The Use of Iron Supplements of Pregnant Women and Pregnancy Outcome

임신부의 철분 보충제 사용과 임신결과

  • Cho, Ji-Hyun (Department of Food & Nutrition, Sungshin Women's University) ;
  • Ahn, Hong-Seok (Department of Food & Nutrition, Sungshin Women's University) ;
  • Bae, Hyun-Sook (Institute of Life & Culture Sungshin Women's University)
  • 조지현 (성신여자대학교 식품영양학과) ;
  • 안홍석 (성신여자대학교 식품영양학과) ;
  • 배현숙 (성신여자대학교 생활문화연구소)
  • Published : 2009.06.30

Abstract

It is known that Korean pregnant women take iron supplements at a higher than the recommended level. This study was designed to provide data on current iron intake levels both from food sources and supplement to better guide iron supplement use during pregnancy. We also explored associations of iron supplement intake levels with various sociocultural factors and pregnancy outcomes. Dietary intakes of 510 pregnant women were assessed by a validated 102-item food frequency questionnaire, and information on types and amounts of nutritional supplement intakes were also attained. While dietary intake levels of most nutrients exceeded the KDRIs (Korea Dietary Reference Intakes: EAR: Estimated Average Requirements), folate fell short of the KDRIs. A total of 428 women (83.9%) reported to take iron supplement. The pregnant women were divided into the three groups (group I: Fe supplement intake ${\le}$ EAR, group II: EAR < Fe supplement intake ${\le}$ 3 times of EAR, group III: 3 times of EAR < Fe supplement intake). The mean dietary intake of iron was 24% of the total iron intake for pregnant women. Iron intake from food was not significantly different among I, II, and III. In case of iron intake from supplements, the most frequent dose (34.1%) was 90-100 mg/day, and the mean iron supplement intake was 362% of the EAR. The study findings showed that those with higher levels of iron supplements had better meal quality measured by NAR (Nutrient Adequacy Ratio) and INQ (Index of Nutrient Quality). In addition iron supplement intake levels were significantly related to age (20s: 66.5 ${\pm}$ 38.6 mg/day, 30s: 77.3 ${\pm}$ 47.8 mg/day, p < 0.0116) and experience of childbirth (1st pregnancy: 70.9 ${\pm}$ 41.2 mg/day, 2nd pregnancy: 64.5 ${\pm}$ 39.5 mg/day, ${\ge}$ 3rd pregnancy: 94.4 ${\pm}$ 63.8 mg/day, p < 0.005). However, no significant difference was found between iron supplement intake levels and various pregnancy outcomes including birth weight, birth height, gestational age, weight gain during pregnancy, and jaundice. It is worrisome that iron intake by supplement use greatly exceeded the EAR, suggesting the need of appropriate guidelines for iron supplement intake during pregnancy. Thus iron overdose from supplements in pregnancy should be considered as a serious condition.

Keywords

References

  1. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, Park C, Kim DH (2007): Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr 61(12): 1435-1441 https://doi.org/10.1038/sj.ejcn.1602657
  2. Allen LH (2000): Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71(5): 1280-1281
  3. Bae HS, Lee GJ, Lee MS, Lee JY, Shin YM, Ahn HS (2002): Iron status indices of maternal, umbilical cord, placenta and birth weight. Korean J Community Nutr 7(5):686-695
  4. Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, Sneyd MJ, Key TJ, Roe L, Day NE (1994): Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr 72(4): 619-643 https://doi.org/10.1079/BJN19940064
  5. Casanueva E, Viteri FE (2003): Iron and oxidative stress in pregnancy. Am Soc Nutr Sci 133: 1700-1708
  6. Choi BS, Lee IS, Shin JJ, Kim WK, Park MH (2001): Factors affecting dietary & nutrients intake during the first, second, and third trimesters and pregnancy outcome. Korean J Food Culture 16(3): 203-214
  7. Cogswell ME, Parvanta I, Ickes L, Yip R, Brittenham GM (2003): Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr 78(4): 773-781
  8. Hyun WJ, Lee JY, Chung SK (1997): Dietary intake and psychological stress of pregnant women in taejon in relation to neonatal birth weight. Korean J Community Nutr 2(2): 169-178
  9. Jang HM, Ahn HS (2005): Serum iron concentration of maternal and umbilical cord blood during pregnancy. Korean J Community Nutr 10(6): 860-868
  10. Kim AS (2009): Iron Deficiency and Brain Development in Infancy. Korean J Pediatr Gastroenterol Nutr symposium (3rd)
  11. Kim EK, Lee KH (1999): Iron status in pregnant women and their newborn infants. Korean J Nutr 32(7): 793-801
  12. Kim HR, Lim HS (2008): Iron intake during pregnancy on serum concentrations of trace minerals in mothers and neonates. Korean J Nutr 41(3): 242-253
  13. Kim KN (2004): Effects of the interaction between the C677T 5, 10- Methylenetetrahydrofolate reductase (MTHFR) Polymorphism and Serum B vitamins on maternal and fetal serum homocysteine levels, Pregnancy Outcomes, and postnatal growth measurements. Ph. D Ewah womens university
  14. Kim WJ, Ahn HS, Chung EJ (2005): Mineral intakes and serum mineral concentrations of the pregnant and lactating women. Korean J Community Nutr 10(1): 59-69
  15. Kim YJ, Mun JA, Min HS (2004): Supplement dose and healthrelated life style of vitamin-mineral supplement user among korean middle-aged. Korean J Community Nutr 9(3): 303-314
  16. Lee EJ, Kim MH, Cho MS, Kim YJ, Kim HY (2003): A study on nutrient intakes and hematological status in women of childbearing age: comparison between non-pregnant and pregnant women. Korean J Nutr 36(2): 191-199
  17. Lee SL, Chang YK (2008): A study of health related factors and food habits during pregnancy of full-term and preterm delivery. J Korean Diet Assoc 14(1): 77-86
  18. Lee JH, Lee YS(2000): Effect of excess calcium and iron supplement on iron bioavailability, liver and kidney functions in anemic model rats. Korean J Community Nutr 5(2): 243-252
  19. Lee JI, Lee JA, Lim HS (2005): Effect of time of initiation and dose of prenatal iron and folic acid supplementation on iron and folate nutriture of Korean women during pregnancy. Am J Clin Nutr 82(4):843-849
  20. Lee YS, Ahn HS, Lim HS, Jang NS (2006): Nutrition Throughout the Life Cycle. p. 71 Kyomunsa., Seoul
  21. Lim HS (2002): A Study on Proper Period and Amount of Supplementation with Iron and Folate in Korean Pregnant Women. Korea Health 21 R & D Project report (00-PJ1-PG3-22000-0063)
  22. Milman N (2006): Iron prophylaxis in pregnancy-general or individual and in which dose? Ann Hematol 85(12): 821-828 https://doi.org/10.1007/s00277-006-0145-x
  23. Palma S, Perez-Iglesias R, Prieto D, Pardo R, Llorca J, Delgado- Rodriguez M (2008): Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case-control study. J Epidemiol Community Health 62(2): 120-124 https://doi.org/10.1136/jech.2006.052985
  24. Park CH, Kwon I, Lee JG, Seo GA, Im HU, Kim YU, Lee Y, Na JG (2004): Is selective iron supplementation needed during gestation? Korean J obstet Gynecol 47(1): 45-50
  25. Park JH, Kim SB, Cho KH, Choue RW (2006): Maternal nutritional status at the end of pregnancy, and correlation among pregnancy weight gain, birth weight and serum leptin levels. Korean J Nutr 39(5): 467-475
  26. Pena-Rosas JP, Viteri FE (2006): Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev 3: 004736
  27. Preziosi P, Prual A, Galan P, Daouda H, Boureima H, Hercberg S (1997): Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Am J Clin Nutr 66(5): 1178-1182
  28. Rioux FM, LeBlanc CP (2007): Iron supplementation during pregnancy: what are the risks and benefits of current practices? Appl Physiol Nutr Metab 32(2): 282-288 https://doi.org/10.1139/H07-012
  29. Siddappa AM, Georgieff MK, Wewerka S, Worwa C, Nelson CA, Deregnier RA (2004): Iron deficiency alters auditory recognition memory in newborn infants of diabetic mothers. Pediatr Res 55(6): 1034-1041 https://doi.org/10.1203/01.pdr.0000127021.38207.62
  30. Steer PJ (2000): Maternal hemoglobin concentration and birth weight. Am J Clin Nutr 71(5): 1285-1287
  31. Takeda Y, Yoneda T, Demura M, Furukawa K, Miyamori I, Mabuchi H (2001): Effects of high sodium intake on cardiovascular aldosterone synthesis in stroke-prone spontaneously hypertensive rats. J hypertens 19(3): 635-639 https://doi.org/10.1097/00004872-200103001-00017
  32. Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL, Nelson KG (2002): Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr 140(2): 165-170 https://doi.org/10.1067/mpd.2002.120688
  33. The Korea Society of Nutrition (2005): Dietary Reference Intakes For Koreans. Kookjin publishing co., seoul
  34. Viteri FE, Berger J (2005): Importance of pre-pregnancy and pregnancy iron status: can long-term weekly preventive iron and folic acid supplementation achieve desirable and safe status? Nutr Rev 63(12): 65-76 https://doi.org/10.1301/nr.2005.dec.S65-S76
  35. Ward RJ, Wilmet S, Legssyer R, Leroy D, Toussaint L, Crichton RR, Pierreux C, Hue L, Piette J, Srai SK, Solanky N, Klein D, Summer K (2009): Effects of marginal iron overload on iron homeostasis and immune function in alveolar macrophages isolated from pregnant and normal rats. Biometals 22(2): 211-223 https://doi.org/10.1007/s10534-008-9155-6
  36. Ward RJ (2003): Iron supplementataion during pregnancy-a necessary or toxic supplement? Bioinorg Chem Appl 1(2): 169-176 https://doi.org/10.1155/S156536330300013X
  37. Weisell RC (2002): Body mass index as indicator of obesity. Asia Pac J Clin Nutr 11(8): 681-684 https://doi.org/10.1046/j.1440-6047.11.s8.5.x
  38. Wulff M, Ekstroöm EC (2003): Iron supplementation during pregnancy in Sweden: to what extent is the national recommendation followed? Acta Obstet Gynecol Scand 82(7): 628-635 https://doi.org/10.1034/j.1600-0412.2003.00186.x
  39. Yoon JS, Park JA, Son SM (2003): The iron status and diet quality of pregnant women during the first five months of pregnancy. Korean J Community Nutr 8(6): 803-813
  40. Zeng L, Dibley MJ, Cheng Y, Dang S, Chang S, Kong L, Yan H (2008): Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ 377: 1211-1214 https://doi.org/10.1136/bmj.a2001