Iron supplements have been reported to increase hemoglobin, serum ferritin, mean cell volume, serum iron, and transferrin saturation (Allen, 2000). Studies have also shown that the benefits of iron supplementation on maternal iron status during pregnancy become even more apparent postpartum (Svanberg et al, 1976, qtd. in Allen, 2000). Rasmussen and Stoltzfus (2003) have reported remarkable effect of iron supplementation on birthweight. Their study concluded that the effect on birth weight was relatively large, much larger than nearly all the effects reported in the iron-supplementation trials.
In fact, the authors were surprised that there has been so little work on the biological pathways through which maternal iron status may affect fetal metabolism and growth. Is Iron Supplementation in Pregnancy Really Useful? Universally, routine iron supplementation during pregnancy has been recommended to prevent maternal anemia, especially in developing countries over the past 30 years (Mungen, 2003). The 1993 Institute of Medicine Committee (qtd. in Beard, 2000) has questioned the usefulness of routine iron supplementation in pregnancy.
The committee raised questions about the side effects due to iron supplementation especially in those who really did not need supplementation. The number of side effects increases dramatically when the dose of iron increases (Beard, 2000). Ziaei et al (2007) studied the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13. 2 g/dl and reported that routine iron supplementation in nonanaemic women is not rational and may be harmful.
Study by Ward et al (2003) reported that iron supplementation to rats of normal iron status at the commencement of pregnancy did not show any beneficial effects to either the foetus or the mother. Giorlandino & Cignini (2008) also have reported that iron supplementation in non-anaemic women does not improve pregnancy outcomes and infact, may be harmful to both mother and baby. Some studies (Cook, 1994, qtd. in Beard, 2000) have reported that severely iron deficient individuals derive more benefit from iron supplementation than less iron-deficient individuals.
Also, there is some proof that low doses of iron are as good as high doses of iron in treating iron deficiency anemia in pregnancy (Thane Toe, 1982, qtd. in Beard, 2000). So the recommended doses in routine supplementation may not be necessary to all. Another important finding in research is that iron supplementation in second trimester attenuates elevation in erythropoietin in the third trimester (Milman et al, 1997, qtd. in Beard, 2000). Erythropoietin in third trimester is essential to prevent anemia in the newborn. Research Implications
Iron deficiency, being one of the commonest problems during pregnancy has attracted lot of research in this field. Since this problem is more seen in developing and underdeveloped countries, many countries have implemented regular supplementation of iron to all pregnant women free of cost. The cochrane database has reported that there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anemia (Reveiz, Gyte & Cuervo, 2007). The question now raised is, whether it is necessary to provide iron supplementation to all pregnant women.
This question arises in the context when iron is given to those who are not anemic. Research has shown that iron supplementation has its own side effects and that since even high hemoglobin levels are not good for the baby, routine supplementation of iron to all pregnant women may be irrational. Only those women who have deficiency should be started on iron supplements . Probably, the most ideal method of prescribing iron supplements to pregnant women would be to check their iron status during the first antenatal visit and then start on treatment.
Conclusion Iron deficiency is one of the most common problems encountered in pregnancy. Traditionally, the physicians used to prescribe iron supplements to all pregnant women on routine basis. However research has shown that it more rational to identify iron deficient mothers and then only initiate treatment.
References
Allen, L. H. (2000). Anemia and iron deficiency: effects on pregnancy outcome. American Journal of Clinical Nutrition, 71(5), 1280S-1284s. Retrieved May 7, 2008 from http://www.ajcn. org/cgi/content/full/71/5/1280S Beard, J. L. (2000). Effectiveness and strategies of iron supplementation during pregnancy. American Journal of Clinical Nutrition, 71(5), 1288S-1294s. Chi, I. , Agoestina, T. , Harbin, J. (1981). Maternal mortality at twelve teaching hospitals in Indonesia—an epidemiologic analysis. Int J Gynaecol Obstet, 19,259–66. Conrad, M. E. (2006). Iron Deficiency Anemia. Emedicine from WebMD. Retrieved on May, 7, 2008 from http://www. emedicine. com/med/TOPIC1188. HTM