) years, were recruited using consecutive sampling. The authors measured biomarkers of iron status and anaemia at < 18 and ± 22 weeks', blood pressure and heart rate at ± 36 weeks', and fasting glucose and glucose tolerance between 24 and 28 weeks' gestation. Associations were determined using multivariable regression models adjusted for confounders. The odds of prehypertension in late pregnancy among women with anaemia at ± 22 weeks' gestation were three times higher than among women without anaemia (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.22, 7.42). Participants with anaemia at ± 22 weeks' gestation had 2.15 times higher odds of having elevated mean arterial pressure than women without anaemia (OR: 2.15, 95% CI: 1.01, 4.60). Anaemia at mid-pregnancy could be a predictor of hypertensive disorders in pregnancy. The cause of antenatal anaemia may need further investigation apart from iron deficiency. The effective management of anaemia in pregnant women living in urban South Africa remains a challenge. This study provides evidence about the health impact of pregnant women regarding antenatal supplementation practices in South Africa.

Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines.

Iron deficiency anemia (IDA) in pregnancy is a common diagnosis that is associated with adverse obstetric and neonatal outcomes. There remains uncertainty regarding how best to screen for, prevent, and treat established IDA in pregnancy. There is no consensus on the benefits of routine iron supplementation in pregnancy, with concerns regarding potential harmful effects of routine iron supplementation in women who are iron replete. Fourteen international guidelines were selected and appraised and compared by a multidisciplinary team. The AGREE II GRS tool was used. Each reviewer independently made their own assessment, and the scores from 1 to 7 were also collated and averaged for an overall score incorporating seven domains: process of development, clarity of presentation, completeness of reporting, clinical validity, and overall quality. The reviewers' scores were also individually compared according to discipline. The mean score across all the guidelines was 4.4 (range 3.5-6.5). Only half of the guidelines recommend routine iron in pregnancy. In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy, two recommend selective screening with ferritin for at risk groups only, and one guideline suggests using ferritin where feasible. Although many of the guidelines recommend similar doses of oral elemental iron of 100-200 mg daily for the treatment of established IDA in pregnancy, two recommend twice or three times daily dosing. Only five guidelines give hemoglobin rises to expect within specific timeframes. There remains a need to clarify the optimal screening method, dosing regimen, timing, and route of iron supplementation in pregnancy. Robust randomized controlled data are needed to guide appropriate prevention and management.

The Interactions between Maternal Iron Supplementation and Iron Metabolism-Related Genetic Polymorphisms on Birth Outcomes: A Prospective Study in Chinese

BackgroundThe effect of iron supplementation during pregnancy on birth outcomes may vary with maternal genetic background and needs more investigation. ObjectivesThis prospective study aimed to evaluate the interactions between maternal iron supplementation and iron metabolism-related genetic polymorphisms on birth outcomes. MethodsThis was a substudy from a community-based randomized control trial conducted in Northwest China, which included 860 women from the 2 micronutrient supplementation groups (folic acid [FA] and FA + iron group). Maternal peripheral blood, sociodemographic and health-related information, and neonatal birth outcomes were collected. Six single nucleotide polymorphisms in iron metabolism-related genes were genotyped. The alleles associated with decreased iron/hemoglobin status were used as the effect alleles. The genetic risk score (GRS) that reflected the genetic risk of low iron/hemoglobin status was estimated using the unweighted and weighted methods. Generalized estimating equations with small-sample corrections were applied to evaluate the interactions between iron supplementation and SNPs/GRS on birth outcomes. ResultsThere were significant interactions between maternal iron supplementation and rs7385804 (P = 0.009), rs149411 (P = 0.035), rs4820268 (P = 0.031), the unweighted GRS (P = 0.018), and the weighted GRS (P = 0.009) on birth weight. Compared with FA supplementation only, FA + iron supplementation significantly increased birth weight among women with more effect alleles in rs7385804 (β: 88.8 g, 95% CI: 9.2, 168.3) and the GRSs (the highest unweighted GRS, β: 135.5 g, 95% CI: 7.7, 263.4; the highest weighted GRS, β: 145.9 g, 95% CI: 43.4, 248.5); it had a trend of decreasing birth weight and increasing low birth weight risk among women with fewer effect alleles. ConclusionsIn our population, maternal genetic background related to iron metabolism plays a significant role in determining the efficacy of iron supplementation. Routine iron supplementation could be more beneficial to fetal weight growth among mothers with higher genetic risk for low iron/hemoglobin status.

EVALUATION OF OXIDATIVE STRESS MARKERS IN ANTENATAL WOMEN RECEIVING ROUTINE IRON

Background: Anaemia is low haemoglobin concentration affecting 47.74% of pregnant women globally.9 WHO recommends routine supplementation of iron to all antenatal mothers irrespective of the haemoglobin status. The aim of this study was to evaluate the levels of oxidative stress markers in antenatal women receiving routine iron supplementation and correlate their maternal and fetal outcomes. A prospective observational study of 100 pregnant wome Methods: n was conducted over 1.5 years at St. John's Medical College Hospital. On screening for inclusion criteria, at baseline, information on maternal socio-demography, anthropometry, dietary intake and clinical examination was collected. A venous blood sample at baseline and 3rd trimester of pregnancy and at delivery was collected for estimation of oxidative stress markers i.e., catalase and lipid peroxidase and results were correlated with pregnancy and birth outcomes. Results: The levels of oxidative stress markers were found to decrease from rst to third trimester in a subset of 30 patients participating in the study. There was a greater incidence of preeclampsia in women with Hb &gt; 13 g/dl receiving routine iron supplementation (37.5%). Also, there was increased risk of GDM, PROM and febrile morbidity although not statistically signicant. Our study suggests t Conclusion: hat there is a trend towards increase in oxidative stress and incidence of pre-eclampsia when excess iron is supplemented to pregnant women with normal haemoglobin. Assessment of other oxidative stress markers in a larger study may be helpful in deciding the need for iron supplementation and its dosage.

Should Physicians Avoid Routine Iron Supplementation in Rheumatic Musculoskeletal Diseases (RMDs)?

Abstract not available&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 01-02

Prevalence and Implications of Low Reticulocyte-Hemoglobin Levels among Extreme Preterm Neonates: A Single-Center Retrospective Study.

This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18-24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and December 2019, who received routine iron supplementation were enrolled. Iron deficiency was defined as reticulocyte-hemoglobin (Ret-Hb) levels ≤ 29 pg at 36 weeks corrected age. A subcohort of neonates completed standardized developmental assessment at 18-24 months corrected age. Significant neurodevelopmental impairment (sNDI) was defined as either Bayley Scales of Infant Development score &lt; 70 or cerebral palsy or blindness or hearing aided. Among a cohort of 215 neonates [GA 25.8 (1.7) weeks, birthweight 885 (232) g], prevalence of iron deficiency was 55%, 21%, 26%, and 13%, in neonates &lt;24 weeks, 24-25 + 6 weeks, 26-27 + 6 weeks, and ≥ 28 weeks GA, respectively. Male sex and receipt of corticosteroid therapy were associated with iron-deficiency. In the subcohort analysis (n = 69), there was no statistically significant association between Ret-Hb levels at 36 weeks corrected age and the risk of sNDI [OR 0.99 (95% CI 0.85-1.2)]. Male infants and those who received postnatal corticosteroids are likely to have iron-limited erythropoiesis at corrected term despite routine iron-supplementation; however, low Ret-Hb levels during the neonatal period were not associated with significant neurological disability in early childhood.

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy<70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P<0.01] and higher GWG at delivery (WMD: 209g; 95% CI: 139, 280g; P<0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P<0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P=0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

18 Prevalence of iron deficiency among extreme preterm neonates based on Reticulocyte-Hemoglobin levels: a single center cross-sectional study

Abstract Background Extreme preterm neonates are at risk of developing iron deficiency due to multiple factors including lack of third trimester placental iron accretion and frequent blood sampling. The true prevalence of iron deficiency in this cohort is not known due to lack of valid markers. Compared to Hemoglobin (Hb) derived from the entire red blood cell population (lifespan 120 days), Hb derived for reticulocytes (lifespan 3 days) is a real-time indicator of functional iron available for erythropoiesis during the previous 3-4 days. Reticulocyte-Hemoglobin (Ret-Hb) levels lower than 29pg can indicate iron deficiency in preterm neonates &amp;lt; 32 weeks gestation with 85% sensitivity and 73% specificity. Objectives This study aims to measure the prevalence and risk factors of iron deficiency at term equivalent age among extreme preterm neonates based on Ret-Hb levels. Design/Methods A single center retrospective chart review of neonates born at &amp;lt;= 29 weeks gestation between June 2016 to December 2019. All neonates received routine iron supplementation from 2 weeks postnatal age at 3-4mg/kg/day (birth weight &amp;lt;1Kg) or 2-3mg/kg/day (birth weight&amp;gt;1Kg) to a maximum of 15mg elemental iron as ferrous sulfate or iron fortified formula. Hb, Reticulocyte count, Ret-Hb, Immature reticulocyte fraction (IRF) and mean corpuscular volume (MCV) was measured at 4 weeks postnatal age, 36 weeks corrected gestation, and at discharge. Iron deficiency at term equivalent age was defined as Ret-Hb levels &amp;lt;= 29pg. Results Among 387 eligible neonates, 187 who had hematological parameters available at term equivalent age were included. The study cohort had a mean gestation of 25.7 (1.6) weeks, birth weight of 863 (220) g, mean SNAPPEII score of 29.2 (19), and gestational age at discharge of 42.7 (7.2) weeks. The prevalence of iron deficiency among neonates &amp;lt; 24 weeks, 24-25 + 6 weeks, 26-27 + 6 weeks, and &amp;gt;=28 weeks was 35.7%, 18.4%, 27.7%, and 15.6% respectively. Male infants were more likely to have iron deficiency at term equivalent [Table 1]. The neonates with iron deficiency had higher rates of necrotising enterocolitis [14% versus 8%], laparotomy [14% versus 10%] and postnatal steroids [69% versus 57%] compared to neonates without iron deficiency, however not statistically significant. Ret-Hb levels at 4 weeks postnatal age showed a positive correlation with Ret-Hb levels [Slope 0.58, R2 squared 0.02] and MCV levels [Slope 0.75, R2 0.11] at discharge [Figure 1]. Contrary to changes in Hb levels and reticulocyte counts, Ret-Hb levels, MCV and IFR progressively decrease from 4 wks postnatal age to discharge. Conclusion Despite routine standardized iron supplementation, extreme preterm neonates may have iron-limited erythropoiesis indicated by low Ret-Hb levels at term equivalent age. Lower levels of Ret-Hb at 4 weeks postnatal age was associated with low IRF and low MCV at discharge although Hb levels may remain within acceptable range. Future studies would need to elucidate the impact of iron deficiency at corrected term on long-term outcome. Guidelines should consider incorporating Ret-Hb levels in the workup of anemia of prematurity.

The I4RON-HF study, Intravenous Iron Isomaltoside for Inpatients veRsus Outpatient Asians with Heart Failure

Abstract Background and purpose Iron deficiency (ID) impacts ∼50% of heart failure (HF) patients [1] and is a risk factor and strong predictor for death and mortality with or without anaemia [2]. Oral iron appears to be ineffective whilst intravenous iron (IV-iron) has proven to be efficacious however data is primarily from a Caucasian population [3] despite ID being more prevalent amongst Asians. The I4RON-HF study assesses efficacy of high-dose IV-iron versus oral iron in stable outpatients and inpatients amongst an Asian population recovering from episodes of decompensated HF. Methods This is a single-centre randomized controlled study, where patients who had symptomatic heart failure (Ejection Fraction &amp;lt;50% and New York Heart Association class 2–3) were randomized into two groups. The intervention arm received anywhere from 500mg to 1500mg of IV Iron Isomaltoside as a single infusion, whereas the control arm received routine iron supplements. The primary study endpoint was the percentage of patients achieving iron repletion at 4,8 and 12 months after enrolment. Secondary endpoints included clinical parameters (6-minute walk test, NYHA status and 2D-Echocardiogram), and biochemical parameters (Serum NTproBNP, Cardiac Troponin-T and hemogloblin) at 4,8 and 12 months. Results A total of 65 patients were enrolled (male 55%), 33 in the interventional arm and 32 in the control arm. There were no patients lost to follow up. 96.9% of patients in the IV Iron arm achieved the primary endpoint at 4 months, compared to 68.7% in the control group. These findings we consistent at 8 months (90.9% vs 65.6%) and 12 months (90.9% vs 56.2%). Looking at the secondary endpoints, the IV Iron cohort recorded a 11.14% increase in Hemogloblin levels versus the control arm which recorded a reduction of 16.23%. There was also lower NTproBNP levels in the IV iron group (81.6% reduction) versus the control group (66.3% reduction). Clinically, the patients who received IV iron had a 42.98% increase in their 6-minute walk test from baseline, compared to an increase of 8.61% in the control arm. There were no significant echocardiographic changes. Conclusion These findings in our single-centre study support the efficacy of IV iron over oral supplements in the treatment of iron deficiency amongst Asian heart failure patients. The secondary endpoints also indicate better clinical and biochemical outcomes when iron stores are successfully repleted. Lastly, this study demonstrates the feasibility and safety of outpatient administration of high-dose IV-iron. Results from large-scale clinical studies looking at hard endpoints (mortality, HF hospitalization) are expected to further advance understandings. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Heart Institute (Institut Jantung Negara) FoundationCompai Pharma

Comparison between iron compounds as oral treatment for iron deficiency anemia during pregnancy

ObjectiveTo compare the efficacy, tolerability, and compliance of iron fumarate, iron bisglycinate, and iron polysaccharides for the treatment of iron deficiency anemia during pregnancy.BackgroundIron deficiency anemia during pregnancy is a significant worldwide health problem. Therefore, routine iron supplementation during the second half of pregnancy has been recommended.Patients and methodsA double-blind study was carried out at the Obstetrics Department in Wadi-El Natroun General Hospital on 120 pregnant females with confirmed iron deficiency anemia from August 2019 till August 2020. Study medications were supplied in the form of tablets. Group A: 100 mg of iron fumarate, once daily. Group B: 100 mg of iron bisglycinate, once daily. Group C: 100 mg of iron polysaccharide, once daily. Full history taking and complete clinical examination was done. Hemoglobin (Hb), mean corpuscular volume, and reticulocyte count were assessed at day 0, and then at the end of first, second, and third month. Serum ferritin was assessed at recruitment (day 0) and at the end of 3rd month.ResultsOur results found that there is high significant difference between the studied groups as regards serum ferritin, Hb and reticulocyte count and serum ferritin (after treatment). However, there was no significant difference regarding mean corpuscular volume.ConclusionFerrous fumarate achieve a faster cure rate and have better results of mean Hb and serum ferritin level than iron bisglycinate and iron polysaccharide in iron deficiency pregnant women.

Effects of Daily Iron Supplementation on Motor Development and Brain Connectivity in Preterm Infants: A Diffusion Magnetic Resonance Study.

Objectives: The aim of the study is to demonstrate the characteristic of motor development and MRI changes of related brain regions in preterm infants with different iron statuses and to determine whether the daily iron supplementation can promote motor development for preterm in early infancy.Methods: The 63 preterm infants were grouped into non-anemia with higher serum ferritin (NA-HF) group and anemia with lower serum ferritin (A-LF) group according to their lowest serum Hb level in the neonatal period as well as the sFer at 3 months old. Forty-nine participants underwent MRI scans and Infant Neurological International Battery (INFANIB) at their 3 months. At 6 months of corrected age, these infants received the assessment of Peabody Developmental Motor Scales (PDMS) after 2 mg/kg/day iron supplementation.Results: In total, 19 preterm infants were assigned to the NA-HF group while 44 preterm infants to the A-LF groups. The serum ferritin (sFer) level of the infants in A-LF group was lower than that in NA-HF group (44.0 ± 2.8 mg/L vs. 65.1 ± 2.8 mg/L, p < 0.05) and was with poorer scores of INFANIB (66.8 ± 0.9 vs. 64.4 ± 0.6, p < 0.05) at 3 months old. The structural connectivity between cerebellum and ipsilateral thalamus in the NA-HF group was significantly stronger than that in the A-LF group (n = 17, 109.76 ± 23.8 vs. n = 32, 70.4 ± 6.6, p < 0.05). The decreased brain structural connectivity was positively associated with the scores of PDMS (r = 0.347, p < 0.05). After 6 months of routine iron supplementation, no difference in Hb, MCV, MCHC, RDW, and sFer was detected between A-LF and NA-HF groups as well as the motor scores of PDMS-2 assessments.Conclusion: Iron status at early postnatal period of preterm infant is related to motor development and the enrichment of brain structural connectivity. The decrease in brain structural connectivity is related to the motor delay. After supplying 2 mg/kg of iron per day for 6 months, the differences in the iron status and motor ability between the A-LF and NA-HF groups were eliminated.

Effects of Iron Supplements on Heme Scavengers in Pregnancy.

ABSTRACT.In malaria endemic countries, anemia in pregnant women occurs as a result of erythrocyte destruction by Plasmodium infections and other causes including malnutrition. Iron supplementation is recommended as treatment of iron-deficiency anemia. Erythrocyte destruction results in increased release of cytotoxic free heme that is scavenged by haptoglobin (Hp), hemopexin (Hx) and heme oxygenase-1 (HO-1). Paradoxically, iron supplementation in pregnant women has been reported to enhance parasitemia and increase levels of free heme. The relationship between free heme, heme scavengers, and birth outcomes has not been investigated, especially in women who are on iron supplementation. We hypothesized that parasite-infected pregnant women on routine iron supplementation have elevated heme and altered expression of heme scavengers. A cross-sectional study was conducted to determine the association between plasma levels of free heme, HO-1, Hp, Hx, and malaria status in pregnant women who received routine iron supplementation and their birth outcomes. Heme was quantified by colorimetric assay and scavenger protein concentration by ELISA. We demonstrated that iron-supplemented women with asymptomatic parasitemia had increased free heme (mean 75.6 µM; interquartile range [IQR] 38.8–96.5) compared with nonmalaria iron-supplemented women (mean 34.9 µM; IQR 17.4–43.8, P < 0.0001). Women with preterm delivery had lower levels of Hx (mean 656.0 µg/mL; IQR 410.9–861.3) compared with women with full-term delivery (mean: 860.9 µg/mL; IQR 715.2–1055.8, P = 0.0388). Our results indicate that iron supplementation without assessment of circulating levels of free heme and heme scavengers may increase the risk for adverse pregnancy outcomes.

Pre-conception serum ferritin concentrations are associated with metal concentrations in blood during pregnancy: A cohort study in Benin

BackgroundIron deficiency is a common nutritional deficiency that impacts maternal health and fetal development and is also associated with increased uptake of toxic metals. Women in sub-Saharan Africa are highly exposed to both iron deficiency and metals in the environment. As research on the developmental origins of health and disease increasingly shows impacts of pre-conception maternal health on pregnancy and fetal health, these environmental exposures are of concern. ObjectivesThis study investigated the association between iron status pre-pregnancy and blood metal concentrations in the first trimester of pregnancy with potential implications for iron supplementation. MethodsPre-conception and first trimester blood samples taken from 262 Beninese women were tested for serum ferritin, inflammation markers, manganese (Mn), cadmium (Cd), lead (Pb), copper, zinc, selenium, mercury and arsenic. Associations between serum ferritin adjusted for inflammation and metal concentrations were analyzed using multivariate linear regression. ResultsWomen with iron deficiency before conception (13%) were more likely to remain iron deficient in the first trimester (4%) (adjusted OR = 41.2, 95%CI 6.2; 275.0) even within the context of routine iron supplementation during pregnancy.Lower pre-pregnancy serum ferritin concentrations were significantly related to higher concentrations of Mn, Cd and Pb in the first trimester. Every 1% increase in serum ferritin concentration was associated with a 0.13% decrease in Mn (adjusted β = −0.13, 95%CI -0.18; −0.07), a 0.22% decrease in Cd (adjusted β = −0.22, 95%CI -0.28; −0.15) and a 0.06% decrease in Pb concentration (adjusted β = −0.06, 95%CI -0.12; −0.006). DiscussionThese results suggest that increasing iron stores prior to pregnancy may prevent excessive uptake of toxic concentrations of the metals Mn, Cd and Pb and argue in favour of testing the effects of iron supplementation prior to pregnancy on metal concentrations.

Does routine iron supplementation improve anemia or health outcomes in menstruating women?

Does routine iron supplementation improve anemia or health outcomes in menstruating women?

Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants.

Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants.Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored.Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found.Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.

DETERMINE THE EFFECT OF VITAMIN D SUPPLEMENTATION ON PREGNANCY OUTCOME: A COMPARATIVE STUDY.

Aim: to determine the effect of vitamin D supplementation on pregnancy outcome.&#x0D; Materials and methods: The present prospective comparative interventional study was conducted in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar. Total 60 patients were divided in to two groups. Group I (n=30): received only routine iron, folic acid and calcium supplementation (irrespective of vitamin D level). Group II (n=30): vitamin D supplementation (irrespective of vitamin D level) in the form of oral cholecalciferol sachet 60,000IU weekly till 10 weeks along with routine iron, folic acid and calcium supplementation.&#x0D; Results: Pre-eclampsia was observed in 26.7% of the patients who didn’t receive vitamin D supplement whereas the group I which received supplementation showed on pre-eclampsia in 6.7% of the patients (p=0.001).&#x0D; Conclusion: This study concludes that there is significant role of vitamin D supplementation in pregnant women in prevention of pre-eclampsia.&#x0D; Keywords: pre-eclampsia, vitamin D, singleton