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Prevention of Iron Deficiency Anemia in Adolescent and Adult Pregnancies

Departments of Obstetrics and Gynecology, Marshfield Clinic, Marshfield, Wisconsin

H. James Nickerson, MD

Pediatrics, Marshfield Clinic, Marshfield, Wisconsin

Kurt A. Olson, MS

Departments of Epidemiology and Biostatistics, Marshfield Medical Research Foundation, Marshfield, Wisconsin

Richard L. Berg, MS

Departments of Epidemiology and Biostatistics, Marshfield Medical Research Foundation, Marshfield, Wisconsin

James A. Meyer, MD

Adolescent Medicine, Marshfield Clinic, Marshfield, Wisconsin

REPRINT REQUESTS: H. James Nickerson, MD, Department of Pediatrics, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, Email: nickerson.harlan{at}marshfieldclinic.org

OBJECTIVE

Worldwide attention over iron deficiency anemia (IDA) in pregnancy has shifted recently from providing supplements during pregnancy to attempting to ensure that women, especially adolescents, have adequate iron stores prior to conception. We sought to determine whether adolescent and/or adult women still need supplements during pregnancy to avoid IDA, even if iron stores are adequate, and whether the IDA translates into maternal and/or infant morbidity and mortality.

DESIGN

Randomized, double-blind clinical trial with placebo control.

SETTING

Multicenter clinic setting in central Wisconsin.

PARTICIPANTS

Adolescent women 18 years or less in their first pregnancy, and adult women 19 years or older, who were found to be healthy and iron sufficient at their first prenatal visit.

METHODS

Participants were randomized to receive iron supplementation (60 mg/day elemental iron) or placebo. Serum ferritin of 12 ng/mL or less with simultaneous hemoglobin of 11 g/dL or less defined IDA. When IDA occurred at the second trimester, a therapeutic supplement of 180 mg of elemental iron per day was initiated.

RESULTS

Forty-seven percent of all placebo-supplemented and 16% of all iron-supplemented patients exhibited IDA (p<0.001); 59% of adolescent placebo-supplemented and 20% of adolescent iron-supplemented patients exhibited IDA (p=0.021). Nausea, vomiting, diarrhea, and constipation were not significantly different in the iron supplemented group compared to the placebo group, and no significant differences were seen in maternal or neonatal health, but the number of women studied was limiting for analysis of these adverse events.

CONCLUSION

IDA is common in healthy, iron-sufficient adolescent pregnant women during the second trimester, and body stores of iron decline in both adolescent and adult pregnancies. The incidence of IDA during adolescent and adult pregnancies is substantially reduced with 60 mg of elemental iron per day. However, there remains no clear evidence that maternal or neonatal health will benefit from correcting these deficits.

Key Words: Iron deficiency anemia (IDA) • Iron deficiency • Iron supplements • Pregnancy

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				S Palma, R Perez-Iglesias, D Prieto, R Pardo, J Llorca, and M Delgado-Rodriguez Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case control study J. Epidemiol. Community Health, February 1, 2008; 62(2): 120 - 124. [Abstract] [Full Text] [PDF]