Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

Is Selective Iron Supplementation Needed During Gestation?

임신시 선택적 철분 투여의 유용성

Park, Cheol-Hoon;Kweon, In;Lee, Jong-Kun;Seo, Keong-A;Lim, Heon-Woo;Kim, Yong-Wook;Lee, Young;Rha, Jong-Gu
박철훈;권인;이종건;서경아;임현우;김용욱;이영;나종구

  • Published : 20040100
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Abstract

Objective : It is controversial whether routine or selective iron supplementation during gestation is needed. The aim of this study is to evaluate whether screening with serum ferritin during the first trimester of pregnancy could be identify women who need prophylactic iron supplementation. Methods : According to the serum ferritin level of cut-off point of 30 $\mu$g/L during the first trimester of pregnancy and the presence of iron supplementation during gestation, the subject was divided into 4 group that were as follows: serum ferritin level of $\leq$30 $\mu$g/L and iron-supplemented group (n=22), serum ferritin level of $\leq$30 $\mu$g/L and non iron-supplemented group (n=13), serum ferritin level of >30 $\mu$g/L and ironsupplemented group (n=40), serum ferritin level of >30 $\mu$g/L and non iron-supplemented group (n=15). Maternal serum ferritin, TIBC, iron, hemoglobin, hematocrit, red cell indices (MCV, MCH, MCHC, RDW) were measured before 14 weeks of gestation and after 34 weeks of gestation. Results : All hematologic and biochemical markers indicated more severe anemic status in the late pregnancy than during the first trimester of pregnancy. The effect of iron supplementation was profounder on the pregnant woman whose ferritin levels were below 30 $\mu$g/L during the first trimester of pregnancy. Regardless of iron supplementation, the group (ferritin >30 $\mu$g/L during the first trimester of pregnancy) showed relatively higher ferritin level in late pregnancy. Conclusion : The screening with serum ferritin level of cut-off point of 30 $\mu$g/L during the first trimester of pregnancy may be useful to identify women who need prophylactic iron supplementation.

목적 : 임신 기간 동안 전반적 혹은 선택적 철분 투여에 대하여 논란의 여지가 있다. 이 연구의 목적은 임신 첫 삼분기의 ferritin치 측정이 예방적 철분 투여가 필요한 산모의 선별검사에 이용될 수 있는 지 알아보기 위한 것이다. 연구 방법 : 임신 첫 삼분기의 ferritin치 30 ug/L와 또한 철분 투여 여부를 기준으로 연구 대상을 4군으로 나누었다. Ferritin치 30 ug/L 이하인 군을 철분 투여한 22명과 투여하지 않은 13명으로 나누었고, ferritin치 30 ug/L를 초과한 군에서 철분 투여한 40명과 투여하지 않은 15명으로 나누었다. 임신 14주 전과 임신 34 이후에 빈혈 검사와 관련된 혈액학적 지표들을 측정하였다. 결과 : 모든 혈액학적 지표들은 임신 전반기에 비해서 임신 후반기에 유의한 빈혈 상태를 나타내고 있었다. 임신 첫 삼분기의 ferritin치가 30 ug/L 미만인 경우에 철분 투여의 효과가 있었다. 철분투여와 관계없이 임신 첫 삼분기의 ferritin치가 30 ug/L 이상인 경우 임신 후반기에 ferritin측정치가 비교적 높았다. 결론 : 임신 첫 삼분기의 ferritin 30 ug/L을 기준치가 예방적 철분 투여가 필요한 산모의 선별에 도움을 줄 수 있음을 암시한다.

Keywords

References

  1. World Health Organization. The Prevalence of Anaemia in Women. WHO/MCH/MSM/92.2 1992
  2. DeMayer E, Adiels-Tegman M. The prevalence of anemia in the world. World Health Statistics Quarterly 1985; 38: 302-16
  3. MacPhail, P. & Bothwell, TH. The prevalence and causes of nutritional iron deficiency anemia. Nutritional anemias(ed. by S.J. Fomon and S. Zlotkin). Nestle Nutrition Workshop Series 1992; 32: 1-9
  4. Hallberg L. Prevention of iron deficiency. Baillieres Clinical Haematology 1994; 7: 805-14 https://doi.org/10.1016/S0950-3536(05)80125-8
  5. Cook, J.D. Iron deficiency anaemia. Baillieres Clinical Haematology 1994; 7: 787-804 https://doi.org/10.1016/S0950-3536(05)80124-6
  6. Letsky EA. The hematological system. In: F. Hytten and G. Chamberlain, editors. Clinical Physiology in Obstetrics. 3rd ed. Oxford: Blackwell Science; 1998
  7. Tietz NW, Rinker AD, Morrison SR. When is a serum iron really a serum iron? The status of seum iron measurements. Clinical Chemistry. 1994; 40: 546-51
  8. Van den Broek NR, Letsky EA, White SA, Shenkin A. Iron status in pregnant women: Which measurements are valid? Br J Haematol 1998; 103: 817-24 https://doi.org/10.1046/j.1365-2141.1998.01035.x
  9. Goldenberg RL, Tamura T, Dubard M, Johnston KE, Copper RL, Neggers Y, et al. Plasma ferrtin and pregnancy outcome. Am J Obstet Gynecol 1996; 175: 1356-9 https://doi.org/10.1016/S0002-9378(96)70054-6
  10. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in Unitied States. MMWR 1989; 38: 400-4
  11. Romslo I, haram K, Sagen N, Augensen K. Iron requirements in normal pregnancy as assessed by serum ferritin, serum transferrin saturation and erythrocyte protoporphyrin determinations. Br J Obstet Gynecol 1993; 90: 101-7
  12. Report of a Joint FAO/WHO Expert Consultation. Requirements of vitamin A, iron, folate and vitamin B12. FAO food and Nutritional Series 1988; 23: 33-50
  13. Prichard JA, Scott DE. Iron demands during pregnancy. In: Iron Deficiency-pathogenensis: Clinical Aspects and Therapy. London: Acaemic Press; 1970. P.13
  14. Steffensen R, Varming K, jersild C. Determination of gene frequencies for two chain common hemochromatosis mutations in the Danish population by a novel polymerase reaction with sequence-specific primers. Tissue Antigens 1998; 52: 230-5 https://doi.org/10.1111/j.1399-0039.1998.tb03037.x
  15. Elina H, Jouni M. Long-term follow-up mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. Am J Obstet Gynecol 1995; 173: 205-9 https://doi.org/10.1016/0002-9378(95)90191-4
  16. Milman N, Gradual NA, Agger AO. Iron status markers during pregnancy. No relationship between levels in the beginning of the second trimester. prior delivery and postpartum. J Intern Med 1995; 237: 261-7
  17. Milman N, Gradual N, Galloe A, Agger AO. Serum ferritin and selective iron prophylaxis in pregnancy? J Intern Med 1996; 240: 47-50