The Ferritin, Hepcidin and Cytokines Link in the Diagnoses of Iron Deficiency Anaemia during Pregnancy: A Review

Abstract

Following a diagnosis of iron deficiency anaemia in pregnancy, iron supplements are prescribed using UK guidelines; however, despite this, the condition remains highly prevalent, affecting up to 30% of pregnant women in the UK. According to the World Health Organisation, it globally accounts for 45% in the most vulnerable groups of pregnant women and infants (<5 years old). Recently, the efficacy of iron replacement therapy and the effectiveness of current standard testing of iron parameters have been reviewed in order to evaluate whether a more accurate diagnosis can be made using alternative and/or supplementary markers. Furthermore, many questions remain about the mechanisms involved in iron metabolism during pregnancy. The most recent studies have shed more light on serum hepcidin and raised questions on the significance of pregnancy related inflammatory markers including cytokines in iron deficiency anaemia. However, research into this is still scarce, and this review aims to contribute to further understanding and elucidating these areas.

Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort

“…In the MINDI cohort, it is likely that iron deficiency and iron restriction coexist; not only is there a high prevalence of total body iron depletion, but the presence of inflammation further prevents iron repletion. We suggest a relative excess of hepcidin in this population, as hepcidin should be blunted because of pregnancy [ 32 ] and because of iron deficiency [ 95 ]. Currently, it is understood that, under normal conditions, hepcidin is suppressed during the second and third trimesters of pregnancy [ 96 ], with reported values up to 10-fold lower in the second trimester over a similar range of ferritin during normal pregnancy [ 33 ].…”

“…Ferritin was the main determinant of anemia, with higher concentrations decreasing its odds, and where decreased odds of anemia were associated with higher serum iron. Using a recently proposed cut-off of ferritin < 30 mg/L indicating severe iron deficiency in pregnancy [ 95 , 99 ], coexistent low ferritin and anemia were found in 35.2% of pregnant women (92.6% of anemic women). Our findings fall in the range of current estimated IDA in pregnancy in developing settings of 35–75% [ 99 ].…”

Unraveling the Role of Maternal Serum Ferritin Levels in Preterm Delivery: A Comprehensive Review

“…Maternal iron status is complex and multifactorial, influenced by dietary intake, physiological changes, and the intricate interplay of hormones. Thus, healthcare providers must consider these dynamic factors when assessing iron status during pregnancy and making clinical decisions about supplementation or dietary recommendations to support maternal and fetal health [ 16 ].…”

Anemia Ferropriva E Atipicidades Gestacionais: Cuidados Médicos Preventivos E Corretivos Necessários

“…Muitos são os riscos e atipicidades produzidas em desfavor das gestantes [1][2][3][4][5][6][7] , as quais colocam em perigo a saúde e vida das mulheres neste período fisiológico. Tendo por base os resultados de alguns estudos analisados por esta pesquisa, é possível listar abaixo alguns dos riscos e atipicidades produzidas pela anemia ferropriva e aferidas pela gestante: gestantes, a fadiga, a fraqueza, a palidez cutânea, a palidez da mucosa, as tonturas, as dificuldades de concentração, as palpitações, a taquicardia, a falta de ar, a respiração ofegante, a sensação de frio nas extremidades, os cabelos enfraquecidos, as unhas quebradiças, a dor de cabeça e outras manifestações clínicas podem sugerir a presença da anemia ferropriva gestacional (Alexandre & Bonani, 2023), (Goelzer, 2023), (Moreira, 2023).…”

“…Os marcadores clínicos são altamente relevantes para direcionar ao diagnóstico laboratorial, mas, mais do que isso, serve como meio preventivo para casos de anemia ferropriva, pois viabilizam a antecipação ao diagnóstico (Chibanda, 2023) No exame de dosagem de hemoglobina e hematócrito são avaliadas as quantidades de Hb (Hb 12 a 15 gramas por decilitro (g/dL) em adultos, normal; Hb de 11 a 13,4 g/dL em homens e de 11 a 11,9 g/dL em mulheres, anemia leve; Hb de 8 a 10,9 g/dL em ambos os sexos, anemia moderada; e Hb inferior a 8 g/dL em ambos os sexos, anemia grave / hematócrito de 38% a 50% em homens e de 36% a 46% em mulheres, normal; hematócrito de 33% a 37,9% em homens e de 30% a 35,9% em mulheres, anemia leve; hematócrito de 20% a 29% em ambos os sexos, anemia moderada; e hematócrito inferior a 20% em ambos os sexos, anemia grave) e a proporção de células sanguíneas com relação ao volume sanguíneo total, sendo que valores indicam a presença de anemia ferropriva É importante considerar o suporte de ações preventivas no acompanhamento médico periódico, como a suplementação por sulfato ferroso em casos com predisposição para anemia ferropriva, de modo que se evite a instauração da patologia (Goelzer, 2023). A prevenção dos riscos é feita por meio do diagnóstico precoce de ordem clínico-laboratorial 21 .…”