Skip to main content

Advertisement

SpringerLink
Log in

Pathophysiology and management of iron deficiency anaemia in pregnancy: a review

  • Review Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother’s blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of supporting data

Not applicable.

References

  1. WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, (WHO/NMH/NHD/MNM/11.1). http://www.who.int/vmnis/indicators/haemoglobin.pdf. Accessed 29 Sept 2023

  2. Ravindran N, Kumar S, Mamathi CA, Thirunavookarasu SN, Sunil CK (2021) Recent advances in surface plasmon resonance (SPR) biosensors for food analysis: a review. Crit Rev Food Sci Nutr 23:1–23

    Google Scholar 

  3. Shokrgozar N, Golafshan HA (2019) Molecular perspective of iron uptake, related diseases, and treatments. Blood research 54(1):10–16

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Belwal E, Pandey S, Sarkar S (2021) Anemia prevalence in India over two decades: evidence from National Family Health Survey (NFHS). Int J Sci Healthcare Res 6(4):335–340

    Article  Google Scholar 

  5. Snook J, Bhala N, Beales IL, Cannings D, Kightley C, Logan RP, Pritchard DM, Sidhu R, Surgenor S, Thomas W, Verma AM (2021) British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 70(11):2030–2051

    Article  PubMed  CAS  Google Scholar 

  6. Shah Y, Patel D, Khan N (2021) Iron deficiency anemia in IBD: an overlooked comorbidity. Expert Rev Gastroenterol Hepatol 15(7):771–781

    Article  PubMed  CAS  Google Scholar 

  7. Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ (2022) Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol 9(1):e000759

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hallberg L, Rossander L, Skånberg AB (1987) Phytates and the inhibitory effect of bran on iron absorption in man. Am J Clin Nutr 45(5):988–996

    Article  PubMed  CAS  Google Scholar 

  9. Disler P, Lynch SR, Charlton RW, Torrance JD, Bothwell TH, Walker RB, Mayet F (1975) The effect of tea on iron absorption. Gut 16(3):193–200

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Gulec S, Anderson GJ, Collins JF (2014) Mechanistic and regulatory aspects of intestinal iron absorption. Am J Physiol Gastrointest Liver Physiol 307(4):G397-409

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Osungbade KO, Oladunjoye AO (2012) Preventive treatments of iron deficiency anaemia in pregnancy: a review of their effectiveness and implications for health system strengthening. J Pregnancy 2012

  12. Surekha MV, Sujatha T, Gadhiraju S, Kotturu SK, Prasad MS, Sarada K, Bhaskar V, Kumar PU (2021) Effect of maternal iron deficiency anaemia on the expression of iron transport proteins in the third trimester placenta. Fetal and Pediatric Pathology 40(6):581–596. https://doi.org/10.1080/15513815.2020.1725942

  13. Peña‐Rosas JP, De‐Regil LM, Garcia‐Casal MN, Dowswell T (2015) Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2015(7)

  14. American College of Obstetricians and Gynecologists (2021) Anemia in pregnancy: ACOG practice bulletin, number 233. Obstet Gynecol 138(2):e55-64

    Article  Google Scholar 

  15. Fisher AL, Nemeth  E (2017) Iron homeostasis during pregnancy. The American journal of clinical nutrition 106;Suppl 6:1567S–1574S. https://doi.org/10.3945/ajcn.117.155812

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ganz T (2019) Anemia of inflammation. N Engl J Med 381(12):1148–1157

    Article  PubMed  CAS  Google Scholar 

  17. Koenig MD, Tussing-Humphreys L, Day J, Cadwell B, Nemeth E (2014) Hepcidin and iron homeostasis during pregnancy. Nutrients 6(8):3062–3083

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Sangkhae V, Fisher AL, Wong S, Koenig MD, Tussing-Humphreys L, Chu A, Lelić M, Ganz T, Nemeth E (2021) Effects of maternal iron status on placental and fetal iron homeostasis. J Clin Investig 130(2)

  19. Mayasari NR, Hu TY, Chao JC, Bai CH, Chen YC, Huang YL, Chang CC, Wang FF, Hadi H, Nurwanti E, Chang JS (2021) Associations of the pre-pregnancy weight status with anaemia and the erythropoiesis-related micronutrient status. Public Health Nutr 24(18):6247–6257

    Article  PubMed  Google Scholar 

  20. Varghese JS, Swaminathan S, Kurpad AV, Thomas T (2019) Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women. PLoS ONE 14(1):e0210634

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Stein J, Dignass AU (2013) Management of iron deficiency anemia in inflammatory bowel disease–a practical approach. Annal Gastroenterol: quarterly publication of the Hellenic Society of Gastroenterology 26(2):104

    Google Scholar 

  22. de Silva AD, Mylonaki M, Rampton DS (2003) Oral iron therapy in inflammatory bowel disease: usage, tolerance, and efficacy. Inflamm Bowel Dis 9(5):316–320

    Article  PubMed  Google Scholar 

  23. Weiss G (2015) Anemia of chronic disorders: new diagnostic tools and new treatment strategies. InSeminars Hematol 52(4):313–320

    Google Scholar 

  24. Jimenez KM, Gasche C (2019) Management of iron deficiency anaemia in inflammatory bowel disease. Acta Haematol 142(1):30–36

    Article  PubMed  CAS  Google Scholar 

  25. Reinisch W, Staun M, Bhandari S, Muñoz M (2013) State of the iron: how to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease. J Crohn’s Colitis 7(6):429–440

    Article  Google Scholar 

  26. Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A (2018) Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert Rev Hematol 11(9):727–736

    Article  PubMed  CAS  Google Scholar 

  27. Teichman J, Nisenbaum R, Lausman A, Sholzberg M (2021) Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv 5(22):4666–4673

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Peña‐Rosas JP, De‐Regil LM, Malave HG, Flores‐Urrutia MC, Dowswell T (2015) Intermittent oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2015(10)

  29. Churchill D, Ali H, Moussa M, Donohue C, Pavord S, Robinson SE, Cheshire K, Wilson P, Grant-Casey J, Stanworth SJ (2022) Maternal iron deficiency anaemia in pregnancy: lessons from a national audit. Br J Haematol 199(2):277–284

    Article  PubMed  Google Scholar 

  30. Shand AW (2021) Iron preparations for iron deficiency anaemia in pregnancy: which treatment is best? Lancet Haematol 8(7):e471–e472

    Article  PubMed  CAS  Google Scholar 

  31. Arija V, Ribot B, Aranda N (2013) Prevalence of iron deficiency states and risk of haemoconcentration during pregnancy according to initial iron stores and iron supplementation. Public Health Nutr 16(8):1371–1378

    Article  PubMed  PubMed Central  Google Scholar 

  32. Achebe MM, Gafter-Gvili A (2017) How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood J Am Soc Hematol 129(8):940–949

    CAS  Google Scholar 

  33. Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G (2020) Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Med J 35(5):e166

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Breymann C (2017) Auerbach M 2017 Iron deficiency in gynecology and obstetrics: clinical implications and management. Hematol 2014 Am Soc Hematol Educ Program Book 1:152–159

    Google Scholar 

  35. Aedh AI, Khalil MS, Abd-Elkader AS, El-Khawanky MM, Alshehri HM, Hussein A, Alghamdi AA, Hasan A (2023) Reticulocyte hemoglobin as a screening test for iron deficiency anemia: a new cut-off. Hematol Rep 15(1):201–211

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Bó SD, Fragoso AL, Farias MG, Hubner DP, de Castro SM (2023) Evaluation of RET-He values as an early indicator of iron deficiency anemia in pregnant women. Hematol Trans Cell Ther 13(45):52–57

    Article  Google Scholar 

  37. Abhilashini GD, Sagili H, Reddi R (2014) Intravenous iron sucrose and oral iron for the treatment of iron deficiency anaemia in pregnancy. J Clin Diagn Res: JCDR 8(5):OC04

    PubMed  PubMed Central  CAS  Google Scholar 

  38. Milman N, Taylor CL, Merkel J, Brannon PM (2017) Iron status in pregnant women and women of reproductive age in Europe. Am J Clin Nutr 106(suppl_6):1655S-S1662

    Article  PubMed  PubMed Central  Google Scholar 

  39. Stelle I, Kalea AZ, Pereira DI (2019) Iron deficiency anaemia: experiences and challenges. Proc Nutr Soc 78(1):19–26

    Article  PubMed  Google Scholar 

  40. Lewkowitz AK, Tuuli MG (2019) Iron-deficiency anaemia in pregnancy: the role of hepcidin. Lancet Glob Health 7(11):e1476–e1477

    Article  PubMed  Google Scholar 

  41. Milman N, Byg KE, Bergholt T, Eriksen L (2006) Side effects of oral iron prophylaxis in pregnancy–myth or reality? Acta Haematol 115(1–2):53–57

    Article  PubMed  CAS  Google Scholar 

  42. Bloor SR, Schutte R, Hobson AR (2021) Oral iron supplementation—gastrointestinal side effects and the impact on the gut microbiota. Microbiol Res 12(2):491–502

    Article  Google Scholar 

  43. Powers JM, Buchanan GR (2014) Diagnosis and management of iron deficiency anemia. Hematol/Oncol Clin 28(4):729–745

    Article  Google Scholar 

  44. Hallak M, Sharon AS, Diukman R, Auslender R, Abramaovici H (1997) Supplementing iron intravenously in pregnancy: a way to avoid blood transfusions. Obstet Gynecol Surv 52(11):666–667

    Article  Google Scholar 

  45. Kusters JG et al (2016) Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev 19(3):449–490. https://doi.org/10.1128/CMR.00054-05

    Article  CAS  Google Scholar 

  46. Cardaropoli S et al (2014) Helicobacter pylori and pregnancy-related disorders. World J Gastroenterol 20(3):654–664. https://doi.org/10.3748/wjg.v20.i3.654

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Yamanouchi J, Azuma T, Yakushijin Y, Hato T, Yasukawa M (2014) Dramatic and prompt efficacy of Helicobacter pylori eradication in the treatment of severe refractory iron deficiency anemia in adults. Annal Hematol 93(10):1779–1780

    Article  Google Scholar 

  48. Afsar MdNA, Jhinu ZN, Bhuiyan MdAI, Islam Z, Siddiqua TJ (2020) Helicobacter pylori infection and micronutrient deficiency in pregnant women: a systematic review and meta-analysis. BMJ Open Gastroenterol 7(1):e000490

    Article  PubMed  PubMed Central  Google Scholar 

  49. Raut AK, Hiwale KM, Hiwale KM (2022) Iron deficiency anemia in pregnancy. Cureus 14(9)

  50. Georgieff MK (2020) Iron deficiency in pregnancy. Am J Obstet Gynecol 223(4):516–524

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Pasricha SR (2012) Should we screen for iron deficiency anaemia? A review of the evidence and recent recommendations. Pathology 44(2):139–147

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biochemistry, JN Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belgaum, 590010, Karnataka, India

    J. P. Akshay Kirthan & Manjunath S. Somannavar

Authors
  1. J. P. Akshay Kirthan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manjunath S. Somannavar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors whose names appear on the submission (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to J. P. Akshay Kirthan.

Ethics declarations

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirthan, J.P.A., Somannavar, M.S. Pathophysiology and management of iron deficiency anaemia in pregnancy: a review. Ann Hematol (2023). https://doi.org/10.1007/s00277-023-05481-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00277-023-05481-2

Keywords

Search

Navigation