EFFECTS OF IRON SUPPLEMENTATION STARTING FROM EARLY GESTATION IN NON- ANEMIC PREGNANCY AND NEONATAL BIRTH OUTCOMES
Keywords:
Iron supplementation, non-anemic pregnancy, low birthweight, multiple imputationAbstract
Iron supplementation, as early as possible, is commonly recommended for all pregnant women in developing countries to reduce maternal anemia. However, this excessive iron can induce a high hemoglobin level and negatively influence neonatal outcomes. The objective of the present study is to assess the impact of iron supplementation starting from early pregnancy and neonatal birth outcomes. All data in the present retrospective cohort study were obtained from the antenatal records and labor registry of non-anemic pregnant Thai women who attended their first antenatal care and delivery at Vajira Hospital, Bangkok, Thailand between June 2006and December 2007. The proportions of low birthweight (LBW), small for gestational age(SGA), and preterm delivery were compared between the early supplement group which started oral iron before 16 weeks of gestation and the control group which started later. Among 880non-anemic pregnancies, there were 477 women in the early supplement group and 403 women in the control group. The incidence of LBW in the early supplement group was significantly lower than in the control group (5.5% vs. 9.4%, risk ratio: 0.58; 95%confidence interval: 0.37-0.94). There were no significant differences in the occurrence of SGA and preterm delivery between groups. Iron supplementation starting from early gestation in non- anemic pregnancy has a significant benefit in reducing the incidence of LBW.
References
Allen, L. H. ( 2001) . Biological mechanisms that mightunderlie iron’ s effects on fetal growth and pretermbirth. J. Nutr., 131:581-589.
Baraldi, A.N. and Enders, C.K. (2010). An introduction tomodern missing data analyses. J. Sch. Psychol. ,48(1):5-37.
Black, R. E. ( 2015) . Global prevalence of small forgestational age births. Nestle Nutr. Works. Se. ,81:1-7.
Black, R. E. , Victora, C. G. , Walker, S. P. , Bhutta, Z. A. ,Christian, P. , de Onis, M. , Ezzati, M. , Grantham-McGregor, S., Katz, J., Martorell, R., and Uauy, R.( 2013) . Maternal and child undernutrition andoverweight in low- income and middle- incomecountries. Lancet, 382(9890):427-451.
Bo, S. , Menato, G. , Villois, P. , Gambino, R. , Cassader,M., Cotrino, I., and Cavallo-Perin, P. (2009). Ironsupplementation and gestational diabetes inmidpregnancy. Am. J. Obstet. Gynecol., 201(2):158e151-156.
Brannon, P. M. and Taylor, C. L. ( 2017) . Ironsupplementation during pregnancy and infancy:uncertainties and implications for research andpolicy. Nutrients, 9(12):1-17.
Cantor, A. G. , Bougatsos, C. , Dana, T. , Blazina, I. , andMcDonagh, M. ( 2015) . Routine ironsupplementation and screening for iron deficiencyanemia in pregnancy: a systematic review for theU.S. Preventive Services Task Force. Ann. Intern.Med., 162(8):566-576.
Chan, K. K. , Chan, B. C. , Lam, K. F. , Tam, S. , and Lao,T. T. ( 2009) . Iron supplement in pregnancy anddevelopment of gestational diabetes - a randomisedplacebo-controlled trial. BJOG, 116(6):789-797.
Cogswell, M. E. , Parvanta, I. , Ickes, L. , Yip, R. , andBrittenham, G. M. ( 2003) . Iron supplementationduring pregnancy, anemia, and birth weight:a randomized controlled trial. Am. J. Clin. Nutr. ,78(4):773-781.
Dewey, K.G. and Oaks, B.M. (2017). U-shaped curve forrisk associated with maternal hemoglobin, ironstatus, or iron supplementation. Am. J. Clin. Nutr.,106(Suppl 6):1694s-1702s.
Etheredge, A.J., Premji, Z., Gunaratna, N.S., Abioye, A.I.,Aboud, S. , Duggan, C. , Mongi, R. , Meloney, L. ,Spiegelman, D. , Roberts, D. , Hamer, D. H. , andFawzi, W.W. (2015). Iron supplementation in ironrepleteand nonanemic pregnant women inTanzania: a randomized clinical trial. JAMAPediatr., 169(10):947-955.
Haider, B. A. , Olofin, I. , Wang, M. , Spiegelman, D. ,Ezzati, M. , and Fawzi, W.W. ( 2013) . Anaemia,prenatal iron use, and risk of adverse pregnancyoutcomes: systematic review and meta- analysis.BMJ, 346:1-19.
Imdad, A. and Bhutta, Z. A. ( 2012) . Routine iron/ folatesupplementation during pregnancy: effect onmaternal anaemia and birth outcomes. Paediatr.Perinat. Epidemiol., 26 Suppl 1:168-177.
Iqbal, S. and Ekmekcioglu, C. ( 2017) . Maternal andneonatal outcomes related to iron supplementationor iron status: a summary of meta- analyses.J. Matern-Fetal Neo. M., 5:1-13.
Moin, A. and Lassi, Z. S. ( 2015) . Can routine screeningand iron supplementation for iron deficiencyanemia in nonsymptomatic pregnant womenimprove maternal and infant health outcomes?J. Family Med. Prim. Care, 4(3):333-334.
Palma, S., Perez-Iglesias, R., Prieto, D., Pardo, R., Llorca,J., and Delgado-Rodriguez, M. (2008). Iron but notfolic acid supplementation reduces the risk of lowbirthweight in pregnant women without anaemia:a case-control study. J. Epidemiol Commun. H. ,62(2):120-124.
Pena-Rosas, J. P. , De-Regil, L. M. , Garcia-Casal, M. N. ,and Dowswell, T. ( 2015) . Daily oral ironsupplementation during pregnancy. Cochrane Db.Syst. Rev., (7):CD004736.
Scholl, T.O. (2005). Iron status during pregnancy: settingthe stage for mother and infant. Am. J. Clin. Nutr.,81(5):1218s-1222s.
Siega-Riz, A.M., Hartzema, A.G., Turnbull, C., Thorp, J.,McDonald, T. , and Cogswell, M. E. ( 2006) . Theeffects of prophylactic iron given in prenatalsupplements on iron status and birth outcomes:a randomized controlled trial. Am. J. Obstet.Gynecol., 194(2):512-519.
Traisrisilp, K. , Jatavan, P. , and Tongsong, T. ( 2017) . Aretrospective comparison of pregnancy outcomesbetween women with alpha-thalassaemia 1 trait andnormal controls. J. Obstet. Gynaecol., 37(8):1000-1003.
World Health Organization. ( 2016) . WHO recommendationson antenatal care for a positive pregnancyexperience. WHO, Geneva, Switzerland. Availablefrom: www. who. int/ iris/ bitstream/ handle/ 10665/250796/ 9789241549912- eng. pdf?sequence= 1.Accessed date: Jan 27, 2017.
Ziaei, S. , Norrozi, M. , Faghihzadeh, S. , and Jafarbegloo,E. (2007). A randomised placebo-controlled trial todetermine the effect of iron supplementation onpregnancy outcome in pregnant women withhaemoglobin > or = 13.2 g/dl. BJOG, 114(6):684-688.
