• Journal of Nutrition and Health
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• v.32 no.7
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• pp.793-801
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• 1999

The purposes of this study are to assess iron status in mothers and their newborn infants at birth and to analyze the influence of maternal iron status on their newborn babies. Venous bloods samples were drawn from 144 pregnant women just before delivery and cord bloods of their newborn babies were collected immediately after birth for measurement of hemoglobin, hematocrit, serum iron, ferritin, total binding capacity and transferrin saturation. The values of hemoglobin and hematocrit were significantly lower in the mothers(10.9$\pm$1.43g/dl and 33.7$\pm$3.67%) than in their newborn infants(14.7$\pm$1.43g/dl and 45.3$\pm$4.76%)(p<0.0001). At delivery, serum iron levels in cord blood were about twice as high as those in the maternal blood, and serum ferritin levels in the cord blood were about four times higher than those in the maternal blood. The serum ferritin levels of multigravidas were higher than those of primigravidas,. but there was no difference between the serum ferritin levels of their infants. The serum ferritin levels of the mothers and their infants were higher in maternal group with iron supplement regularly than in other maternal group without iron supplement during pregnancy. Among the mothers, 26.4% had a serum ferritin levels below 12ng/ml(i.e. depleted iron stores)and 78.9% had a hemoglobin below 12g/dl(i.e.iron deficient anemia). When the maternal group was classified according to their serum ferritin levels by 9ng/ml, 12ng/dl or 20ng/ml, there was no significant difference in the iron status of their newborn infants among the three groups. The hemoglobin and serum ferritin levels of the mothers were well correlated with those of their babies. The maternal hemoglobin values negatively correlated with infant birth weight. It is possible that the demands of iron of the mother might be increased in the case of a newborn infant of greater size. The results of this study provide useful information regarding establishment of RDA for iron in pregnant women and guidance about the need for iron supplement during pregnancy.

• Korean Journal of Community Nutrition
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• v.3 no.1
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• pp.53-61
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• 1998

This study was designed to estimate mean daily iron intake and its bioavailabi- lity and to assess nutrition knowledge for 144 pregnant women in the last trimester. Serum ferritin concentration was analyzed to estimate their iron stores. Dietary intakes of iron(heme iron and nonheme iron), the amounts of MPF(meat, poultry and fish) and ascorbic acid were assessed by modified 24-hr recall method. The food frequency questionnaire was used to assess subjects usual food consumption patterns. The mean value of serum ferritin was $21.3\pm{15.2ng/ml}$ and 26.4% of the pregnant women had a serum ferritin level <12ng/ml(i.e. depleted iron stores). The mean daily intake of total orin in the pregnant women was 56.5%(17.0mg) of RDA and heme iron intake was 0.94mg which was 5.5% of total iron intake. Total absorbable iron calculated by the method of Monsen was 2.41mg and bioavailability of dietary iron was 2.41%. Food frequency test score of meats group was positively correlated(r=0.443) with the bioaavailability of dietary iron. The mean score on the nutrition knowledge test of subjects was 12.76(out of a possible 20 points). These results indicate that the nutritional iron status may be improved by increasing either the amount of iron in the diet or its availability.

• Proceedings of the KSCN Conference
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• 2000.11a
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• pp.62-62
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• 2000

• Korean Journal of Community Nutrition
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• v.10 no.6
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• pp.860-868
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• 2005

Anemia diagnosed early in pregnancy is associated with increased risks of low birth weight and preform delivery. The purposes of this study were to assess the maternal iron status during pregnancy and to evaluate the relationships between the iron indices of maternal-umbilical cord serum iron and ferritin levels and pregnancy outcomes. Dietary intakes of the pregnant women were estimated by 24 hour-recall (3 times). Serum iron and ferritin levels in maternal blood and umbilical cord were measured at 1st-, 2nd-, 3rd- trimester and delivery, respectively. The mean of maternal se겨m iron levels of the trimester and delivery were $124.27\;{\mu}g/dl,\;97.03\;{\mu}g/dl,\;94.32\;{\mu}g/dl,\;and\;145.53\;{\mu}g/dl$. Those maternal levels were significantly lower than that of umbilical cord blood ($222.59\;{\mu}g/dl$). Serum ferritin levels of maternal trimester and delivery were 22.68 $22.68\;{\mu}g/l,\;11.09\;{\mu}g/l,\;14.18\;{\mu}g/l,\;and\;\;24.54\;{\mu}g/l$, which were significantly lower than those of umbilical cord blood ($184.35\;{\mu}g/l$) (p < 0.0001). This prevalence of anemia of total subjects was $30.3\%$ by WHO criteria (Hb < 11.0 g/dl, Hct < $33\%$). Iron levels of 2nd-trimester was significantly higher in the normal group than in the anemia group. And ferritin levels of 3rd-trimester and delivery was significantly higher in the normal group than in the anemia group. Therefore, we suggest for successful pregnancy outcome and delivery differential iron supplementation programs will be carried out with individual Pregnant women on the basis of pre-Pregnancy nutrition. (Korean J Community Nutrition 10(6) : $860\∼868$, 2005)

• Korean Journal of Community Nutrition
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• v.8 no.2
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• pp.160-170
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• 2003

Pregnant women in South Korea are a highly risk group fur iron deficiency anemia. Previous studies indicated that the 24-hour recall method was insensitive in distinguishing iron deficiency anemic women from normal women. This method is also impractical to when used at community health centers where no public health dietitians are employed. The objective of this study was to develop a convenient tool to evaluate the usual iron (Fe) intake of pregnant women. The study participants were 115 pregnant women (age 23 to 37 years) at gestational stage of 13 to 24 weeks. Anemic subjects were classified on the basis of their serum ferritin < 12.0 ${\mu}$g/L and hemoglobin < 12.0 g/dL levels. Food frequency questionnaires with 46, 29, and 15 commonly consumed food items were used to measure the usual intake of iron of the subjects. Hemoglobin and serum ferritin were measured from fasting blood samples. Nutrients intake was assessed on three consecutive days using the 24-hour recall method and the food record method. The iron index score calculated using the food frequency method showed a significantly positive correlation with iron intake for the three days dietary intake. The iron index showed a significantly difference (p < 0.05) between the normal and anemic groups. However, there was no significant difference in the iron intake between the anemic and the normal women as measured by the 24-hour recall and food record method. Our study indicated that the 29-food items questionnaire could be used as a screening tool to identify poor dietary intake of iron. (Korean J Community Nutrition 8(2) : 160170, 2003)

• Korean Journal of Community Nutrition
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• v.6 no.5
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• pp.734-743
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• 2001

Iron deficiency anemia is a worldwide public health problem relevant to unsound nutritional practice. While the prevalence of iron deficiency anemia is very common among pregnant women, appropriate nutritional service programs to improve the iron status are lacking in Korea. In an attempt to develop a nutritional screening tool to separate the high-risk subjects of iron deficiency, we carried out a nutritional survey for 115 Korean pregnant women whose gestational age ranged from 13 to 24 weeks. Each subject was interviewed with questionnaires for general characteristics and dietary habits. Food intake was measured by 24-hour recap method and 2 day record. Fasting blood was drawn for measuring hemoglobin and serum ferritin. It appeared that half of the pregnant women belonged to the anemia group and had insufficient dietary habits to provide adequate amounts of dietary iron. The first gravida and the working women had better hematological iron indicators than the second or more gravida and the housewives. It also appeared that women who had bigger family size and lower BMI in pre-pregnancy had poorer iron status. Among the food consumption habits, fruit dependent dietary habit was related to poor iron status. Sufficiently consumed green leafy vegetable and appropriate amount of food before morning sickness were positive factors of iron stares. Our results indicated that parity, BMI, current job, family size, food habits including consumption of fruits, green & yellow vegetables, and food habits before the onset of morning sickness are significant factors to contribute the Fe deficiency anemia during pregnancy.

• Korean Journal of Community Nutrition
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• v.8 no.6
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• pp.803-813
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• 2003

Literature suggests that iron deficiency anemia is prevalent among pregnant women all over the world. This study was designed to evaluate the iron status of pregnant women during the fist five months, with the intention of determining ways to reduce the prevalence of iron deficiency anemia among pregnant women in Korea. We collected dietary information and measured the biochemical status of iron in 171 pregnant women over 16 weeks of gestation (=16.7$\pm$2.34 week). Dietary intakes for 3 days were collected using the 24 hour recall and food record methods. The daily Fe intake was measured using the food frequency method. The Body Mass Index (BMI), calculated by using the pre-pregnancy weight and height, indicated that 31.3% of subjects were under-weight. We divided the subjects into normal and anemic group by using the serum ferritin levels. It appeared that the mean dietary intake of iron was 52.3% of the recommended level for pregnant women. The dietary quality evaluation showed that pregnant women ate only 58% of the recommended amount in the food groups of meat, fish, eggs, beans and milk and dairy products. The hematological indices showed that the mean Hemoglobin (Hb) was 11.9 g/dl, Hematocrit (Hct) was 35.1%, ferritin was 23.9 $ng/ml$, and transferrin was 297.3 ${\mu}g/dl$. The dietary intake of iron was significantly lower and the vitamin C intake was significantly higher in the anemic group. The pre-pregnancy BMI was significantly lower in the anemic group. Variables affecting iron intake were the Fe intake frequency index and the food group score. The Fe index showed significantly positive correlation with the pre-pregnancy food intake and the food group score. Hb showed a significantly positive correlation with the pre-pregnancy food intake. We concluded that strategies to improve iron status be implemented in the pre-pregnant stage so as to reduce the prevalence of iron deficiency and that we should stress on the importance of an adequate diet as well as the maintenance of a heathy weight.

• Journal of Nutrition and Health
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• v.31 no.8
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• pp.1270-1282
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• 1998

The purpose of this research is to compare the effdct of the new weekly iron supplementation on maternal iron and zinc nutritional status with the effect of the present daily iron supplementation. To assess the iron ad zinc status of rpegant women visiting public health center in Ulsan, interview for dietary survey and general aspect of each subject was given and biochemical analysis of blood and urine was performed. The study subjects were divided to two groups randomly, but the subjects whose Hgb level was very low were allocated in daily group ethically because theeffect of weekly supplementation was not yet established as safety. Daily group received 80mg elemental Fe(250mg Fe as ferrous sulfate) per day for 100days, while weekly group received 160mg elemental Fe once a week for 15 weeks. After treatement, Hgb(p<0.01), Hct(p<0.01) , serum iron(p<0.05) and serum ferritin(p<0.001) in weekly group but RBC, Hgb , Hct , serum iron and serum iron and serum ferritin increased slightly. After correction for the initial Hgb by including it in the MANIVA, the difference in treatment effects of Hgb and TIBC between groups was statistically significant. The effect of weekly vs, daily iron supplementation program on zinc status was also studied. The difference in treatment effect between two groups was, however, not sifnificant. It is concluded that once weekly rion supplementation program in pregnant women was less effectgive to improve the iron status than daily iron supplementation program. However, because the weekly dose prevented a decline in Hgb as well as in ferritin, itw effect was positive , given the fact that non-supplemented women almost always exhibit a sifnificant drop in Hgb values. It seems that it will improve the iron status well if the amount or frequency of supplements is to be adjusted . Biweekly supplementation of a different dose or antother type of iron supplement, such as through a gastric delivery system, might be better.

• Journal of Nutrition and Health
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• v.33 no.5
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• pp.532-539
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• 2000

The purpose of this research is to assess th iron nutritional status of pregnant women and to evaluate the appropriateness of the present cut off levels of hemoglobin(Hgb), hematocrit(Hct) and total iron binding capacity(TIBC) for assessing iron deficiency status. Pregnant women who were visiting public helath centers in Ulsan were interviewed and agreed to attend the study. Blood sample was taken and biochemical analysis of blood was performed. The collected data were classified into 3 trimesters by gestational age and then statistical analysis was performed. The prevalence of anemia in all subjects was 32.3% by WHO criteria(Hgb < 11.0g/dl) and 17.8% of all subjects was iron deficient anemia by CDC criteria(Hgb < 11.0/dl and serum ferritin < 12.0ug/l). Since the iron deficient anemia generally occures at the last stage of iron deficiency, it is not efficient to diagnose and prevent the iron deficient anemia in pregnant women by using the present cut off level of Hgb. Therefore, the new cut off level of iron status indices is necessary for assessing iron deficiency in early pregnancy before manifestation of anemia and for reducing the prevalence of anemia in later pregnancy. For this reason, the present cut off levels of iron status indices were estimated and compared by assessing the iron deficiency judged by serum ferritin level (<12.0ug/l)as true iron deficiency. It follows from the results of this research that present cut off levels of Hgb, Hct and TIBC were very insensitive in identifying the subjection with iron deficiency. The appropriate cut off levels of Hgb were 11.5g/dl for total period of pregnancy, 12.0g/dl for 1st and 3rd trimester, and 11.5g/dl for 2nd trimester. The cut off level of Hct was 34.0% for total period for pregnancy, 35.0% for 1st trimester, and 34.0% for 2nd and 3rd trimester. The cut off level of TIBC was 400ug/dl for total period, 360ug/dl for 1st 2nd trimester, and 450ug/dl for 3rd trimester.

• Journal of Nutrition and Health
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• v.32 no.8
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• pp.887-896
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• 1999

The purpose of this research is to assess hematological and biochemical status and the prevalence of iron deficiency of pregnant women by gestational age to provide the primary data about iron nutritional status of pregnant women. Pregnant women visiting public health centers in Ulsan participated in study and were divided into 3 trimester by last menstrual period(LMP). Hemoglobin (Hgb), hematocrit(Hct)and mean corpuscular volume(MCV) among iron status indices were not statistically different from normal distribution, however total iron binding capacity(TIBC) and serum ferritin were skewed to left and serum iron and transferrin saturation(TS) were skewed to right. Hgb was positively correlated with Hct(r=0.93, p<0.001) but TIBC was negatively correlated with all indices. Serum ferritin was also correlated with all indices, especially in 3rd trimester but not reached to 1st trimester level. Mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), Red cell distribution width(RDW), serum iron and TS were not significantly different by trimester, however when serum serum iron was adjusted with hematocrit to correct the hemodilution, it significantly decreased in 2nd trimester. MCV increased in 2nd trimester and was maintained until late pregnancy, TIBC continued to increase throughout the trimester. The prevalence of anemic by CDC(Centers for Disease Control) Hgb criteria(Hgb <11.0g/dl in 1st and 3nd trimester, Hgb<10.5g/dl in 2nd trimester) was 2.8% in 1st trimester, 22.5% in 2nd trimester, 27.1% in 3rd trimester and was similar with prevalence by CDC Hct criteria(Hct < 33% in 1st and 3rd, Hct < 32% in 2nd). The prevalence of anemic of total subjects was 32.7% by WHO criteria(Hgb < 11.0g/dl). Although almost iron status indices increased in 3rd trimester, the prevalence of anemia by different criteria of all indices increased throughout the trimester, so iron nutritional status was considered as serious during late pregnancy. However, since factors other than iron deficiency, such as infection, infection, inflammation, other nutrient deficiency may also play a significant role, to differentiate the anemia due to mainly iron deficiency from the anemia due to other factors, serum ferritin is among the more useful indices in distinguishing the two conditions because it is depressed only in iron deficiency. Hgb<11.0g/dl and serum ferritin<12.0ug/L as the criteria of iron deficiency was suggested by CDC. 17.8% of all subjects were classified as iron deficient anemia, 14.9% as anemic from other reasons, 21.2% as iron deficiency any only 46.2% were in normal iron status.