![]() For this reason, the subcommittee considered low iron stores in late pregnancy to be physiologic and reserved the term iron deficiency for the second and third stages. This is a particularly thorny issue with respect to pregnancy, because storage iron, estimated from bone marrow aspirates (or less directly by the serum ferritin), is low or absent in most women during the third trimester, whether (Svanberg et al., 1976a) or not (Heinrich et al., 1968 Svanberg et al., 1976a) they have received an iron supplement. This stage is the most difficult to define because it involves an arbitrary decision about how low iron stores should be before they are considered depleted. The first stage, depletion of iron, is characterized by a low serum ferritin level. Impaired hemoglobin production (or iron deficiency without anemia) 3. Iron depletion is generally described in terms of three stages of progressively increasing severity (Bothwell et al., 1979): 1. Although iron deficiency is the most common cause of anemia, infection, genetic factors, and many other conditions can also lead to anemia. This higher hemoglobin concentration as a result of an improved iron supply not only increases the oxygen-carrying capacity, but it also provides a buffer against the blood loss that will occur during delivery (Hallberg, 1988).Īnemia is defined as a hemoglobin concentration that is more than 2 standard deviations below the mean for healthy individuals of the same age, sex, and stage of pregnancy. Iron deficiency is common among pregnant women in industrialized countries, as shown by numerous studies in which hemoglobin concentrations during the last half of pregnancy were found to be higher in iron-supplemented women than in those given a placebo or no supplement ( Table 14-1) (Chanarin and Rothman, 1971 Dawson and McGanity, 1987 Puolakka et al., 1980b Romslo et al., 1983 Svanberg et al., 1976a Taylor et al., 1982 Wallenburg and van Eijk, 1984). During pregnancy, more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass (Hallberg, 1988). Both groups have to absorb substantially more iron than is lost from the body, and both are at a considerable risk of developing iron deficiency under ordinary dietary circumstances. Among healthy human beings, pregnant women and rapidly growing infants are most vulnerable to iron deficiency (Bothwell et al., 1979).
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