Effect of oral iron supplementation during pregnancy on maternal and fetal iron status

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Abstract
The known increased need for Fe during pregnancy appears to be met only in part by increased Fe absorption and amenorrhea. Considerable demands are made on maternal Fe stores and, since many women lack sufficient storage Fe, pregnancy may be expected to cause Fe deficiency. This may lead to anemia in pregnancy and post partum and could also have a bearing on the Fe status of the fetus and the neonate. Based on these considerations, prophylactic supplementation of dietary Fe is advocated but remains a disputed issue. In the present controlled, prospective and longitudinal study, changes in hematologic status, and in particular in Fe stores, during pregnancy were investigated in 44 healthy Caucasian women with uncomplicated pregnancies and deliveries. They were randomly assigned to a study group (n = 21) receiving oral Fe supplements from the 16th wk of amenorrhea until 6 wk post partum and a control group (n = 23) without Fe supplementation. Maternal concentrations of Hb, serum Fe, serum transferrin and serum ferritin were determined at 16, 28 and 36 wk of amenorrhea, at delivery, and 6 and 12 wk postpartum. The same variables were determined in cord blood. Fe supplementation appeared to prevent the physiologic fall in Hb and serum Fe concentrations which occurred in the control group, but had little influence on the observed rise in transferrin concentration. Ferritin levels in serum, which are known to reflect mobilization Fe stores, fell to 30% of the initial values in the control group and to 70% in the study group. Six and 12 wk postpartum ferritin levels were still low in the nonsupplemented group. No differences were found between the hematologic variables in venous cord blood from infants from supplemented and nonsupplemented women. No correlations were found between the various variables of the maternal hematologic status, in particular not between Hb concentrations and ferritin levels; a normal Hb concentration appears to be a poor indicator of Fe stores. No relationship between maternal and fetal Fe status. The study shows that depleted Fe stores are still found 3 mo. following pregnancy without Fe supplementation. To prevent depletion of Fe stores during pregnancy prophylactic Fe supplementation is favored in all pregnant women from the beginning of the 2nd trimester until delivery.

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