Maternal first trimester iron status and its association with obstetric and perinatal outcomes

Rebecka Hansen*, Anne Lærke Spangmose, Veronika Markova Sommer, Charlotte Holm, Finn Stener Jørgensen, Lone Krebs, Anja Pinborg

*Corresponding author for this work
1 Citation (Scopus)

Abstract

Purpose: To assess the following in singleton pregnant women: (1) associations between first trimester iron deficiency and obstetric and perinatal outcomes, (2) overall first trimester iron status and (3) post-treatment iron status after intensified iron supplementation. Methods: A prospective cohort study was conducted with linkage of first trimester hemoglobin and plasma ferritin with obstetric and perinatal data from a hospital database. Blood sample data were obtained from a Danish University Hospital. The cohort was divided into groups according to ferritin and hemoglobin: (1) iron-deficient anemic (ferritin < 30 ng/mL and Hb < 110 g/L), (2) iron-deficient non-anemic (ferritin < 30 ng/mL and Hb ≥ 110 g/L), and (3) iron-replete non-anemic (ferritin 30–200 ng/mL and Hb ≥ 110 g/L). Obstetric and perinatal outcomes in each iron-deficient group were compared to the iron-replete non-anemic group using multivariable logistic regression. The effect of 4 weeks intensified iron supplementation on hemoglobin and ferritin was assessed by groupwise comparisons. Results: The cohort comprised 5763 singleton pregnant women, of which 14.2% had non-anemic iron deficiency, and 1.2% had iron-deficiency anemia. Compared to iron-replete non-anemic women, iron-deficient anemic women had a higher risk of gestational diabetes (aOR 3.8, 95% CI 1.4–9.0), and iron-deficient non-anemic women had a higher risk of stillbirth (aOR 4.0, 95% CI 1.0–14.3). In group 1 and 2, 81.5% and 67.7% remained iron-deficient after intensified iron supplementation. Conclusion: Iron-deficiency anemia was associated with gestational diabetes, and non-anemic iron deficiency with stillbirth, although risk estimates were imprecise due to few events. Iron deficiency was present in 15.4% and often persisted despite 4 weeks intensified iron supplementation.

Original languageEnglish
JournalArchives of Gynecology and Obstetrics
Volume306
Issue number4
Pages (from-to)1359-1371
Number of pages13
ISSN0932-0067
DOIs
Publication statusPublished - Oct 2022

Keywords

  • Ferritin
  • Hemoglobin
  • Iron deficiency
  • Iron status
  • Iron-deficiency anemia
  • Pregnancy
  • Hemoglobins/analysis
  • Prospective Studies
  • Humans
  • Anemia, Iron-Deficiency/complications
  • Pregnancy Trimester, First
  • Iron Deficiencies
  • Diabetes, Gestational/epidemiology
  • Female
  • Stillbirth/epidemiology
  • Iron/therapeutic use
  • Ferritins

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