Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy

Daru, Jahnavi; Cooper, Natalie Am; Khan, Khalid S.

doi:10.1111/aogs.12812

Cited by 20 publications

(12 citation statements)

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“…Furthermore, the traditional ferritin cut‐off values of <12 or <15 μg L −1 used to define iron deficiency in this patient group are based on international consensus guidelines from 1998 and 2001 and not on published evidence (Daru et al, June 2017). Likewise, the cut‐off value of <30 μg L −1 quoted by numerous national guidelines, including the British Committee for Standards in Haematology (BCSH) guidelines, are based on a study (van den Broek et al, ) in which half the patients had HIV and, therefore, possible inflammation (Daru et al, ). Pregnancy‐specific ferritin levels have never been researched in high‐quality studies.…”

Section: Iron Deficiency Anaemia – Testingmentioning

confidence: 99%

“…June 2017). Likewise, the cut-off value of <30 g L −1 quoted by numerous national guidelines, including the British Committee for Standards in Haematology (BCSH) guidelines, are based on a study (van den Broek et al, December 1998) in which half the patients had HIV and, therefore, possible inflammation (Daru et al, March 2016). Pregnancy-specific ferritin levels have never been researched in high-quality studies.…”

Section: Fig 2 Genetic and Acquired Factors Influencing Serum Hepcimentioning

confidence: 99%

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The management of anaemia and haematinic deficiencies in pregnancy and post‐partum

Roy

Pavord

2018

Transfusion Medicine

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Anaemia is one of the most common disorders in the world (24·8% of the world population) (de Benoist 2008) and affects patients of all ages and ethnic origins. Underlying causes and prevalences vary by age group and socioeconomic background, but pregnant women everywhere are at high risk of anaemia, the vast majority of cases being due to iron deficiency. One in four pregnant women in Europe are thought to have iron deficiency anaemia (Daru et al., March 2016), whereas in parts of Africa, where hookworm infestation is common, this has been estimated to be as high as 38% (Stevens et al., 2013) to 50% (Bah et al., June 2017). Women of menstruating age are rarely iron replete (Low et al., 18 April 2016) and then enter pregnancy, which carries a major negative iron balance (Bentley, October 1985). Despite a good understanding of the causes of anaemia in pregnancy, there is still uncertainty about how best this should be investigated, prevented and managed. This reflects the limitations of laboratory tests, as well as the poor understanding of how best to replace iron, given the complex physiological mechanisms of iron absorption and distribution. A strategy for iron replacement in a population of anaemic pregnant women needs to be developed not only based on what is biologically and clinically most appropriate but also in the context of each organisation's delivery of care structure, taking into consideration aspects of cost effectiveness. For this reason, management algorithms must be adapted locally, ensuring they meet basic clinical imperatives.

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Section: Iron Deficiency Anaemia – Testingmentioning

confidence: 99%

Section: Fig 2 Genetic and Acquired Factors Influencing Serum Hepcimentioning

confidence: 99%

The management of anaemia and haematinic deficiencies in pregnancy and post‐partum

Roy

Pavord

2018

Transfusion Medicine

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“…This is an important consideration since many humans consume supplemental iron (in addition to dietary iron), and it is conceivable that this could lead to copper depletion (32). Notably, some of the experimental diets used here, containing iron at 4-and 9.5-fold above requirements, are within the range of iron intake that humans could achieve when consuming iron supplements (6)(7)(8)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…Defining the minimum dietary iron concentration that antagonizes copper is important, given that many humans consume supplemental iron (6,7). Individuals most likely to require iron supplements include infants and children, adolescents, and menstruating and pregnant women, particularly amongst those of modest economic means (8)(9)(10)(11)(12). Moreover, some pathologic situations may impair intestinal iron absorption, thus increasing the risk for iron depletion and the likelihood that iron supplementation may be recommended.…”

Section: Introductionmentioning

confidence: 99%

Progressive Increases in Dietary Iron Are Associated with the Emergence of Pathologic Disturbances of Copper Homeostasis in Growing Rats

Doguer

Flores

et al. 2018

The Journal of Nutrition

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Increasing dietary iron intakes to ∼9.5-fold above dietary recommendations caused copper deficiency. Importantly, human iron supplementation is common, and recommended intakes for at-risk individuals may be ≤10-fold above the RDA. Whether these iron intakes perturb copper metabolism is worth considering, especially since copper defi-ciency can impair iron utilization (e.g., by decreasing the ferroxidase activity of ceruloplasmin).

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“…Globally, the prevalence of anaemia in pregnant women in 2011 was estimated to be 38%, equivalent to 32 million women (Stevens et al ., ). Prevalence of iron deficiency in the absence of anaemia is estimated to be between 30 and 60% (Daru et al ., ). As erythropoiesis becomes more and more compromised, iron stores progress from being replete to reduced and finally depleted, resulting in anaemia (Scholl, ; Pavord et al ., ).…”

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confidence: 97%

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

Daru

Allotey

Peña-Rosas

et al. 2017

Transfusion Medicine

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SUMMARYThe aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL−1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.

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Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy

Abstract: Serum ferritin appears to change more than hemoglobin following iron supplementation. The clinical effects of this need further investigation.

Cited by 20 publications

References 57 publications

The management of anaemia and haematinic deficiencies in pregnancy and post‐partum

The management of anaemia and haematinic deficiencies in pregnancy and post‐partum

Progressive Increases in Dietary Iron Are Associated with the Emergence of Pathologic Disturbances of Copper Homeostasis in Growing Rats

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

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