Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation

Milman, Nils; Bergholt, Thomas; Byg, Keld-Erik; Eriksen, Lisbeth; Graudal, Niels

doi:10.1080/j.1600-0412.1999.780902.x

Cited by 94 publications

(77 citation statements)

References 35 publications

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“…All reviews concluded that iron supplementation increased haematological markers (haemoglobin or haematocrit), improved serum ferritin levels, and decreased the incidence of anaemia. Three reviews [27,32,33] (one high, one intermediate and one low quality) showed that such positive effects extended into the postnatal period, with improved maternal haemoglobin concentrations one month to eight weeks postpartum.…”

Section: Resultsmentioning

confidence: 99%

“…One systematic review of high quality [32] and one of low quality, [27] reported infant outcomes. In both, infants born to iron supplemented mothers had a higher serum ferritin at birth compared to non-supplemented women.…”

Section: Resultsmentioning

confidence: 99%

“…Anaemia management remains an uncertain area of research focus, despite its clinical importance. The identification or management of maternal anaemia was the main stated aim in only seven reviews [14-16,27,28,33,34] and overall, the number of RCTs that specifically reported on outcomes relevant to maternal anaemia was small (median 7, interquartile range 1–23).…”

Section: Discussionmentioning

confidence: 99%

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Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Parker

Barroso

Stanworth

et al. 2012

BMC Pregnancy Childbirth

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BackgroundAnaemia, in particular due to iron deficiency, is common in pregnancy with associated negative outcomes for mother and infant. However, there is evidence of significant variation in management. The objectives of this review of systematic reviews were to analyse and summarise the evidence base, identify gaps in the evidence and develop a research agenda for this important component of maternity care.MethodsMultiple databases were searched, including MEDLINE, EMBASE and The Cochrane Library. All systematic reviews relating to interventions to prevent and treat anaemia in the antenatal and postnatal period were eligible. Two reviewers independently assessed data inclusion, extraction and quality of methodology.Results27 reviews were included, all reporting on the prevention and treatment of anaemia in the antenatal (n = 24) and postnatal periods (n = 3). Using AMSTAR as the assessment tool for methodological quality, only 12 of the 27 were rated as high quality reviews. The greatest number of reviews covered antenatal nutritional supplementation for the prevention of anaemia (n = 19). Iron supplementation was the most extensively researched, but with ongoing uncertainty about optimal dose and regimen. Few identified reviews addressed anaemia management post-partum or correlations between laboratory and clinical outcomes, and no reviews reported on clinical symptoms of anaemia.ConclusionsThe review highlights evidence gaps including the management of anaemia in the postnatal period, screening for anaemia, and optimal interventions for treatment. Research priorities include developing standardised approaches to reporting of laboratory outcomes, and information on clinical outcomes relevant to the experiences of pregnant women.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Parker

Barroso

Stanworth

et al. 2012

BMC Pregnancy Childbirth

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“…Serious adverse effects are rare with iron sucrose, however minor side effects occur in up to 18% of patients which may in part be attributed to its non-physiological physical properties (high pH and high osmolarity). Ferric carboxymaltose is a newer dextran-free iron formulation with a near neutral pH, physiological osmolarity and increased bioavailability which allows for single dose, short 15 minute infusion time and higher dosing (up to 1000 mg) [17]. These properties make ferric carboxymaltose an attractive alternative to iron sucrose in terms of risk profile, efficacy, patient comfort and convenience, staff and institutional resource utilization.…”

Section: Introductionmentioning

confidence: 99%

Intravenous ferric carboxymaltose for anaemia in pregnancy

Froessler

Collingwood

Hodyl

et al. 2014

BMC Pregnancy Childbirth

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BackgroundIron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester.MethodsProspective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.ResultsIntravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients.ConclusionsOur prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy.

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“…The fetus is amazingly efficient at obtaining adequate iron from all but the most iron-deficient mother (20). There is no evidence that mild maternal anemia has adverse effects on the newborn.…”

Section: Maternal Anemia and Neonatal/childhood Outcomesmentioning

confidence: 99%

A “Conservative” Approach to Iron Supplementation During Pregnancy

Graves

Barger

2001

J Midwife Womens Health

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A review of current knowledge about iron metabolism during pregnancy and the evidence from various studies on the effects of iron supplementation in pregnancy on maternal, fetal, and infant outcomes suggest that the implicit goal of current recommendations regarding iron supplementation may be to achieve the highest hemoglobin concentration possible. This goal is only weakly related to improved maternal and infant outcomes in the current pregnancy or to improved maternal iron stores long-term. Indeed, the claim that iron supplementation is universally innocuous is shown to be controversial. For women in developed countries who are generally clinically healthy and have access to adequate nutrition, the benefits of iron supplementation are unclear, and there may be risks. Thus, a better "conservative" approach may be that such women do not require routine iron supplementation during pregnancy. The midwifery philosophy of individualizing care based on a woman's history and health status is one that should be taken in approaching the issue of iron supplementation in pregnancy.

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Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation

Cited by 94 publications

References 35 publications

Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Intravenous ferric carboxymaltose for anaemia in pregnancy

A “Conservative” Approach to Iron Supplementation During Pregnancy

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