Optimum Iron Dosage in Pregnancy:

What does the evidence tell us?

Thank you to the

Northern 2020 Maternity and Midwifery Festival for this opportunity and to Active Iron

for their Sponsorship

Online, Manchester

June 2020

Avril Flynn LLB BSc RM

• Midwife, Childbirth Educator & Hypnobirth Practitioner

• Writer

• Speaker

• Passionate Educationalist

• Presentation sponsored by Active iron Solvotrin

Introduction

• Iron: a Vital Micro-Nutrient

• Current Guidelines

• Current Challenges of Supplementation

• Deficiency is progressive

• ‘Prevention is better than a cure’- could a lower dosage offer the solution?

• Questions?

Iron : A Vital Micronutrient

• Essential for Oxygen transportation

• Energy Metabolism

• Cognitive function

• Blood Cell formation & Cell division

• Globally- Most common Nutritional deficiency

• Affects low, middle and high income countries

• Estimated up to 1 in 4 Pregnant women in the UK have Iron Deficiency Anaemia

Risks and Effects on Mother and Baby of Iron Deficiency

Mother• Depletion of iron stores and

Ferritin levels

• Impaired haemoglobin production

• Anaemia in pregnancy

• Increased susceptibility and severity of Infections

• Poor cognition and low productivity

• Increased risk of maternal mortality & morbidity

• Fatigue, SOB, palpitations

• Depression, Low Mood, Irritability

Baby• Infant iron deficiency (in the

first 3 months of life)

• Low birthweight

• Preterm birth

• Congenital abnormalities

• Cognitive impairment

• Increased risk of perinatal mortality and morbidity

Current Guidelines: Anaemia Defined

Anaemia defined as• <110g/l in the first trimester• <105g/l in the second and third• <100g/l in the postnatal period

British Committee for Standards of Haematology (BCSH) and NICE Recommend: • FBC at booking and 28 weeks

• Serum Ferritin should be checked in women who although not anaemic, are at increased risk of deficiency

Women at Risk of Iron Deficiency in Pregnancy

• Low iron stores before pregnancy

• Previous Hx of deficiency

• Pre-existing blood condition (sickle cell, thalassaemia)

• Age <20 years

• Gut disorder (IBS, coeliac)

• Eating disorder

• Restricted diet (vegetarian/vegan)

Current Guidelinesfor Iron Intake in pregnancy• 2-3 fold increase in Iron

Requirements (NHS) during pregnancy and postnatal period

• Healthy mother- healthier infant

• CDC Recommend 27mg Iron daily in pregnancy

• WHO Recommend 30-60 mg

Challenges: Getting Enough Iron via Diet

• More and more people are on restricted diets

• Once a pregnant woman is deficient, diet alone will not replenish levels

• Ferritin stores will be exhausted

• Women may become deficient in between booking and re-check

• Many women need addition Iron supplementation

Supplementation

Traditional Oral supplements

• Low cost

• Readily available

Problems

• Side effects

• GI Issues

• Constipation

• Non-Compliance

• Supplements are not created equally

• Some ’Iron Supplements’ have a negligible iron content

• Bioavailability varies hugely

• Iron Compound v Elemental iron

• Iron is absorbed via a carrier mechanism (DMT -1)

Bioavailability

Deficiency is progressive: A Sliding Scale

WHO. (2017) Nutritional Anaemias: Tools for Effective Prevention and Control. World Health Organization, Geneva.

Treating Iron Deficiency In Pregnancy

- Iron Deficiency Anaemia has enormous health implications for mum and baby

- High Dose Oral Treatment = Increased Side effects

- If that fails, IV Iron Treatment

- Uncomfortable, Costly and challenging for Mum and Healthcare provider

- Preventative supplementation can decrease Maternal Anaemia at term by 70%

Solution: Health Optimisation‘Prevention is better than Cure’

- Increasing body of evidence suggests lower dosage Iron supplementation could be key

- Preventing the deficiency in the 1st instance

- Ensuring Iron stores can cope with increased demand in Pregnancy

- Less side effects for Mums= increased compliance

- Midwives have key role in information dissemination

- Could ensure less intervention and less women becoming ‘Medical Patients’

Active Iron Vs Traditional Iron SupplementsActive Iron is clinically proven to

have x2 the absorption compared to standard ferrous

sulfate

Active Iron user studies show 9 out of 10 users report no side effects

compared to 1 out of 10 with ferrous sulfate

The Active Iron formulation helps provide gut cell protection, allowing lower doses to be

administered and improved gut tolerability

Conclusions• Iron Deficiency, and the possible resulting Anaemia, have far reaching

health consequences for mum, baby and wider global community

• Getting the optimum Iron intake in pregnancy can be challenging

• Early intervention to encourage maintenance of iron levels throughout pregnancy may preclude the need for much more expensive, risky & uncomfortable treatments

• Preventing the deficiency in the 1st instance should be a key objective of maternity provision

• Midwives have a key role in health optimisation & education, providing holistic, women centred care

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