Routine Iron Supplementation during Pregnancy: Its Reflection on Iron and Oxidative Status in a Cohort of Pregnant Women in Kinshasa, DR Congo

Abstract

Background: Due to maternal and fetal physiologic demand, the rate along with amplitude of anemia is expected to rise over pregnancy. The iron and oxidative status also are expected to vary accordingly. It is thus assumed that iron supplementation will somewhat modify the profile observed in markers of iron and oxidative status of our series. Objectives: We aimed to measure variations of indices of iron and oxidative status of iron supplemented women over pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status have been recently assessed at University Clinics of Kinshasa, DR Congo. Women with anemia (Hb < 10 g%) took iron for curative purposes (320 mg/day of ferric ammonium citrate) while the others received preventive iron supplementation (160 mg/day). Iron was associated with 15 mg folate/day. Nutritional iron intake was measured through a 24-hour recall using a questionnaire of common foods, including stuffs and habits likely to impede iron absorption. Biological parameters of iron and oxidative status included hemoglobin, hematocrit, ferritin, serum iron, transferrin, superoxide dismutase or SOD, uric acid, oxidized LDL and blood glucose. For statistical calculations we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p < 0.05. Results: Trimester wise evolution of hematologic status in anemic women shows a rise in values of hemoglobin (+average 1 gr/dl) and hematocrit (+3%) throughout pregnancy, with significant change only between recruitment and 28-32 weeks. In non anemic women a significant decrease was observed, although levels remained normal. For ferritin (7.5-53 ng/mL from recruitment to term) and transferrin (107-157 g/L), significant rise was found in anemic women from recruitment to 28-32 weeks, while in

Iron and Oxidative Status Following Routine Iron Supplementation: Reflection on Pregnancy Outcomes in a Cohort of Women in Kinshasa, DR Congo

“…Authors who found that the risk was increased observed that it was most increased by high serum iron for some authors [37] So, even though anemia was found significantly associated with most of complications known to be linked with it, in our series the effect of iron supplementation on pregnancy outcomes is far to be obvious. This could be owed to the fact that improvement of 9.01 -9.6 g/dl observed among anemic women [5] might be too small to induce notable changes in outcomes. Furthermore, Viteri and Berger [44] suggest that maternal hemoglobin between 9.5 and 10.5 g/dl in the third trimester correlates with the best clinical outcome.…”

“…Supplemental iron intake was determined with a sheet containing details on the duration of the treatment. Additionally to baseline measurements at recruitment (±15 weeks of gestation) blood sampling and analysis were carried out at 28 -32 weeks and at term [5] [20]. Biological parameters were: Hb, hematocrit, ferritin, serum iron, transferrin and iron saturation capacity for iron status and superoxide dismutase (SOD), uric acid, oxidized low-density lipoprotein (LDL) and fasting blood glucose for oxidative status.…”

“…Use of iron in women during pregnancy improves hematologic values [4] [5] and is expected to prevent these adverse outcomes. The beneficial effect has been evidenced as depending on dose of iron, duration of use, and baseline hemoglobin (Hb) concentration before treatment [5] [6].…”

“…However, iron supplementation both reverses the weakening of anti-oxidant defenses and increases lipid peroxidation [5] [7]- [12], which has been claimed to increase the generation of free radicals leading to oxidative stress [13] [14] [15] [16].…”

“…So, anemic condition is likely to generate the same consequences as that attributed to pro-oxidant properties of iron used to prevent it [18]. Open Journal of Obstetrics and Gynecology Evolution of iron and related oxidative status alongside iron supplementation thus means that beneficial effect of the treatment will vary according to the level of iron-deficiency throughout pregnancy [5]. Therefore, a routine administration may be harmful for women who are or become iron-replete at any period of supplementation.…”