Prophylactic Iron Supplementation in Pregnancy: A Controversial Issue

Friedrisch, João Ricardo; Friedrisch, Bruno Kras

doi:10.1177/1178626417737738

Cited by 31 publications

(33 citation statements)

References 73 publications

(195 reference statements)

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“…This corroborates other studies carried out in similar environments [11] [ ng/ml, respectively) [20] and India (mean serum ferritin of 60.42 ± 20.24 -47.33 ± 13.49 ng/ml) [21], but lower than values from wealthy environments (26 -38 ng/ml for ferritin) [22]. Ferritin reflects iron storage in the body, and it is claimed that in the absence of inflammatory situation the lowest levels are close to 15 ng/ml [23]. So, the level of our overall group (20.9 ± 18.6 ng/ml) as well as that of the anemic subgroup (7.5 ± 3.9 ng/ml) at ± 16 weeks of gestation is very low since it is expected to decrease over pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

Mbangama¹,

Tandu-Umba²,

Roger³

2018

OJOG

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Objective: To determine baseline iron and oxidative status in a cohort of pregnant women before iron supplementation in our setting. Background: Screening of iron deficiency before supplementation during pregnancy has been scarce. Therefore, following routine iron supplementation confounding results might be found in outcomes of groups of patients considered. Taking in account that body/serum iron status is reportedly linked to maternal oxidative status, we aimed to associate assessment of baseline iron and oxidative status of women in need of oral supplementation during pregnancy. Methods: This is a cross-sectional study concerning 74 women attending antenatal care at the University Clinics of Kinshasa from September 2017 throughout June 2018, with a singleton pregnancy not exceeding 19 weeks, regardless of age and parity. Variables of the study included sociodemographic and anthropometric ones along with parameters of iron status (hemoglobin, hematocrit, ferritin, serum iron, transferrin and iron saturation capacity). Oxidative status was assessed using superoxide dismutase (SOD) and uric acid as antioxidants, while oxidant agents were oxidized LDL and blood glucose (beside serum iron and ferritin). According to local standards anemia was defined as hemoglobin < 10 g/L and pathologic serum ferritin as < 15 ng/ml. For statistical calculations we used t-test, chi-square test and Pearson's correlation test, the significance being stated at p ≤ 0.05. Results: At recruitment (15.9 ± 1.7 9 week gestational age) mean hemoglobin value of the overall study group was 10.3 ± 1.5 g/dl. Anemia was diagnosed to 39 women that represented 52.2% of the study group, most of anemic women belonging to low socioeconomic sub-group (69.2% vs 29%; P < 0.001). The majority was para 2, with average weight of 70.2 ± 14.5 Kg (P not significant between sub-groups) and BMI of 26 ± 5.2 Kg/m 2 (P < 0.01).higher among anemic women (61.5% vs 34.3%; P < 0.02) that had lower alimentary iron intake (22.8 ± 4.9 gr/day vs 31.4 ± 9.5 gr; P < 0.001). Of markers of iron status serum ferritin and iron were lower in anemic women (7.5 ± 3.9 ng/ml vs 35.7 ± 17.1 ng/ml; P < 0.001 and 52.7 ± 38.9 μg/dl vs 96.2 ± 41.8 μg/dl, respectively. Both sub-groups were similar in serum transferrin. As of markers of oxidative stress anemic women had significantly higher superoxide dismutases (SOD) (1056.4 ± 762.1 UI/L vs 682.6 ± 543.9 UI/L (P < 0.02) and oxidizedd anti LDL Ac (439.6 ± 209.5 UI/L vs 192.8 ± 136.3 UI/L (P < 0.001). Serum iron, ferritin, SOD and oxidized LDL were more likely to assess iron and oxidative status in our setting. Conclusion: The rate of anemic mothers found in our study (52.2%) has been quite constant in our setting for years, meaning endemicity. Serum iron and ferritin were significantly lower in anemic women, which is supportive of routine iron supplementation during pregnancy. Significantly higher level of SOD and oxidized LDL in anemic women suggests that maternal anemia may count into oxidative stress likely to be found in these women.

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Section: Discussionmentioning

confidence: 99%

Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

Mbangama¹,

Tandu-Umba²,

Roger³

2018

OJOG

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“…The authors declare no conflict of interest. Ж елезодефицитная анемия (ЖДА) является одним из самых распространенных заболеваний в мире [1,2]. ЖДА -синдром, характеризующийся нарушением синтеза гемоглобина вследствие дефицита железа и проявляющийся анемией.…”

Section: Conflict Of Interestunclassified

Efficacy of iron sulfate with ascorbic acid in pregnant women with iron deficiency of varying degrees of severity

Ильина

Доброхотова

2019

Med. sov.

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Iron deficiency anemia (IDA) is one of the most common diseases in the world, characterized by hemoglobin synthesis disorder due to iron deficiency and manifested by anemia. According to WHO, the rate of IDA in pregnant women in different countries ranges from 21 to 80%, judging by the level of hemoglobin, and from 49 to 99% - by serum iron. Lack of treatment of iron-deficient pregnant women with varying degrees of iron deficiency leads to an increase in the frequency of complicated pregnancy, such as the threat of termination of pregnancy, placental insufficiency, delay in intrauterine development and hypoxia of the fetus, premature delivery, poor uterine contraction strength, pathological bleeding, infectious complications. Aim of the study: study of the efficacy of the drug containing iron sulfate (Ferrous sulfate) and ascorbic acid in pregnant women with latent and manifest forms of iron deficiency. Patients and methods: 66 pregnant women were examined. Group 1 consisted of 36 pregnant women with latent iron deficiency, Group 2–30 pregnant women with manifest iron deficiency and moderate anemia. Pregnant women in the 1st group were prescribed the drug only for 1 month due to the fact that there were no manifestations of anemia in this category of patients. Blood parameters were monitored dynamically after 1 month of treatment and after 2 months, which means after 1 month of absence of the drug intake. Patients of the 2nd group received treatment during 2 months, dynamic treatment after laboratory parameters was carried out after 1 and 2 months of treatment. Results of the study. Analyzing the data obtained, it was found that all laboratory parameters differ significantly from those before treatment. Pregnant women of the 1st group have no reliable changes between the parameters after 1 and 2 months of observations, as during this period the patients did not receive iron medication. And even a slight decrease in some indicators is noted, but when compared with laboratory data before treatment, the results differ significantly. Conclusion: Ferrous sulfate and ascorbic acid can be recommended to compensate iron deficiency in pregnant women with LID to prevent the development of anemia, in patients with MID to treat anemia and prevent the development of possible complications in pregnant women associated with this condition. Thus, earlier detection and elimination of LID leads to prevention of anemia later on.

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“…Iron supplementation is recommended to pregnant women at risk of anaemia, generally from the second trimester to birth, continuing postpartum in populations where IDA is highly prevalent (Casanueva & Viteri 2003). However, controversy exists regarding prophylactic iron supplementation in lowrisk populations due to potential adverse effects of iron overload, associated with increased oxidative stress and cellular toxicity (Friedrisch & Friedrisch 2017) (see later section).…”

Section: Clinical Studiesmentioning

confidence: 99%

Effects of micronutrients on placental function: evidence from clinical studies to animal models

Baker¹,

Hayes²,

Jones³

2018

Reproduction

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Micronutrient deficiencies are common in pregnant women due to low dietary intake and increased requirements for fetal development. Low maternal micronutrient status is associated with a range of pregnancy pathologies involving placental dysfunction, including fetal growth restriction (FGR), small-for-gestational age (SGA), pre-eclampsia and preterm birth. However, clinical trials commonly fail to convincingly demonstrate beneficial effects of supplementation of individual micronutrients, attributed to heterogeneity and insufficient power, potential interactions and lack of mechanistic knowledge of effects on the placenta. We aimed to provide current evidence of relationships between selected micronutrients (vitamin D, vitamin A, iron, folate, vitamin B12) and adverse pregnancy outcomes, combined with understanding of actions on the placenta. Following a systematic literature search, we reviewed data from clinical, and studies of micronutrient deficiency and supplementation. Key findings are potential effects of micronutrient deficiencies on placental development and function, leading to impaired fetal growth. Studies in human trophoblast cells and rodent models provide insights into underpinning mechanisms. Interestingly, there is emerging evidence that deficiencies in all micronutrients examined induce a pro-inflammatory state in the placenta, drawing parallels with the inflammation detected in FGR, pre-eclampsia, stillbirth and preterm birth. Beneficial effects of supplementation are apparent and in animal models and for combined micronutrients in clinical studies. However, greater understanding of the roles of these micronutrients, and insight into their involvement in placental dysfunction, combined with more robust clinical studies, is needed to fully ascertain the potential benefits of supplementation in pregnancy.

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Prophylactic Iron Supplementation in Pregnancy: A Controversial Issue

Cited by 31 publications

References 73 publications

Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

Efficacy of iron sulfate with ascorbic acid in pregnant women with iron deficiency of varying degrees of severity

Effects of micronutrients on placental function: evidence from clinical studies to animal models

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