Optimum Iron Dosage in Pregnancy: What does the evidence tell us? Thank you to the - Maternity & Midwifery Forum
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Optimum Iron Dosage in
Pregnancy:
What does the evidence tell us?
Thank you to the
Northern 2020 Maternity and Midwifery
Festival for this opportunity and to Active Iron
for their Sponsorship
Online, Manchester
June 2020
Avril Flynn LLB BSc RM • Midwife, Childbirth Educator & Hypnobirth Practitioner • Writer • Speaker • Passionate Educationalist • Presentation sponsored by Active iron Solvotrin
Introduction • Iron: a Vital Micro-Nutrient • Current Guidelines • Current Challenges of Supplementation • Deficiency is progressive • ‘Prevention is better than a cure’- could a lower dosage offer the solution? • Questions?
Iron : A Vital Micronutrient • Essential for Oxygen transportation • Energy Metabolism • Cognitive function • Blood Cell formation & Cell division • Globally- Most common Nutritional deficiency • Affects low, middle and high income countries • Estimated up to 1 in 4 Pregnant women in the UK have Iron Deficiency Anaemia
Risks and Effects on Mother
and Baby of Iron Deficiency
Mother
• Depletion of iron stores and
Ferritin levels
• Impaired haemoglobin production Baby
• Anaemia in pregnancy • Infant iron deficiency (in the
first 3 months of life)
• Increased susceptibility and
severity of Infections • Low birthweight
• Poor cognition and low productivity • Preterm birth
• Increased risk of maternal • Congenital abnormalities
mortality & morbidity • Cognitive impairment
• Fatigue, SOB, palpitations • Increased risk of perinatal
• Depression, Low Mood, Irritability mortality and morbidity
Current Guidelines: Anaemia Defined Anaemia defined as •
Women at Risk of Iron Deficiency in Pregnancy • Low iron stores before pregnancy • Previous Hx of deficiency • Pre-existing blood condition (sickle cell, thalassaemia) • Age
Current Guidelines for Iron Intake in pregnancy • 2-3 fold increase in Iron Requirements (NHS) during pregnancy and postnatal period • Healthy mother- healthier infant • CDC Recommend 27mg Iron daily in pregnancy • WHO Recommend 30-60 mg
Challenges: Getting Enough Iron via
Diet
• More and more people are on restricted diets
• Once a pregnant woman is deficient, diet
alone will not replenish levels
• Ferritin stores will be exhausted
• Women may become deficient in between
booking and re-check
• Many women need addition Iron
supplementation
Supplementation Bioavailability
• Supplements are not created equally
Traditional Oral supplements
• Some ’Iron Supplements’ have a
• Low cost negligible iron content
• Readily available • Bioavailability varies hugely
• Iron Compound v Elemental iron
Problems • Iron is absorbed via a carrier mechanism
• Side effects (DMT -1)
• GI Issues
• Constipation
• Non-ComplianceDeficiency is progressive: A Sliding Scale WHO. (2017) Nutritional Anaemias: Tools for Effective Prevention and Control. World Health Organization, Geneva.
Treating Iron Deficiency In Pregnancy - Iron Deficiency Anaemia has enormous health implications for mum and baby - High Dose Oral Treatment = Increased Side effects - If that fails, IV Iron Treatment - Uncomfortable, Costly and challenging for Mum and Healthcare provider - Preventative supplementation can decrease Maternal Anaemia at term by 70%
Solution: Health Optimisation ‘Prevention is better than Cure’ - Increasing body of evidence suggests lower dosage Iron supplementation could be key - Preventing the deficiency in the 1st instance - Ensuring Iron stores can cope with increased demand in Pregnancy - Less side effects for Mums= increased compliance - Midwives have key role in information dissemination - Could ensure less intervention and less women becoming ‘Medical Patients’
Active Iron Vs Traditional Iron Supplements
Active Iron is clinically proven to The Active Iron formulation helps Active Iron user studies show 9 out of
have x2 the absorption provide gut cell protection, 10 users report no side effects
compared to standard ferrous allowing lower doses to be compared to 1 out of 10 with ferrous
sulfate administered and improved gut sulfate
tolerabilityConclusions • Iron Deficiency, and the possible resulting Anaemia, have far reaching health consequences for mum, baby and wider global community • Getting the optimum Iron intake in pregnancy can be challenging • Early intervention to encourage maintenance of iron levels throughout pregnancy may preclude the need for much more expensive, risky & uncomfortable treatments • Preventing the deficiency in the 1st instance should be a key objective of maternity provision • Midwives have a key role in health optimisation & education, providing holistic, women centred care
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Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89‐94. doi:10.5830/CVJA-2016-021 Soppi ET. Iron deficiency without anaemia – a clinical challenge. Clinical Case Reports 2018; 6 (6): 1082-1086. Tolkien Z et al. Ferrous sulphate supplementation causes significant gastrointestinal side effects in adults: a systematic review and metaanalysis. PLoS ONE 2015; 10 (2): e0117383 doi: 10.1371/journal. pone.0117383 10. UN Children’s Fund, UN University, WHO, Iron deficiency Anaemia: Assessment, Prevention and Control. A Guide for Programme Managers, 2001. Wang J et al. Novel iron-whey protein microspheres protect gut epithelial cells from iron-related oxidative stress and damage and improve iron absorption in fasting adults. Acta Haematol 2017; 138: 223-232. Doi: 10.1159/000480632. WHO 2012 Daily iron and folic acid supplementation in pregnant women Geneva: World Health Organisation Zhou, S., Gibson, R., Crowther, C. et al. Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose– response trial. Eur J Clin Nutr 63, 183–190 (2009). https://doi.org/10.1038/sj.ejcn.1602926
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