Review Article

Clinical Drug Investigation

, Volume 19, Supplement 1, pp 29-43

First online:

Strategies for the Prevention and Treatment of Iron Deficiency during Pregnancy

  • Angel F. RemachaAffiliated withHematology Department, Hospital de Sant Pau Email author 

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Iron deficiency is the most frequent micronutrient deficiency in humans. It is especially prevalent in certain risk groups, which, because of their elevated requirements, include pregnant women and women of childbearing age. During pregnancy the parameters of iron metabolism are altered, and suitable measures are thus needed to evaluate iron deficiency. Monitoring serum concentrations of ferritin and soluble transferrin receptor is of great use in diagnosing iron deficiency and evaluating the effects of therapy.

Control of iron deficiency during pregnancy encompasses two facets: prophylaxis and therapy. Ideally, iron-deficiency anaemia should be prevented and treatment should be reserved for confirmed iron-deficiency anaemia. However, this situation is not always possible, particularly in the developing world. Therapy of iron-deficiency anaemia during pregnancy is similar to that at any other period in life. Oral iron in the form of ferrous salts is the treatment of choice; its main disadvantages are gastrointestinal adverse effects leading to noncompliance and even discontinuation of therapy. Most of these obstacles can be overcome by using strategies such as preparations with a gastroprotective component, decreasing the dosage, or giving iron with meals.

True malabsorption of iron is rare. Parenteral iron therapy is reserved for very few specific cases, and can be given intramuscularly or intravenously.

Prophylaxis of iron-deficiency anaemia is a health priority everywhere, but is most urgently needed in developing countries, where several strategies, including food fortification and preventive supplementation, should be established for iron alone or with other micronutrients such as folate and zinc. In industrialised countries, targeted prophylaxis is also important for risk groups such as pregnant women. Iron prophylaxis for the general population is a controversial issue in industrialised countries, where the prevalence of haemochromatosis is high. However, adequate reserves of iron are advisable in women of childbearing age, especially when they are planning to become pregnant. Folate is also essential to prevent neural tube defects.