Iron deficiency anemia is common in pregnancy. It occurs due to two separate mechanisms. First is the process of hemodilution and second due to sequestration of iron by developing fetus. In order to treat iron deficiency anemia most doctors recommend that women take a daily iron supplement and increase iron containing foods in their diet. Most pre-natal vitamins also contain some iron.
However, not all women will become anemic and not all women need to take additional iron because they will get substantial amounts in their diet. This said, severe anemia can result after the delivery in untreated women if a large amount of blood was lost. Postpartum anemia can increase the risk of infection and can cause decreased breast milk output. Severe anemia also causes extreme fatigue which can exacerbate any situation for a new mother who is not getting regular sleep.
A study from Australia was published in May in the American Journal of Clinical Nutrition that investigated the value of taking an iron supplement during pregnancy. The study measured rates of anemia, but also wanted to determine if daily iron supplementation had any effect on the cogntive development of the unborn child.
Previous animal studies had shown some negative effects of severe anemia on the brain development of offspring. So the researchers wanted to determine if reverse effect was present: could iron supplementation improve brain function and development?
A total of 430 pregnant women were enrolled in the study and divided between two groups. The first group received 20 mg of iron daily from 20 weeks to delivery and the second group received placebo. The children's behavior and intelligence (IQ) were assessed at 4 years of age.
Women in the treatment group had very low incidence of anemia, only 1%, whereas 11% of women in the placebo group had anemia at delivery. There was no difference in the children's IQ between the two groups at four years of age. Children in the iron treatment group did have a higher rates of abnormal behavior compared to placebo group, but that trait was not determined to be due to iron.
The authors state that physicians should be cautious when recommending iron supplementation due to this potential risk of behavioral abnormalities. However, the risks of not treating a true iron deficiency anemia could be greater than that of possible behavioral changes. Iron supplementation is safe and very effective when guided by the proper care of a physician or midwife. Accidental overdose by infants is another consideration, but not to be considered during antenatal treatment.
Posted by Dr. Christina Gutierrez on June 13, 2006 02:46 PM
