3.Iron,status,during,pregnancy_,setting,the,stage,for,mother,and,infant.

Iron status during pregnancy setting the stage for mother and infant1 4 Theresa O Scholl ABSTRACT Supplementation with iron is generally recommended during preg nancytomeettheironneedsofbothmotherandfetus Whendetected early in pregnancy iron deficiency anemia IDA is associated with a 2 fold increase in the risk of preterm delivery Maternal anemia when diagnosed before midpregnancy is also associated with an increasedriskofpretermbirth Resultsofrecentrandomizedclinical trials in the United States and in Nepal that involved early supple mentation with iron showed some reduction in risk of low birth weightorpretermlowbirthweight butnotpretermdelivery During the 3rd trimester maternal anemia usually is not associated with increased risk of adverse pregnancy outcomes and may be an indi cator of an expanded maternal plasma volume High levels of he moglobin hematocrit and ferritin are associated with an increased risk of fetal growth restriction preterm delivery and preeclampsia While iron supplementation increases maternal iron status and stores factors that underlie adverse pregnancy outcome are consid ered to result in this association not iron supplements On the other hand ironsupplementsandincreasedironstoreshaverecentlybeen linked to maternal complications eg gestational diabetes and in creasedoxidativestressduringpregnancy Consequently whileiron supplementationmayimprovepregnancyoutcomewhenthemother isirondeficientitisalsopossiblethatprophylacticsupplementation may increase risk when the mother does not have iron deficiency or IDA Anemia and IDA are not synonymous even among low income minority women in their reproductive years Am J Clin Nutr 2005 81 suppl 1218S 22S KEY WORDSAnemia iron deficiency ferritin oxidative stress pretermdelivery lowbirthweight gestationaldiabetes iron supplementation pregnancy INTRODUCTION Anemia as determined by low hemoglobin or hematocrit is common among women in their reproductive years in particular if the women are poor pregnant and members of an ethnic minority Untilrecently itwasassumedthatanemiaduringpreg nancyhadfewuntowardsequelae Duringthepastfewyears the relationbetweenanemiaearlyinpregnancyandanincreasedrisk ofpretermdeliveryhasbeensuggested Likewise therelationof adverse pregnancy outcomes with high hemoglobin and in creasedironstoreshasbeendocumented However therisksand benefits of prophylactic iron supplementation in pregnant women who are not iron deficient remains a source of contro versy PRENCE AND ETIOLOGY OF ANEMIA AND IRON DEFICIENCY IN WOMEN Iron deficiency is the most commonly recognized nutritional deficit in either the developed or the developing world During theirreproductiveyearswomenareatriskofirondeficiencydue to blood loss from menstruation in particular that 10 who suffer heavy losses 80 mL mo Contraceptive practice also plays a part the intrauterine devices increases menstrual blood loss by 30 50 while oral contraceptives have the opposite effect Pregnancy is another factor During pregnancy there is a significantincreaseintheamountofironrequiredtoincreasethe red cell mass expand the plasma volume and to allow for the growth of the fetal placental unit Finally there is diet Women intheirreproductiveyearsoftenhaveadietaryironintakethatis toolowtooffsetlossesfrommenstruationandtheincreasediron requirement for reproduction 1 Consequently the overall prence of iron deficiency in non pregnant women of repro ductiveageintheUnitedStates 9 11 ishigherthanatother ages apart from infancy The prence of IDA in the same age group is 2 5 Prence of iron deficiency and IDA is in creased 2 fold or more for those women who are minorities belowthepovertylevelorwith 12yofeducation Riskisalso increasedwithparity nearly3 foldhigherforwomenwith2 3 children and nearly 4 fold greater for women with 4 or more children thus implicating pregnancy 2 Itisestimatedthat 50 ofwomendonothaveadequateiron stores for pregnancy 1 3 Because the iron required for preg nancy 3 4 mg d is substantial risk of iron deficiency and IDA should increase with gestation However the prence of ane mia and IDA in pregnant women from the United States is not welldefinedbutmustbesubstantial particularlyamongthepoor During pregnancy anemia increases 4 fold from the 1stto the 3rdtrimester in the low income women monitored as part of pregnancy nutritional surveillance by the CDC 3 In the Cam den Study where the cohort is mostly minority current data 2000 2004 suggest that the prence of anemia increases 1From the Department of Obstetrics and Gynecology The University of MedicineandDentistryofNewJersey SOM Stratford NewJersey08084 2Presentedattheconference WomenandMicronutrients Addressingthe Gap Throughout the Life Cycle held in New York NY June 5 2004 3Supported by HD18269 HD38329 and ES07437 from the National Institutes of Health 4Address reprint requests and correspondence to Theresa O Scholl UMDNJ SOM DepartmentofOb Gyn ScienceCenter Suite390 Stratford NJ 08104 E mail scholl umdn