Iron deficiency is one of the most prevalent single-nutrient deficiencies in the world (Beard, 2000). Decrease in total iron content in the body is known as iron deficiency and when this is severe enough to diminish erythropoiesis, it causes iron deficiency anemia (Conrad, 2006). “Iron deficiency is defined as a condition in which there is no mobilizable iron stores and in which signs of compromised supply of iron to tissues, including erythron are noted” (WHO, 2000). Incidence and Prevalence Iron deficiency is most common in women in child-bearing age.
It has been estimated that approximately 4-8% of women in this age group suffer from iron deficiency anemia. According to the World Health Organization, 35% to 75% (56% on average) of pregnant women in developing countries, and 18% of women from industrialized countries suffer from iron deficiency anemia. In these countries, the women are anemic mostly from the time of conception. This is because of poor nutrition due to poverty and lack of knowledge. Consequences of Iron Deficiency in Pregnancy Studies have shown that anemia in pregnancy contributes to greater risk of perinatal mortality and morbidity.
Severe iron deficiency anemia (hemoglobin concentration of 90–100 g/L) in pregnancy is related to both impaired fetal and maternal health (Beard, 2000). However there is a great deal of debate over whether it is actually anemia that contributes to mortality or morbidity or other associated factors. A large Indonesian study (Chi, Agoestina, & Harbin, 1981) demonstrated that the maternal mortality rate for pregnant women with hemoglobin less than 10 gram per dl was 70 per 10000 deliveries when compared to those with hemoglobin more than 10 gram per dl wherein the rates were 19. 7 per 10000 deliveries.
As far as the baby is concerned, maternal anemia leads to low birth weight in the baby. This occurs due to chronic hypoxia. But even high hemoglobin is not good for the baby. Studies have shown that there is a U-shaped association between maternal hemoglobin concentrations and birth weight (Murphy et al, 1986). There is an increased risk for infants whose mothers have either a very low or a very high hemoglobin concentration. Hemoglobin values higher than 13. 5gram per dl can lead to poor plasma volume expansion, which is also a risk for low birth weight (Steer, 2000, qtd. in Allen 2000).
In a study by Murphy et al (1986), the researchers reported that mothers with hemoglobin range 10. 4-13. 2 g/dl in the first 2 trimesters fared best in pregnancy. Maternal anemia in early pregnancy (first and second trimester) can lead to preterm delivery (Allen, 2000). Anemia in third trimester usually does not affect the pregnancy. This probably is because in the third trimester there is a higher hemoglobin concentration reflecting poor plasma volume expansion. Thus there is an inability to discriminate between low hemoglobin caused by iron deficiency from that caused by plasma volume expansion (Allen, 2000).
Murphy et al (1986) reported that women who were diagnosed to be anemic at 13 to 24 weeks of gestation had about one and half times increased risk of preterm delivery, low birth weight baby and perinatal mortality. Similar reports were demonstrated by Klebanoff et al (qtd. in Allen, 2000). There is also an association between maternal anemia and lower infant Apgar scores. This is evident from the study by Rusia et al (1995) (qtd. in Allen, 2000), wherein better Apgar scores and lower risk of birth asphyxia were seen in babies born to mothers with higher hemoglobin concentrations in the first stage of labor.
Another study from Jamaica reported that mortality in the first year of life increased by 50% for those infants whose mothers had not been given iron supplements during pregnancy (Greenwood et al, 1994, qtd. in Allen, 2000). Studies in animals have shown that iron deficiency leads to alterations in brain iron content, distribution, and metabolism in the perinatal and postnatal period (Beard, 2000), thus stressing the need for importance of adequate iron stores in the pregnant mother.