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

Abstract

Iron is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development. Much attention has been given to conditions of iron deficiency (ID) and iron deficient anemia (IDA) because of the high global prevalence estimated in these vulnerable life stages. Emerging and preliminary evidence demonstrates, however, a U-shaped risk at both low and high iron status for birth and infant adverse health outcomes including growth, preterm birth, gestational diabetes, gastrointestinal health, and neurodegenerative diseases during aging. Such evidence raises questions about the effects of high iron intakes through supplementation or food fortification during pregnancy and infancy in iron-replete individuals. This review examines the emerging as well as the current understanding of iron needs and homeostasis during pregnancy and infancy, uncertainties in ascertaining iron status in these populations, and issues surrounding U-shaped risk curves in iron-replete pregnant women and infants. Implications for research and policy are discussed relative to screening and supplementation in these vulnerable populations, especially in developed countries in which the majority of these populations are likely iron-replete.

Association of Iron Status and Intake During Pregnancy with Neuropsychological Outcomes in Children Aged 7 Years: The Prospective Birth Cohort Infancia y Medio Ambiente (INMA) Study

“…Overall, our findings are consistent with those of previous studies demonstrating the potential importance of maternal iron status in fetal programming and lifelong health [3][4][5][6]13,20,25,[55][56][57]. Although a previous review concluded that maternal nutritional status has no effect on offspring neurodevelopmental outcomes, [28] differences in iron status indicators, iron measurements during pregnancy, and the domains assessed [58] could explain some of these inconsistencies. The results of our study also show that in addition to initial iron status, reflected by SF levels, a total intake of iron higher than 14.50 mg/day was associated with higher working memory scores in their children at 7 years, a key executive function that influences other more complex executive functions.…”

Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: The HEIRS Study

“…Iron deficiency (ID) in women is a cosmopolitan health and nutritional problem [1]. ID in women is associated with fatigue, impaired muscular performance, decreased ability to maintain body temperature on exposure to cold, mucosal and epithelial abnormalities, pica, disturbances in menstruation [2], adverse pregnancy outcomes [3,4], and decreased mental development of children [5]. The estimated prevalence of ID is lower in women in North America than Africa, Asia, Europe, Latin America and the Caribbean, and Oceania [6], but few cross-sectional studies report the prevalence of ID in women of different race/ethnicity and age who reside in North America [7,8].…”

Population-Based Estimation of the Preterm Birth Rate in Lilongwe, Malawi: Making Every Birth Count

“…29 Interventions aimed at reducing anemia and malnutrition, however, have not always resulted in reduced rates of PTB. [40][41][42][43] Nevertheless, other future interventions may prove beneficial. Finally, we found that women with PTB were less likely to have had an ultrasound.…”