Iron deficiency in pregnancy

World over, half of the anaemic burden is assumed to be due to iron deficiency. In pregnancy, it has been estimated that 38.2% (95% CI: 33.5-42.6) of pregnant women which corresponds to 32 million women have anaemia globally. Iron deficiency results when there is inadequate iron intake and absorption, increased iron requirement during growth, and excessive iron losses. Iron absorption is tightly regulated according to body iron reserves and the intensity of erythropoiesis. An important iron regulatory peptide hormone, hepcidin secreted by the liver, is detected to play significant role in iron homeostasis. Serum ferritin levels are the accurate indicator of total body iron stores and serum sTfR a sensitive marker of iron deficiency in pregnancy. Iron deficiency anaemia in pregnancy is known to be associated with increased risk of maternal and perinatal morbidity and mortality. Iron is important for early placental development, which maintains pregnancy and provides nutrients and oxygen to the developing fetus. Iron deficiency can adversely impact birth outcomes and result in preterm birth and low birth weight. Dietary iron which is the commonest source of iron is mostly in ferric form and it has to be reduced by the enzyme ferric reductase to the ferrous form before it can be absorbed by the enterocytes in the duodenum and jejunum. Iron absorption can vary from 1% to 40%, depending on the mix of enhancers and inhibitors in the meal. Oral iron therapy is standard care for the iron deficiency anaemia and parenteral iron is indicated when oral iron cannot be tolerated or absorbed or patient compliance is in doubt or if the woman is approaching term and there is insufficient time for oral supplementation to be effective (Level C recommendation). It is, however, more invasive and expensive to administer. Due to risk of allergic reactions, intravenous iron products should only be administered when staff trained to evaluate and manage anaphylactic or anaphylactoid reactions, as well as resuscitation facilities, are immediately available.