Iron Deficiency in Pregnancy: A Brief Review

Authors

DOI:

https://doi.org/10.20883/medical.e776

Keywords:

anaemia, iron deficiency, pregnancy, iron supplements

Abstract

This paper highlights iron deficiency anaemia in pregnancy; its prevalence, causes, screening, and management. Iron deficiency is a spectrum that ranges from iron depletion to iron deficiency anaemia. Iron deficiency is the most common and leading cause of anaemia in pregnancy both in developed and underdeveloped countries. The incidence of iron deficiency anaemia varies worldwide depending on differences in race, socioeconomic factors, nutritional status, health condition, and the frequency of parasitic illnesses. Untreated Iron deficiency has significant adverse foetal and maternal consequences.  The management of iron deficiency anaemia includes education regarding dietary modification, specifically ways to enhance iron absorption and iron supplementation. Although oral supplementation is typically the mainstay of treatment, more severe cases of iron deficiency anaemia may require intravenous supplementation.

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References

Tunkyi K, Moodley J. Anemia and pregnancy outcomes: a longitudinal study. J Matern Fetal Neonatal Med 2018: 31: 2594-2598. DOI: https://doi.org/10.1080/14767058.2017.1349746

Lopez A, Cacoub P, Macdougall IC, et al. Iron deficiency anaemia. Lancet 2016; 387: 907-916. DOI: https://doi.org/10.1016/S0140-6736(15)60865-0

Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy: A randomized controlled trial. BMC Pregnancy Childbirth 2017; 17. DOI: https://doi.org/10.1186/s12884-017-1313-9

Lewkowitz AK, Gupta A, Simon L, et al. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. J Perinatol 2019; 1-14. DOI: https://doi.org/10.1038/s41372-019-0320-2

World Health Organisation, “Iron deficiency anaemia: Assessment,prevention and control,” World Health Organisation, Geneva, 2001.

Steer PJ. Maternal hemoglobin concentration and birth weight. Am Journal of Clin Nutri 2000; 7:1285S‑1287S. DOI: https://doi.org/10.1093/ajcn/71.5.1285s

Beutler EWJ. The definition of anaemia: What is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107:1747‑1750. DOI: https://doi.org/10.1182/blood-2005-07-3046

S. Shams, Z. Ahmad and A. Wadood, “Prevalence of Iron Deficiency Anemia in Pregnant Women of District Mardan, Pakistan. J Pregnancy Child Health 2007; 4.

Stevens G, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population representative data. Lancet Glob Health 2013; 1:1016-1025. DOI: https://doi.org/10.1016/S2214-109X(13)70001-9

Khaskheli M, Baloch S, Sheeba S, et al. Iron deficiency anaemia is still a major killer of pregnant women. Pak J Med Sci 2016; 630-634. DOI: https://doi.org/10.12669/pjms.323.9557

Pavord S, Myers B, Robinson S, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012, 156: 588–600. DOI: https://doi.org/10.1111/j.1365-2141.2011.09012.x

Loy SL, Lim LM, Chan S-Y, et al. Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. BMC Public Health 2019, 19: 397. DOI: https://doi.org/10.1186/s12889-019-6736-y

Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Ther Adv Gastroenterol 2011, 4: 177-184. DOI: https://doi.org/10.1177/1756283X11398736

Mast Q, Syafruddin D, Keijmel S, et al. Increased serum hepcidin and alterations in blood iron parameters associated with asymptomatic P. falciparum and P. vivax malaria. Haematologica 2020; 95: 1068-1074. DOI: https://doi.org/10.3324/haematol.2009.019331

Ugwu NI, Uneke CJ. Iron deficiency anemiain pregnancy in Nigeria—A systematic review. Niger J Clin Pract 2020; 23: 889-896. DOI: https://doi.org/10.4103/njcp.njcp_197_19

Ahamed NH, Kotb SAM, Hassanen RH. Knowledge and Attitude of Pregnant Women about Iron Deficiency Anemia in Assist University Women Health Hospital, Egypt. J of Nur Health Sci 2018; 3: 49-58.

Balci Y, Karabulut A, Gurses D., et al. Prevalence and risk factors of anemia among adolescents in Denizli, Turkey. Iran J Pediatr 2013: 22: 77-81.

Gabee SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 4th Eds., New York, Churchill Livingstone, 1996, pp 1348.

Khalafallah, AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum:pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy 2012; 2012: 1-10. DOI: https://doi.org/10.1155/2012/630519

Milman N, Taylor CL, Merkel J, et al. Iron status in pregnant women and women of reproductive age in Europe. Am J Clin Nutr 2017, 106: 1655S-1662S. DOI: https://doi.org/10.3945/ajcn.117.156000

Lozoff B. Early iron deficiency has brain and behavior effects consistent with dopaminergic dysfunction. J Nutr 2011: 141: 740S-746S. DOI: https://doi.org/10.3945/jn.110.131169

Breymann C, Bian, XM, Blanco-Capito LR, et al. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 2011; 39:112-121. DOI: https://doi.org/10.1515/jpm.2010.132

Tan J, Qi Y, Yang H,et al. Prevalence of anemia and iron deficiency anemia in Chinese pregnant women (IRON WOMEN): a national cross-sectional survey. BMC Pregnancy Childbirth 2020; 20. DOI: https://doi.org/10.1186/s12884-020-03359-z

Rezk M, Marawan H, Dawood R. Prevalence and risk factors of iron-deficiency anaemia among pregnant women in rural districts of Menoufia governorate, Egypt. J Obstet Gynecol 2015; 35, 663-666. DOI: https://doi.org/10.3109/01443615.2014.991289

Okafor IM, Asemota EA, Antai AB, et al. Prevalence of Iron Deficiency Anaemia among Pregnant Women in Calabar, Cross River State, Nigeria. IOSR J Pharm Biol Sci 2013; 7: 60-64. DOI: https://doi.org/10.9790/3008-0726064

Olubukola A, Odunayo A, Adesina O. Anemia in pregnancy at two levels of health care in Ibadan, south west Nigeria. Ann Afr Med 2011; 10: 272- 277. DOI: https://doi.org/10.4103/1596-3519.87042

Ajepe AA, Okunade KS, Sekumade AI, et al. Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant womenin Lagos, Nigeria. PLoS ONE 2020; 15: e0227965. DOI: https://doi.org/10.1371/journal.pone.0227965

Erhabor O, Isaac IZ, Isah A, et al. Iron deficiency among antenatal women in Sokoto, Nigeria. British J of Med Health Sci 2013; 1: 47-57.

Hassan AMAI, Adaji SMB, Kene S. Anemia and Iron Deficiency in Pregnant Women in Zaria, Nigeria. Sub-Saharan Afr J Med 2014; 1: 36-39. DOI: https://doi.org/10.4103/2384-5147.129311

Obasi IO, Nwachukwu N. Comparative iron related anaemia at pregnancy in Ebonyi State, South‑east Nigeria. J Med Sci 2013;13:425-431. DOI: https://doi.org/10.3923/jms.2013.425.431

Gwarzo MY, Ugwa EA. The pattern of anaemia in northern Nigerian pregnant women. J Med Med Sci 2013; 4: 319-323.

Joseph CM, Albert MT, Herman TK, et al. Prevalence and associated factors of anemia during pregnancy in Lubumbashi, in the south of Democratic Republic of Congo: situation in 2020. PAMJ Clinic Med 2021; 7(19): 1-9.

Tomayeva KG, Gaydukov SN, Komissarova EN, et al. Prognosis of iron deficiency anemia in pregnant women with different somatotypes. Journal of Obstetrics and Women’s Diseases 2021; 70(2): 83-89. DOI: https://doi.org/10.17816/JOWD46387

Asrie F. Prevalence of anemia and its associated factors among pregnant women receiving antenatal care at Aymiba Health Center, northwest Ethiopia. J Blood Med 2017; 8: 35-40 DOI: https://doi.org/10.2147/JBM.S134932

Suryanarayana R, Chandrappa M, Santhuram AN, et al. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Family Med Prim Care 2017; 6: 739-743. DOI: https://doi.org/10.4103/jfmpc.jfmpc_33_17

Liyew AM, Tesema GA, Alamneh TS, et al. Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys. PLoS ONE 2021; 16(4): e0250560. DOI: https://doi.org/10.1371/journal.pone.0250560

Daru J, Zamora J, Fernández-Félix BM, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health 2018; 6: e548–e554.

Detlefs SE, Jochum MD, Salmanian B, et al. The impact of response to iron therapy on maternal and neonatal outcomes among pregnant women with anemia. Am J Obstet Gynecol MFM 2022; 4: 100569. DOI: https://doi.org/10.1016/j.ajogmf.2022.100569

Wemakor A, Prevalence and determinants of anaemia in pregnant women receiving antenatal care at a tertiary referral hospital in Northern Ghana. BMC Pregnancy and Childbirth 2019; 19:495 DOI: https://doi.org/10.1186/s12884-019-2644-5

Shi H, Chen L, Wang Y, et al. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Network Open 2022; 5(2): e2147046 DOI: https://doi.org/10.1001/jamanetworkopen.2021.47046

Agarwal AM, Rets A. Laboratory approach to investigation of anemia in pregnancy. Int J Lab Hematol 2021; 43: 65-70. DOI: https://doi.org/10.1111/ijlh.13551

Margwe JA, Lupindu AM. Knowledge and attitude of pregnant women in rural Tanzania on prevention of anaemia. Afr J Reprod Health 2018; 22: 71-79.

Serbesa ML, Iffa MT. Knowledge, attitude and practice on prevention of iron deficiency anemia among pregnant women attending ante natal care unit at public hospitals of Harar Town, Eastern Ethiopia: institutional based cross-sectional study. Int J Pregnancy Child Birth 2019; 5: 48-55. DOI: https://doi.org/10.15406/ipcb.2019.05.00146

Daru J, Zamora J, Fernandez-Felix BM. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health 2018; 6:e548-e554. DOI: https://doi.org/10.1016/S2214-109X(18)30078-0

Sobhy S, Arroyo-Manzano D, Murugesu N. Maternal and perinatal mortality and complications associated with caesarean section in low-income review and meta-analysis. Lancet 2019; 10184: 1973-1982. DOI: https://doi.org/10.1016/S0140-6736(18)32386-9

Pasricha SR, Flecknoe-Brown SC, Allen KJ. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust 2010;193: 525-532. DOI: https://doi.org/10.5694/j.1326-5377.2010.tb04038.x

Tandon R, Jain A, Malhortra P. Management of Iron Deficiency Anemia in Pregnancy in India. Indian J Hematol Blood Transfus 2018; 34: 204-215. DOI: https://doi.org/10.1007/s12288-018-0949-6

Zaman B, Rasool S, Jasim S, et al. Hepcidin as a diagnostic biomarker of iron deficiency anemia during pregnancy. J Matern Fetal Neonatal Med 2019; 1-10. DOI: https://doi.org/10.1080/14767058.2019.1635112

Vanamala VG, Rachel A, Pakyanadhan SS. Incidence and outcome of anemia in pregnant women: a study in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2018; 7: 462-466. DOI: https://doi.org/10.18203/2320-1770.ijrcog20180155

Zolotor AJ, Carlough MC. Update on prenatal care. Am Fam Physician 2014; 3:199-208.

Panigragi A, Sahoo B. Nutritional Anemia and its Epidemiological Correlates among Women of Reproductive Age in Urban Slum of Bhubaneswar, Orissa. Indian J Public health 2011; 55. DOI: https://doi.org/10.4103/0019-557X.92415

Khuu G, Dika C. Iron deficiency anemia in pregnant women. Nurse Pract 2017; 42:42-47. DOI: https://doi.org/10.1097/01.NPR.0000516124.22868.08

Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr 2010; 91:1461S-1467S. DOI: https://doi.org/10.3945/ajcn.2010.28674F

Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci 2014;19:164-174.

Raut K, Kumar B, Shretha J, et al. Prevalence of iron deficiency anemia among pregnant women before iron supplementation in Kathmandu University Hospital/Dhulikhel Hospital. J Obstet Gynecol 2014; 2:54-58. DOI: https://doi.org/10.11648/j.jgo.20140204.12

Goot K, Hazeldine S, Bentley P, et al. Elevated serum ferritin: what should GPs know? Aus Fam Physician 2012; 41: 945-949.

Jimenez K, Kulnigg-Dabsch S, Gasche C. Management of Iron Deficiency Anemia. Gastroenterol Hepatol 2015, 11: 241-250.

Stoffel NU, von Siebenthal HK, Moretti D, et al. Oral iron supplementation in iron-deficient women: How much and how often? Molecular Aspects of Medicine 2020, 75: 100865. DOI: https://doi.org/10.1016/j.mam.2020.100865

Schwartz AJ, Das NK, Ramakrishnan SK, et al. Hepatic hepcidin/intestinal HIF-2alpha axis maintains iron absorption during iron deficiency and overload. J Clin Invest 2019, 129: 336–348. DOI: https://doi.org/10.1172/JCI122359

Viteri FE, Xunian L, Tolomei K, et al. True absorption and retention of supplemental iron is more efficient when iron is administered every three days rather than daily to iron-normal and iron-deficient rats. J Nutr 1995, 125: 82-91.

Cook JD, Reddy MB. 1995. Efficacy of weekly compared with daily iron supplementation. Am J Clin Nutr 1995, 62: 117-120. DOI: https://doi.org/10.1093/ajcn/62.1.117

Olivares M, Pizarro F, Walter T, et al. Bioavailability of iron supplements consumed daily is not different from that of iron supplements consumed weekly. Nutr Res 1999, 19: 179-190. DOI: https://doi.org/10.1016/S0271-5317(98)00182-1

Bloor SR, Schutte R, Hobson AR. Oral Iron Supplementation-Gastrointestinal Side Effects and the Impact on the Gut Microbiota. Microbiol Res 2021, 12: 491–502. DOI: https://doi.org/10.3390/microbiolres12020033

Christoph P, Schuller C, Studer H, et al. Intravenous iron treatment in pregnancy: comparison of high-dose ferric carboxymaltose vs. iron sucrose. J Perinat Med 2012; 40; 469-474. DOI: https://doi.org/10.1515/jpm-2011-0231

Simons FE, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ. J 2015, 8: 32. DOI: https://doi.org/10.1186/s40413-015-0080-1

Rampton D, Folkersen J, Fishbane S, et al. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica 2014, 99: 1671–1676. DOI: https://doi.org/10.3324/haematol.2014.111492

Schaefer B, Meindl E, Wagner S, et al. Intravenous iron supplementation therapy. Molecular Aspects of Medicine 2020, 75: 100862. DOI: https://doi.org/10.1016/j.mam.2020.100862

Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr 2015, 102: 1585–1594. DOI: https://doi.org/10.3945/ajcn.114.103366

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Published

2023-06-28

How to Cite

1.
Yusuf ZU, Isaac Dibal N, Chiroma MS. Iron Deficiency in Pregnancy: A Brief Review. JMS [Internet]. 2023 Jun. 28 [cited 2024 May 7];92(2):e776. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/776

Issue

Section

Review Papers
Received 2022-11-18
Accepted 2023-03-28
Published 2023-06-28