Iron deficiency anemia during pregnancy and consequences related to it
Abstract
the article summarizes the arguments and counterarguments in the scientific discussion on the mechanisms of iron deficiency anemia. The main purpose of this study is to summarize information on the effects of iron deficiency anemia during pregnancy and its consequences. Due to a detailed study of the literature, their systematization and approaches to solving the problem, it was found that antenatal anemia is a risk factor for maternal and perinatal mortality, premature birth, low birth weight infants and postpartum hemorrhage. Maternal anemia can also be associated with poor development of the baby's nervous system. Recent advances in systemic and placental iron homeostasis may improve therapeutic efficacy by varying the dose and frequency of oral iron intake. And intravenous iron is a safe way to quickly correct maternal anemia. The relevance of the study of this pathology is that it largely determines the perinatal and maternal morbidity. However, today there is no clear idea of the features of the molecular and vascular mechanisms of iron deficiency anemia, so this leads to inconsistencies in the treatment of such pregnant women, which prevents timely, adequate treatment and prevention. The study used methods of bibliographic and content analysis of literature, semantic grouping, as well as a comparative approach and synthesis on new research on the mechanisms of iron deficiency anemia, iron homeostasis and current definitions of IDA during pregnancy, adverse effects on mother and newborn, associated with anemia, as well as the latest recommendations for the treatment of IDA during pregnancy and postpartum. The official documents found on the websites were analyzed and the relevant information was grouped and compared. The article presents the results of studies that have shown that iron plays a key role in the normal and pathological course of pregnancy and affects the development of the newborn. Iron uptake and metabolism are strictly regulated, and a full study of iron metabolism during pregnancy is of interest for preventing complications in the mother and fetus. This paper emphasizes the need for early detection of iron deficiency. In addition, it is important to treat the deficiency to ensure optimal development of the newborn. At present, measures such as oral or intravenous iron do not appear to be working to the extent necessary to achieve the WHO's goal of reducing the prevalence of anemia in women of childbearing potential by 50%. This may be due in part to uncertainty about how best to investigate, prevent, and treat maternal anemia. The development of our understanding of the physiology of iron has led to the possibility of significant improvement by changing the dosing strategy of oral iron. New laboratory iron levels, such as hepcidin, may ultimately help manage iron deficiency therapy, but a recent study found no benefit from using a hepcidin-based screening and treatment approach over the WHO recommended regimen. Therefore, further research is needed on patient-centered outcomes and cost-effectiveness. The results of the study may be useful for primary care physicians, gynecologists, therapists.
References
Athe, R., Dwivedi, R., Pati, S., Mazumder, A., & Banset, U. (2020). Meta-analysis approach on iron fortification and its effect on pregnancy and its outcome through randomized, controlled trials. Journal of family medicine and primary care, 9(2), 513–519. https://doi.org/10.4103/jfmpc.jfmpc_817_19
Barks, A. K., Liu, S. X., Georgieff, M. K., Hallstrom, T. C., & Tran, P. V. (2021). Early-Life Iron Deficiency Anemia Programs the Hippocampal Epigenomic Landscape. Nutrients, 13(11), 3857. https://doi.org/10.3390/nu13113857
Benson, C. S., Shah, A., Frise, M. C., & Frise, C. J. (2021). Iron deficiency anaemia in pregnancy: A contemporary review. Obstetric medicine, 14(2), 67–76. https://doi.org/10.1177/1753495X20932426
Brenner, A., Roberts, I., Balogun, E., Bello, F. A., Chaudhri, R., Fleming, C., Javaid, K., Kayani, A., Lubeya, M. K., Mansukhani, R., Olayemi, O., Prowse, D., Vwalika, B., & Shakur-Still, H. (2022). Postpartum haemorrhage in anaemic women: assessing outcome measures for clinical trials. Trials, 23(1), 220. https://doi.org/10.1186/s13063-022-06140-z
Churchill, D., Nair, M., Stanworth, S. J., & Knight, M. (2019). The change in haemoglobin concentration between the first and third trimesters of pregnancy: a population study. BMC pregnancy and childbirth, 19(1), 359. https://doi.org/10.1186/s12884-019-2495-0
Daru, J., Sobhy, S., & Pavord, S. (2019). Revisiting the basis for haemoglobin screening in pregnancy. Current opinion in obstetrics & gynecology, 31(6), 388–392. https://doi.org/10.1097/GCO.0000000000000580
Erlandsson, L., Masoumi, Z., Hansson, L. R., & Hansson, S. R. (2021). The roles of free iron, heme, haemoglobin, and the scavenger proteins haemopexin and alpha-1-microglobulin in preeclampsia and fetal growth restriction. Journal of internal medicine, 290(5), 952–968. https://doi.org/10.1111/joim.13349
Güven, Z., Holm, C., Rosthoej, S., & Langhoff-Roos, J. (2020). Association between blood loss at delivery and fatigue in the puerperium: a prospective longitudinal study. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(4), 606–611. https://doi.org/10.1080/14767058.2018.1498479
Kanu, F. A., Hamner, H. C., Scanlon, K. S., & Sharma, A. J. (2022). Anemia Among Pregnant Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children - United States, 2008-2018. MMWR. Morbidity and mortality weekly report, 71(25), 813–819. https://doi.org/10.15585/mmwr.mm7125a1
Lewkowitz, A. K., Gupta, A., Simon, L., Sabol, B. A., Stoll, C., Cooke, E., Rampersad, R. A., & Tuuli, M. G. (2019). Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. Journal of perinatology : official journal of the California Perinatal Association, 39(4), 519–532. https://doi.org/10.1038/s41372-019-0320-2
McClure, E. M., Saleem, S., Goudar, S. S., Tikmani, S. S., Dhaded, S. M., Hwang, K., Guruprasad, G., Shobha, D., Sarvamangala, B., Yogeshkumar, S., Somannavar, M. S., Roujani, S., Reza, S., Raza, J., Yasmin, H., Aceituno, A., Parlberg, L., Kim, J., Bann, C. M., Silver, R. M., … PURPOSe Study Group (2022). The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe). The Lancet. Global health, 10(7), e970–e977. https://doi.org/10.1016/S2214-109X(22)00180-2
Nair, M., Knight, M., Robinson, S., Nelson-Piercy, C., Stanworth, S. J., & Churchill, D. (2018). Pathways of association between maternal haemoglobin and stillbirth: path-analysis of maternity data from two hospitals in England. BMJ open, 8(4), e020149. https://doi.org/10.1136/bmjopen-2017-020149
Qassim, A., Grivell, R. M., Henry, A., Kidson-Gerber, G., Shand, A., & Grzeskowiak, L. E. (2019). Intravenous or oral iron for treating iron deficiency anaemia during pregnancy: systematic review and meta-analysis. The Medical journal of Australia, 211(8), 367–373. https://doi.org/10.5694/mja2.50308
O'Brien K. O. (2022). Maternal, fetal and placental regulation of placental iron trafficking. Placenta, 125, 47–53. https://doi.org/10.1016/j.placenta.2021.12.018
Pavord, S., Daru, J., Prasannan, N., Robinson, S., Stanworth, S., Girling, J., & BSH Committee (2020). UK guidelines on the management of iron deficiency in pregnancy. British journal of haematology, 188(6), 819–830. https://doi.org/10.1111/bjh.16221
Sangkhae, V., Fisher, A. L., Wong, S., Koenig, M. D., Tussing-Humphreys, L., Chu, A., Lelić, M., Ganz, T., & Nemeth, E. (2020). Effects of maternal iron status on placental and fetal iron homeostasis. The Journal of clinical investigation, 130(2), 625–640. https://doi.org/10.1172/JCI127341
Shah, A., Chester-Jones, M., Dutton, S. J., Marian, I. R., Barber, V. S., Griffith, D. M., Singleton, J., Wray, K., James, T., Drakesmith, H., Robbins, P. A., Frise, M. C., Young, J. D., Walsh, T. S., McKechnie, S. R., Stanworth, S. J., & INTACT Investigators (2022). Intravenous iron to treat anaemia following critical care: a multicentre feasibility randomised trial. British journal of anaesthesia, 128(2), 272–282. https://doi.org/10.1016/j.bja.2021.11.010
Shi, H., Chen, L., Wang, Y., Sun, M., Guo, Y., Ma, S., Wang, X., Jiang, H., Wang, X., Lu, J., Ge, L., Dong, S., Zhuang, Y., Zhao, Y., Wei, Y., Ma, X., & Qiao, J. (2022). Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA network open, 5(2), e2147046. https://doi.org/10.1001/jamanetworkopen.2021.47046
Sultan, P., Bampoe, S., Shah, R., Guo, N., Estes, J., Stave, C., Goodnough, L. T., Halpern, S., & Butwick, A. J. (2019). Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. American journal of obstetrics and gynecology, 221(1), 19–29.e3. https://doi.org/10.1016/j.ajog.2018.12.016
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