Integrating themes, evidence gaps, and research needs identified by workshop on iron screening and supplementation in iron-replete pregnant women and young children

Abstract

This report addresses the evidence and the uncertainties, knowledge gaps, and research needs identified by participants at the NIH workshop related to iron screening and routine iron supplementation of largely iron-replete pregnant women and young children (6-24 mo) in developed countries. The workshop presentations and panel discussions focused on current understanding and knowledge gaps related to iron homeostasis, measurement of and evidence for iron status, and emerging concerns about supplementing iron-replete members of these vulnerable populations. Four integrating themes emerged across workshop presentations and discussion and centered on 1) physiologic or developmental adaptations of iron homeostasis to pregnancy and early infancy, respectively, and their implications, 2) improvement of the assessment of iron status across the full continuum from iron deficiency anemia to iron deficiency to iron replete to iron excess, 3) the linkage of iron status with health outcomes beyond hematologic outcomes, and 4) the balance of benefit and harm of iron supplementation of iron-replete pregnant women and young children. Research that addresses these themes in the context of the full continuum of iron status is needed to inform approaches to the balancing of benefits and harms of screening and routine supplementation.Am J Clin Nutr 2017;106(Suppl):1703S-12S.

Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy

“…The prospect for developing standard reference methods for SF and sTfR is poor because of the size of the proteins involved and technical challenges inherent in doing so [ 46 , 47 ]. In the absence of such standardization, measures may exhibit imprecision and inflated Confidence Intervals [ 46 , 48 ] that can create interpretative challenges and also contribute to misclassification of ID and IDA.…”

“…A number of knowledge gaps and research needs were identified at the NIH Workshop on Iron Screening and Supplementation of Iron-Replete Pregnant Women and Young Children in 2016. Four major themes emerged from these gaps and research needs focusing on (1) elucidating adaptations of iron homeostasis in pregnancy and early infancy including their mechanisms, responsiveness to iron status, interaction with genetic and ethnic factors and implication’s for the differential prioritization of iron to developing tissues and hematopoiesis; (2) improving the assessment of iron status particularly in these two vulnerable periods including the measurement uncertainties, need for indicators across the full continuum of iron status that are adjustable or independent of inflammation; (3) evaluating iron status relative to maternal and infant health outcomes, especially non-hematologic outcomes; and (4) determination of short and long term beneficial and adverse health outcomes, especially non-health outcomes such as GDM, LBW, SGA, postnatal growth and DOHaD, with iron supplementation of iron-replete pregnant women and young children [ 45 , 48 ]. In Figure 1 , an analytic framework of these knowledge gaps and research needs is depicted along the pathway from screening to supplementation to outcomes.…”

“…Abbreviations include ID, iron deficiency; IDA, iron deficient anemia; GI, gastroinestine; GDM, gestational diabetes; T2D, type 2 diabetes. (From Brannon et al [ 48 ] and reprinted with permission by American Journal of Clinical Nutrition: Am. J. Clin.…”

Gebeli̇kte Demi̇r Ve Folat Eksi̇kli̇ği̇ Anemi̇si̇nde Kanita Dayali Güncel Yaklaşimlar

“…Bunula birlikte askorbik asit demir emilimini artırdığından bazı demir takviyeleri C vitamini içermesine rağmen, portakal suyu genellikle demir desteği alan gebelere önerilir. Vejeteryan gebelere; fasulye, mercimek, ıspanak, tam buğday ekmekleri, bezelye, kuru kayısı, kuru erik ve kuru üzüm gibi demir içeriği yüksek gıdaları tüketmeleri için teşvik edilmelidir (3,10,17,18). (3,8,20,21).…”

Maternal iron intake during pregnancy and the risk of small for gestational age

“…The evidence supports the effectiveness of routine iron supplementation during pregnancy for improving maternal haematological indices, but the clinical significance for pregnant women and their newborns remains unclear (Brannon, Stover, & Taylor, ; Brannon & Taylor, ; Cantor, Bougatsos, Dana, Blazina, & McDonagh, ; Demuth, Martin, & Weissenborn, ; Marangoni et al, ; O'Brien & Ru, ). Despite this, the WHO recommends universal iron supplements of 30–60 mg/day during pregnancy (WHO, , ).…”