Iron Deficiency management during pregnancy and the puerperium (906)

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Maternal anaemia is defined as:

  • Hb <110g/l 1st trimester
  • Hb <105g/l 2nd & 3rd trimesters

Maternal anaemia can result in maternal fatigue, increased risk of postpartum haemorrhage and is associated with an increased risk of stillbirth, preterm birth and neonatal low ferritin levels (1). Iron deficiency anaemia, the commonest cause of maternal anaemia can be treated easily by oral iron replacement.

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Editorial Information

Last reviewed: 19/02/2021

Next review date: 01/02/2024

Author(s): Vicki Brace.

Version: 3

Approved By: Obstetrics Clinical Governance Group

Document Id: 906

References
  1. Briley, A., Seed, P.T., Tydeman, G., et al. Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study. British Journal of Obstetrics and Gynaecology 2014;121: 876–888.
  2. Pavord S., Daru J., Prasannan N., et al. Uk Guidelines on the management of iron deficiency in pregnanacy. British Journal of Haematology 2019 doi: 10.1111/bjh.16221.
  3. van den Broek NR., Letsky EA., White SA., et al. Iron status in pregnant women: which measurements are valid? British Journal of Haematology 1998;103:817–824.
  4. Daru J., Allotey J., Pena-Rosas JP.,et al. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfusion Medicine, 2017, 27, 167–174.
  5. Schaap, C.C., Hendriks, J.C., Kortman, G.A., et al (2013) Diurnal rhythm rather than dietary iron mediates daily hepcidin variations. Clinical Chemistry, 59, 527–535.
  6. Pena-Rosas, J.P., De-Regil, L.M., Malave, H.G., et al (2015) Intermittent oral iron supplementation during pregnancy. Cochrane Database of Systematic Reviews, Issue 10, Art. No. CD009997.
  7. Moretti D., Goede JS., Zeder C., et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. 2015; 126(17):1981-1989.
  8. Haider, B.A., Olofin, I., Wang, M., et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. British Medical Journal 2013;346, f3443.
  9. Shinar S., Skornick-Rapaport A., & Masiovitz S. Iron supplementation in singleton pregnancy: is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? A randomised controlled trial.  Journal of Perinatology 2017;37:782-786.
  10. Smith GA., Fisher SA., Doree C., et al Cochrane Database Systematic Reviews 2014; 7, CD009532.
  11. Tapiero H., Gate L., Tew KD. Iron: deficiencies and requirements. Biomedicine and Pharmacotherapy, 2001; 55: 324–332.
  12. Reveiz L, Gyte  GML, Cuervo  LG, et al. Treatments for iron‐deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD003094. DOI:10.1002/14651858.CD003094.pub3.
  13. Broche DE., Gay C., Armand-Branger S., et al. Severe anaemia in the immediate post-partum period. Clinical practice and value of intravenous iron. European Journal of Obstetrics & Gynecology and Reproductive Biology 2005; 123:S21-27