Anemia and Iron Supplement in Pregnancy:
A Mini Review
PhD Candidate of Health and Social Welfare, Department of social welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
Submission: April 09, 2018; Published: April 17, 2018
*Corresponding author: Asiyeh Namazi, PhD Candidate of Health and Social Welfare, Department of social welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Email: email@example.com
How to cite this article: Asiyeh N. Anemia and Iron Supplement in Pregnancy: A Mini Review. JOJ Nurse Health Care. 2018; 7(3): 555711. DOI: 10.19080/JOJNHC.2018.07.555711
Anemia during pregnancy is a public health concern throughout the world, which increases the risk of advers maternal and infant outcomes. This article investigates the benefits of routine daily iron prophylaxis and iron-folic acid supplementation on prevention of anemia during pregnancy and highlights the role of health care providers in improving awareness of nutrition intakes during pregnancy.
Keywords: Anemia Prevention, Pregnancy, Iron Supplementation
Abbreviations: WHO: World Health Organization; CDC: Center for Disease Control and Prevention; HGB: hemoglobin; UNIMAP: United Nations Multiple Micronutrient Preparation
Iron deficiency is a major contributor to anemia that affects more than half a billion women of reproductive age . Iron deficiency in pregnant women has a prevalence of 17.4% in industrialized countries, whereas in underdeveloped countries, this number is close to 60% . According to the World Health Organization (WHO) criteria, pregnant women with hemoglobin (Hgb) less than 11 g/dL or hematocrit less than 33% [at the sea level] are considered anemic regardless of their gestational age . The Center for Disease Control and Prevention (CDC) uses the same criteria to diagnose anemia as WHO, except that it has a lower threshold of 10.5g/dLfor hemoglobin in the second trimester . There have been a number of contradictory studies on the relationship between anemia and neonatal adverse outcomes. The findings show that the low birth weight, preterm birth, maternal cardiac failure, hemorrhage, and infection are correlated with the severity of hemoglobin deficit and severity of anemia . Considerable increase in plasma volume than erythrocyte volume during pregnancy results in relative anemia, which is normal and can be treated with iron supplements . The increase in plasma volume slows down after mid-pregnancy . Anemia test should be conducted prior to 20 weeks of gestation to avoid the difficulties in anemia detection. Bencaiova  recommended screening for hemoglobin and iron status in early pregnancy. Studies have shown more interstitial volume, plasma volume, and extracellular fluid volume in the intravascular space of pregnant women in their trimester than non-pregnant women . When there is a good compliance with iron supplementation and the pregnancy is uncomplicated, there is no need for hematological tests during further prenatal visits, even in cases of mild iron deficiency anemia and depleted iron stores detected in early pregnancy .
One of the main causes of anemia during pregnancy is iron deficiency, which has an estimated worldwide prevalence of 20% to 80% and is more common among female . A study on the WHO’s Vitamin and Mineral Nutrition Information System revealed that the global anemia prevalence decreased from 33% to 29% in non-pregnant women, and from 43% to 38% in pregnant women . Findings of another study showed that Prevalence dropped for both sexes, particularly for male, from 1990 to 2010. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions . Iron deficiency is associated with a number of adverse health consequences for both women and their children. Maternal anemia is associated with mortality and morbidity in the mother and baby, including risk of miscarriages, stillbirths, prematurity, and low birth weight [1,11-13]. On the other hand, severe maternal anemia, particularly in the first trimester, is associated with adverse outcomes, namely, preterm birth, low birth weight, intrauterine growth restriction, low Apgar score, and operative deliveries [14,15]. Iron deficiency is less common in countries that have animal proteins in their diet. Nonheme iron diet is not a good supplement for heme iron diet , since it should be changed before it can be absorbed . Brown et al.  observed statistically significant correlation between anemia and residence, gravidity, pregnancy interval, and malaria infection during pregnancy.
Despite numerous research efforts, there is lack of coordinated strategies and systematic programs to effectively manage anemia throughout the world . Oral iron supplements including pills, capsules, drops, and extended-release tablets are often prescribed to treat anemia. WHO recommends oral iron and folic acid supplements as part of antenatal care to reduce the risk of low birth weight, maternal anemia, and iron deficiency. In addition to iron and folic acid, supplements may be formulated to include other vitamins and minerals, according to the United Nations Multiple Micronutrient Preparation (UNIMAP), to overcome other possible maternal micronutrient deficiencies . Systematic iron prophylaxis and iron-folic acid supplementation during pregnancy have been debated [20-22]. Many developed countries follow the WHO recommendations about the intermittent iron and folic acid supplementation for nonanemic pregnant women . WHO and CDC recommend60 mg/d and 30 mg/dlS for all pregnant women, respectively. However, British guidelines do not recommend IS routinely in normal gestation.
Knowledge and practices of pregnant women based on their beliefs play an important role in anemia prevention. Namazi et al. showed a statistically significant relationship between the prevalence of anemia and women knowledge. Among 86.5% of the pregnant women taking into regular iron supplements, only 20.6% knew that iron supplements should be consumed with fruit juice. Tapish  showed that among women in the community taking iron tablets, 61.3% found them to be beneficial, and the remaining did not feel that iron supplementation improved their health in any significant way. It was seen that of the women taking regular iron supplements, 58.1% took the tablets with food, 98.2% thought that iron tablets should be taken with milk or water, and only 29.7% thought that the tablets should be taken with orange juice toget the best results. The absorption of iron is inhibited by calcium, approximately 40%, which is most abundant in milk and milk products, by polyphenols in tea, coffee, and some wines and by phytates in cereal products such as bread. Milman recommends ferrous iron supplements to be taken between meals and preferably with a good source of Vitamin C such as juice to boost the iron absorption.