The Facts

How common is iron deficiency in pregnancy and what are the risks?

Prevalence

Iron deficiency (ID) and iron deficiency anemia (IDA) during pregnancy are highly prevalent in both developed and developing countries.

The World Health Organization (WHO) estimates that 25% of pregnant women in industrialized countries will develop IDA, with a much higher proportion of women being iron deficient without anemia.

At St. Michael’s Hospital, we retrospectively assessed ferritin levels in all pregnant women between January 1, 2017 and December 31, 2017. We found that 90% women were iron deficient in pregnancy.

This is not surprising as the iron demands in pregnancy are at an all time high. It takes over 1 gram of iron to make a baby, the placenta, and to expand maternal blood volume. One gram of iron is equivalent to 177 large steaks!.

BOTTOM LINE: ID in pregnancy is a pandemic.

 

McMahon, LP.  Iron deficiency in pregnancy.  Obstet Med. 2010; 3(1): 17-24.

Worldwide prevalence of anaemia 1993–2005.WHO Global Database on Anaemia. Geneva: World Health Organization; de Benoist B, McLean E, Egli I, Cogswell [http://whqlibdoc.who.int/publications/2008/9789241596657_eng.df].

Risks to mother

  • Cardiovascular/respiratory symptoms of anemia
  • Preterm labour
  • Blood transfusion with associated risk of alloimmunization and other transfusion reactions
  • Post-partum depression
  • Lower concentration affecting IQ
  • Diminished quality of life
  • Death

Anemia during pregnancy must be taken seriously. In fact, a recent international study of 312, 281 women showed that the odds of maternal death were twice as high (adjusted OR 2.36 {95% CI 1.60-3.48}) in those with severe anemia (hemoglobin less than 70g/L) compared with those without severe anemia.

 

Risks to baby

  • Preterm delivery
  • Low birth weight
  • Need for neonatal intensive care unit admission
  • Delayed neurodevelopment
  • Poorer future academic performance into the early childhood years

BOTTOM LINE: There are multiple risks associated with iron deficiency anemia in pregnancy. The IRON MOM is a patient-centred application that counsels patients about the risks. Remind them to download it.

Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017 Feb;129(8):940–9.

Barroso F, Allard S, Kahan BC, Connolly C, Smethurst H, Choo L, et al. Prevalence of maternal anaemia and its predictors: A multi-centre study. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):99–105.

Allen LH. Anemia and iron deficiency: Effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5 SUPPL.):1280–4.

Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005 Feb;135(2):267–72.

Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003. Dec;133(12):4139–42.

Milman N. Prepartum anaemia: Prevention and treatment. Ann Hematol. 2008;87(12):949–59.

Tunkyi K, Moodley J. (2017). Anemia and pregnancy outcomes: a longitudinal study. J Matern Fetal Neonatal Med. 11:1–5. doi: 10.1080/14767058.2017.1349746.

Chang, S., Zeng, L., Brouwer, I. D., Kok, F. J., & Yan, H. (2013). Effect of iron deficiency anemia in pregnancy on child mental development in rural China. Pediatrics, 131(3), e755-763. doi: 10.1542/peds.2011-3513.

Scholl, T. O. (2005). Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr, 81(5), 1218S-1222S.

Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P. 

Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. The Lancet Global Health. 2018 May 1;6(5):e548-54.

Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017 Feb;129(8):940–9.

Barroso F, Allard S, Kahan BC, Connolly C, Smethurst H, Choo L, et al. Prevalence of maternal anaemia and its predictors: A multi-centre study. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):99–105.

Allen LH. Anemia and iron deficiency: Effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5 SUPPL.):1280–4.

Ren A, Wang J, Ye RW, Li S, Liu JM, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. Int J Gynaecol Obstet. 2007 Aug;98(2):124–8.

Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL, et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. 2002;165–70.

PenaRosas, Pablo J, DeRegil, Maria L, Gomez M, Heber, et al. Intermittent oral iron supplementation during pregnancy [Systematic Review]. Cochrane database Syst Rev [Internet]. 2015;(10).