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Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Iron supplementation during pregnancy – a cross-sectional study undertaken in four German states

Authors: Irmela Rosina Demuth, Annett Martin, Anke Weissenborn

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

Iron deficiency but also iron overload during pregnancy has been associated with unwanted health effects. In Germany, iron supplements are only recommended for pregnant women with diagnosed iron deficiency/anaemia. Prevalence of anaemia among pregnant women was reported at 24.4% in 2011. However, limited data suggest that more than 60% of women in Germany use iron supplements during gestation. Against this background, we investigated the prevalence of iron supplement intake among pregnant women and explored determining factors in order to assess whether women are following the advice to only supplement iron in case of a diagnosed iron deficiency/anaemia.

Methods

A cross-sectional study was carried out in four German states in 2015 where, with the help of midwives, women in childbed were asked to retrospectively answer a questionnaire about iron intake from various sources and reasons for supplementing iron during their recent pregnancy. We used Chi-square-tests and logistic regression analysis to evaluate associations between iron supplementation and other nutritional, sociodemographic and maternal variables and to assess attitudes of women meeting versus not meeting the official recommendation on iron supplement intake during pregnancy.

Results

Of 207 participants, 65.2% had supplemented iron. 84.4% reported to have done this because of a diagnosed iron deficiency/anaemia. Iron intake ranged from 5 to 200 mg/day, and duration of supplementation varied between two weeks and throughout gestation. Of women who reported to have been diagnosed with iron deficiency/anaemia, 47.5% had supplemented ≥80 mg/day iron, while 26.2% had taken iron in lower amounts ≤40 mg/day. Six percent of the participating women had not supplemented iron in spite of a diagnosed iron deficiency/anaemia, whereas 19.7% of women without iron deficiency/anaemia still had supplemented iron (range: 7 to 80 mg/day).

Conclusion

The majority of pregnant women used iron supplements in case of a diagnosed iron deficiency/anaemia. However, not all women with iron deficiency/anaemia supplemented (sufficient amounts of) iron, while there was also indiscriminate use of iron supplements in women without iron deficiency/anaemia. Further research is warranted to confirm these findings in representative samples.
Appendix
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Footnotes
1
A validated Food Frequency Questionnaire [37] was used with permission from the Robert Koch-Institute in Germany.
 
2
Guidelines of the Joint Federal Committee concerning medical care during pregnancy and after childbirth (“Mutterschafts-Richtlinien”) in the version of 10 December 1985 (published in the Federal Gazette No. 60a of 27 March 1986) last amended on 21 April 2016, published in the Federal Gazette AT 19.07.2016 B5 entered into force on 20 July 2016.
 
Literature
1.
go back to reference Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257–64.CrossRef Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257–64.CrossRef
2.
go back to reference Milman N. Iron and pregnancy a delicate balance. Ann Hematol. 2006;85:559–65.CrossRef Milman N. Iron and pregnancy a delicate balance. Ann Hematol. 2006;85:559–65.CrossRef
3.
go back to reference Milman N. Iron in pregnancy: how do we secure an appropriate iron status in the mother and child? Ann Nutr Metab. 2011;59:50–4.CrossRef Milman N. Iron in pregnancy: how do we secure an appropriate iron status in the mother and child? Ann Nutr Metab. 2011;59:50–4.CrossRef
4.
go back to reference EFSA NDA Panel (EFSA Panel on dietetic products, nutrition and allergies). Scientific opinion on dietary reference values for iron. EFSA J. 2015;13:4254.CrossRef EFSA NDA Panel (EFSA Panel on dietetic products, nutrition and allergies). Scientific opinion on dietary reference values for iron. EFSA J. 2015;13:4254.CrossRef
5.
go back to reference Deutsche Gesellschaft für Ernährung e.V. Eisen. In: Deutsche Gesellschaft für Ernährung (DGE), Österreichische Gesellschaft für Ernährung (ÖGE), Schweizerische Gesellschaft für Ernährung (SGE), editors. Referenzwerte für die Nährstoffzufuhr. Bonn, 2017. Deutsche Gesellschaft für Ernährung e.V. Eisen. In: Deutsche Gesellschaft für Ernährung (DGE), Österreichische Gesellschaft für Ernährung (ÖGE), Schweizerische Gesellschaft für Ernährung (SGE), editors. Referenzwerte für die Nährstoffzufuhr. Bonn, 2017.
6.
go back to reference Max Rubner-Institut. Nationale Verzehrsstudie II - Ergebnisbericht, Teil 2. Die Bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen 2008. Max Rubner-Institut. Nationale Verzehrsstudie II - Ergebnisbericht, Teil 2. Die Bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen 2008.
7.
go back to reference Menon KC, Ferguson EL, Thomson CD, Gray AR, Zodpey S, Saraf A, et al. Effects of anemia at different stages of gestation on infant outcomes. Nutrition. 2016;32:61–5.CrossRef Menon KC, Ferguson EL, Thomson CD, Gray AR, Zodpey S, Saraf A, et al. Effects of anemia at different stages of gestation on infant outcomes. Nutrition. 2016;32:61–5.CrossRef
8.
go back to reference Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr. 1992;55:985–8.CrossRef Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr. 1992;55:985–8.CrossRef
9.
go back to reference Milman N. Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy 2012;2012:514345. Milman N. Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy 2012;2012:514345.
11.
go back to reference Viteri FE, Casanueva E, Tolentino MC, Diaz-Frances J, Erazo AB. Antenatal iron supplements consumed daily produce oxidative stress in contrast to weekly supplementation in Mexican non-anemic women. Reprod Toxicol. 2012;34:125–32.CrossRef Viteri FE, Casanueva E, Tolentino MC, Diaz-Frances J, Erazo AB. Antenatal iron supplements consumed daily produce oxidative stress in contrast to weekly supplementation in Mexican non-anemic women. Reprod Toxicol. 2012;34:125–32.CrossRef
12.
go back to reference Bhatla N, Kaul N, Lal N, Kriplani A, Agarwal N, Saxena R, et al. Comparison of effect of daily versus weekly iron supplementation during pregnancy on lipid peroxidation. J Obstet Gynaecol Res. 2009;35:438–45.CrossRef Bhatla N, Kaul N, Lal N, Kriplani A, Agarwal N, Saxena R, et al. Comparison of effect of daily versus weekly iron supplementation during pregnancy on lipid peroxidation. J Obstet Gynaecol Res. 2009;35:438–45.CrossRef
13.
go back to reference Lu ZM, Goldenberg RL, Cliver SP, Cutter G, Blankson M. The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991;77:190–4.CrossRef Lu ZM, Goldenberg RL, Cliver SP, Cutter G, Blankson M. The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991;77:190–4.CrossRef
14.
go back to reference Casanueva E, Viteri FE, Mares-Galindo M, Meza-Camacho C, Loria A, Schnaas L, et al. Weekly iron as a safe alternative to daily supplementation for nonanemic pregnant women. Arch Med Res. 2006;37:674–82.CrossRef Casanueva E, Viteri FE, Mares-Galindo M, Meza-Camacho C, Loria A, Schnaas L, et al. Weekly iron as a safe alternative to daily supplementation for nonanemic pregnant women. Arch Med Res. 2006;37:674–82.CrossRef
15.
go back to reference Hwang JY, Lee JY, Kim KN, Kim H, Ha EH, Park H, et al. Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from mothers and Children's environmental health (MOCEH) study. Nutr J. 2013;12:38.CrossRef Hwang JY, Lee JY, Kim KN, Kim H, Ha EH, Park H, et al. Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from mothers and Children's environmental health (MOCEH) study. Nutr J. 2013;12:38.CrossRef
16.
go back to reference Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, et al. Association of oral iron supplementation with birth outcomes in non-anaemic south Indian pregnant women. Eur J Clin Nutr. 2015;69:609–13.CrossRef Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, et al. Association of oral iron supplementation with birth outcomes in non-anaemic south Indian pregnant women. Eur J Clin Nutr. 2015;69:609–13.CrossRef
17.
go back to reference Rawal S, Hinkle SN, Bao W, Zhu Y, Grewal J, Albert PS, et al. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort. Diabetologia. 2017;60:249–57.CrossRef Rawal S, Hinkle SN, Bao W, Zhu Y, Grewal J, Albert PS, et al. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort. Diabetologia. 2017;60:249–57.CrossRef
18.
go back to reference McDonagh M, Cantor A, Bougatsos C, Dana T, Blazina I. Routine Iron supplementation and screening for Iron deficiency Anemia in pregnant women: a systematic review to update the U.S. preventive services task force Recommendation Rockville (MD). Agency for Healthcare Research and Quality (US). 2015. McDonagh M, Cantor A, Bougatsos C, Dana T, Blazina I. Routine Iron supplementation and screening for Iron deficiency Anemia in pregnant women: a systematic review to update the U.S. preventive services task force Recommendation Rockville (MD). Agency for Healthcare Research and Quality (US). 2015.
19.
go back to reference Pouchieu C, Levy R, Faure C, Andreeva VA, Galan P, Hercberg S, et al. Socioeconomic, lifestyle and dietary factors associated with dietary supplement use during pregnancy. PLoS One. 2013;8:e70733.CrossRef Pouchieu C, Levy R, Faure C, Andreeva VA, Galan P, Hercberg S, et al. Socioeconomic, lifestyle and dietary factors associated with dietary supplement use during pregnancy. PLoS One. 2013;8:e70733.CrossRef
20.
go back to reference Alwan N, Cade J. Routine iron supplementation in pregnancy: why is the UK different? Perspect Public Health. 2011;131:207–8.CrossRef Alwan N, Cade J. Routine iron supplementation in pregnancy: why is the UK different? Perspect Public Health. 2011;131:207–8.CrossRef
21.
go back to reference RCPI, HSE. Clinical practice guideline. Nutrition for Pregnancy. In: Royal College of Physiciany of Ireland and Health Service Executiv; 2016. RCPI, HSE. Clinical practice guideline. Nutrition for Pregnancy. In: Royal College of Physiciany of Ireland and Health Service Executiv; 2016.
22.
go back to reference WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, 2012. WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, 2012.
23.
go back to reference Koletzko B, Bauer CP, Bung P, Cremer M, Flothkotter M, Hellmers C, et al. German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy start - young family Network'. Ann Nutr Metab. 2013;63:311–22.CrossRef Koletzko B, Bauer CP, Bung P, Cremer M, Flothkotter M, Hellmers C, et al. German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy start - young family Network'. Ann Nutr Metab. 2013;63:311–22.CrossRef
25.
go back to reference Becker S, Schmid D. Verwendung von Nährstoffsupplementen vor und während der Schwangerschaft. Ernährungs Umschau. 2010;58:36–41. Becker S, Schmid D. Verwendung von Nährstoffsupplementen vor und während der Schwangerschaft. Ernährungs Umschau. 2010;58:36–41.
26.
go back to reference Bergmann RL, Gravens-Muller L, Hertwig K, Hinkel J, Andres B, Bergmann KE, et al. Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany. Eur J Obstet Gynecol Reprod Biol. 2002;102:155–60.CrossRef Bergmann RL, Gravens-Muller L, Hertwig K, Hinkel J, Andres B, Bergmann KE, et al. Iron deficiency is prevalent in a sample of pregnant women at delivery in Germany. Eur J Obstet Gynecol Reprod Biol. 2002;102:155–60.CrossRef
28.
go back to reference Arkkola T, Uusitalo U, Pietikäinen M, Metsälä J, Kronberg-Kippilä C, Erkkola M, et al. Dietary intake and use of dietary supplements in relation to demographic variables among pregnant Finnish women. Br J Nutr. 2006;96:913–20.CrossRef Arkkola T, Uusitalo U, Pietikäinen M, Metsälä J, Kronberg-Kippilä C, Erkkola M, et al. Dietary intake and use of dietary supplements in relation to demographic variables among pregnant Finnish women. Br J Nutr. 2006;96:913–20.CrossRef
29.
go back to reference Knudsen VK, Hansen HS, Ovesen L, Mikkelsen TB, Olsen SF. Iron supplement use among Danish pregnant women. Public Health Nutr. 2007;10:1104–10.CrossRef Knudsen VK, Hansen HS, Ovesen L, Mikkelsen TB, Olsen SF. Iron supplement use among Danish pregnant women. Public Health Nutr. 2007;10:1104–10.CrossRef
30.
go back to reference Casparis D, Del Carlo P, Branconi F, Grossi A, Merante D, Gafforio L. Effectiveness and tolerability of oral liquid ferrous gluconate in iron-deficiency anemia in pregnancy and in the immediate post-partum period: comparison with other liquid or solid formulations containing bivalent or trivalent iron. Minerva Ginecol. 1996;48:511–8.PubMed Casparis D, Del Carlo P, Branconi F, Grossi A, Merante D, Gafforio L. Effectiveness and tolerability of oral liquid ferrous gluconate in iron-deficiency anemia in pregnancy and in the immediate post-partum period: comparison with other liquid or solid formulations containing bivalent or trivalent iron. Minerva Ginecol. 1996;48:511–8.PubMed
31.
go back to reference Milman N, Paszkowski T, Cetin I, Castelo-Branco C. Supplementation during pregnancy: beliefs and science. Gynecol Endocrinol. 2016;32:509–16.CrossRef Milman N, Paszkowski T, Cetin I, Castelo-Branco C. Supplementation during pregnancy: beliefs and science. Gynecol Endocrinol. 2016;32:509–16.CrossRef
32.
go back to reference Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, Haya-Palazuelos J, Ciria-Recasens M, Manasanch J, et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29:291–303.CrossRef Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, Haya-Palazuelos J, Ciria-Recasens M, Manasanch J, et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29:291–303.CrossRef
34.
go back to reference Chatterjee R, Shand A, Nassar N, Walls M, Khambalia AZ. Iron supplement use in pregnancy - are the right women taking the right amount? Clin Nutr. 2016;35:741–7.CrossRef Chatterjee R, Shand A, Nassar N, Walls M, Khambalia AZ. Iron supplement use in pregnancy - are the right women taking the right amount? Clin Nutr. 2016;35:741–7.CrossRef
35.
go back to reference Kirschner W, Dudenhausen JW, Henrich W. Are there anamnestic risk factors for iron deficiency in pregnancy? Results from a feasibility study. J Perinat Med. 2016;44:309–14.CrossRef Kirschner W, Dudenhausen JW, Henrich W. Are there anamnestic risk factors for iron deficiency in pregnancy? Results from a feasibility study. J Perinat Med. 2016;44:309–14.CrossRef
36.
go back to reference Milman N, Rosdahl N, Lyhne N, Jorgensen T, Graudal N. Iron status in Danish women aged 35-65 years. Relation to menstruation and method of contraception. Acta Obstet Gynecol Scand. 1993;72:601–5.CrossRef Milman N, Rosdahl N, Lyhne N, Jorgensen T, Graudal N. Iron status in Danish women aged 35-65 years. Relation to menstruation and method of contraception. Acta Obstet Gynecol Scand. 1993;72:601–5.CrossRef
37.
go back to reference Haftenberger M, Heuer T, Heidemann C, Kube F, Krems C, Mensink GB. Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J. 2010;9:36.CrossRef Haftenberger M, Heuer T, Heidemann C, Kube F, Krems C, Mensink GB. Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J. 2010;9:36.CrossRef
Metadata
Title
Iron supplementation during pregnancy – a cross-sectional study undertaken in four German states
Authors
Irmela Rosina Demuth
Annett Martin
Anke Weissenborn
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-2130-5

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