# Effect of Iron Deficiency in Expectant

Kumari Sunita, Ajeet Kumar

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Kumari Sunita, Ajeet Kumar. Effect of Iron Deficiency in Expectant. 2021, pp.3 (6): 533-534. hal-05460198

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# Effect of Iron Deficiency in Expectant

Article ID: 11191

Dr. Kumari Sunita<fnref n="1" />, Dr Ajeet Kumar<fnref n="2" />

## Introduction

A high proportion of women in both industrialized and developing countries become anaemic during pregnancy. WHO reports that 35 to 75 per cent of pregnant women in developing countries become anaemic. In India anaemia is one of the most common nutritional deficiencies in human population. According to NFHS-3 anaemia is a public health problem in India. It is prevalent in 56 percent women and 87 percent of pregnant women. In slums of Bombay anaemia was found to be present in 70 % of women over the age of 70,52% in women over the age of 60 and 38 % of men (Sharma, 2003). The prevalence of iron deficiency is far greater than prevalence of anaemia and iron deficiency i.e. low serum ferritin and scare or absent stainable iron in bone marrow which develop during the later stage of pregnancy even in women who enter pregnancy with relatively adequate iron stores.

Food based approaches to address anaemia in India is promoted through nutri kitchen gardening but information to which and what extent food combinations would improve the bioavailability of dietary iron is fragmentary, however there is a positive correlation between dietary iron supplementation in the form of taking moringa powder along with iron enhancer in the form of aonla juice as revealed while conducting feeding trial at kvk level.

## Iron Metabolism During Pregnancy

The iron requirements during pregnancy are well established. Most of the iron is required to increase the haemoglobin mass of the mother. This increase occurs in all healthy pregnant women who have sufficiently large iron stores or who are adequately supplemented with iron. The increase is directly proportional to the increased need for oxygen transport during pregnancy and is one of the physiological adaptations that occur in pregnancy.

Iron absorption during pregnancy is determined by the amount of iron in the diet, its bio availability(meal composition)and changes in the iron absorption that occur during pregnancy. Several studies have found that the composition of the meal is almost unchanged during pregnancy in spite of extra energy requirement related to pregnancy per se. These are however balanced by a simultaneous reduction in physical activity.

With regard to iron balance in pregnancy even considering the marked increase in Iron absorption it is impossible for mothers to cover her very high iron requirements from the diet alone. It can be calculated that there will be a deficit of about 400-500mg iron between requirement and amount of iron absorbed during pregnancy.

It is therefore recommended that iron supplementation should be in the form of tablet and preferably together with folic acid.

At delivery, the average blood loss corresponds to the about 250mg. At the same time however haemoglobin mass of the mother is normalized and about 200 mg from the expanded haemoglobin mass is returned to the mother.

Early in the pregnancy there are marked hormonal, hemodynamic and haematological changes. There is for e.g., a very early increase in the plasma volume which has been used to explain physiological anaemia of pregnancy. The primary cause of this phenomenon is an increased ability of haemoglobin to deliver oxygen to the foetus. This change is induced early in pregnancy by an increase in the content of 2-3 DPG in red cells which shifts the Hb-O₂ dissociation curve to the right. The anaemia is thus a consequence of this important adaption and is not a desirable change to improve placental blood flow by reducing viscosity.

<footnote n="1">¹SMS (Home science), KVK Madhopur, West Champaran 845454 DRPCAU, Pusa (Samastipur).</footnote>

<footnote n="2">²Assistant Professor -Cum-Scientist, Department of soil Science, SRI, DRPCAU, Pusa, Samastipur, 848125.</footnote>
## Iron Transfer to Foetus

Transfer of iron from the mother to the foetus is supported by a substantial increase in maternal iron absorption during pregnancy and is regulated by placenta. Serum ferritin generally fall markedly between 12-25 weeks of gestation, probably as a result of iron utilisation for expansion of maternal red cell mass.

If the maternal iron status is poor the number of placental transferrin receptor s increases so that more iron is taken up by placenta. Excessive iron transport o the foetus may be prevented by the placental synthesis of ferritin.

## Effect of Anaemia on Maternal Mortality and Morbidity

The population of pregnant women is at greater risk of maternal morbidity and mortality. (Allen,2000).
Maternal mortality in selected developing countries ranges from 27(India) to 194 (Pakistan) per 1000000 live birth (WHO,1992). Some data show association between maternal mortality and severe anaemia however this relation has not been proved and other reasons may cause mortality. The increased risk of mortality may be related to poor ability to withstand the adverse effect of excessive blood loss, an increased risk of infection and maternal fatigue however these have not been evaluated systematically.

## Maternal Anaemia and Birth Weight

The increased foetal demand for iron increases maternal daily iron requirement (1 to1.25mg/day) in early pregnancy and 6.5 mg/day in late pregnancy. The percentage of iron absorbed from food increases from 7% at 12-week gestation to 36% at 24 weeks to 66% at 36%. These dramatic changes enable the healthy pregnant women to cope with without becoming anaemic but only if there is adequate iron in the diet. In developing countries diet is deficient in iron and iron requirement is met by additional contribution of iron from maternal stores. This demand of iron causes the mother to develop iron deficiency anaemia if she has inadequate amount of iron at the beginning of pregnancy.

## Maternal Anaemia and Infant Health

An association between maternal anaemia and lower infant Apgar score was reported in some studies on 102 Indian women in the first stage of labour, higher maternal haemoglobin concentration was correlated with better Apgar score and with lower risk of birth asphyxia.

## Strategies to Prevent Iron Deficiency Anaemia

Iron deficiencies affecting the lives of 2-billion-person s despite considerable efforts are being done to decrease its prevalence. Normal dietary intake of iron is insufficient to meet daily requirements so current control program include supplementation, fortification, dietary modifications and parasitic disease control.

## Summary

The public health program of iron fortification and community awareness have great success in many parts of the world in reducing anaemia. Program targeted to increase the consumption of iron fortified and iron enriched products have reduced the prevalence of anaemia. Fortification of baby foods has resulted in a dramatic reduction in childhood iron deficiency in USA. A variation on the theme of food fortification is emerging world of designer food in which particular compound of a food are either increased or decreased through bio manipulation. Such attempt to increase bio available micronutrient includes genetically deleting iron inhibitors and genetically enhancing the amount of nutrient.

## References

1. Allen LH (2000) Anaemia and iron deficiency :effects on pregnancy outcome .Am J Clin Nutr 71,1280S-1284S

2. NFHS3-National family health survey 2003-2004.

3. Sharma K K(2003)Improving bioavailability of iron in Indian Diets through food based approachesfor control of iron deficiency anaemia .Food Nutrition and Agriculture,(32)51-61.

4. WHO(1992)The prevalence of anaemia in women: a tabulation of available information,2nd ed.