Optimum Iron Dosage in Pregnancy: What does the evidence ... · •Presentation sponsored by Active...
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Optimum Iron Dosage in Pregnancy:
What does the evidence tell us?
Thank you to the
Northern 2020 Maternity and Midwifery Festival for this opportunity and to Active Iron
for their Sponsorship
Online, Manchester
June 2020
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Avril Flynn LLB BSc RM
• Midwife, Childbirth Educator & Hypnobirth Practitioner
• Writer
• Speaker
• Passionate Educationalist
• Presentation sponsored by Active iron Solvotrin
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Introduction
• Iron: a Vital Micro-Nutrient
• Current Guidelines
• Current Challenges of Supplementation
• Deficiency is progressive
• ‘Prevention is better than a cure’- could a lower dosage offer the solution?
• Questions?
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Iron : A Vital Micronutrient
• Essential for Oxygen transportation
• Energy Metabolism
• Cognitive function
• Blood Cell formation & Cell division
• Globally- Most common Nutritional deficiency
• Affects low, middle and high income countries
• Estimated up to 1 in 4 Pregnant women in the UK have Iron Deficiency Anaemia
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Risks and Effects on Mother and Baby of Iron Deficiency
Mother• Depletion of iron stores and
Ferritin levels
• Impaired haemoglobin production
• Anaemia in pregnancy
• Increased susceptibility and severity of Infections
• Poor cognition and low productivity
• Increased risk of maternal mortality & morbidity
• Fatigue, SOB, palpitations
• Depression, Low Mood, Irritability
Baby• Infant iron deficiency (in the
first 3 months of life)
• Low birthweight
• Preterm birth
• Congenital abnormalities
• Cognitive impairment
• Increased risk of perinatal mortality and morbidity
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Current Guidelines: Anaemia Defined
Anaemia defined as• <110g/l in the first trimester• <105g/l in the second and third• <100g/l in the postnatal period
British Committee for Standards of Haematology (BCSH) and NICE Recommend: • FBC at booking and 28 weeks
• Serum Ferritin should be checked in women who although not anaemic, are at increased risk of deficiency
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Women at Risk of Iron Deficiency in Pregnancy
• Low iron stores before pregnancy
• Previous Hx of deficiency
• Pre-existing blood condition (sickle cell, thalassaemia)
• Age <20 years
• Gut disorder (IBS, coeliac)
• Eating disorder
• Restricted diet (vegetarian/vegan)
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Current Guidelinesfor Iron Intake in pregnancy• 2-3 fold increase in Iron
Requirements (NHS) during pregnancy and postnatal period
• Healthy mother- healthier infant
• CDC Recommend 27mg Iron daily in pregnancy
• WHO Recommend 30-60 mg
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Challenges: Getting Enough Iron via Diet
• More and more people are on restricted diets
• Once a pregnant woman is deficient, diet alone will not replenish levels
• Ferritin stores will be exhausted
• Women may become deficient in between booking and re-check
• Many women need addition Iron supplementation
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Supplementation
Traditional Oral supplements
• Low cost
• Readily available
Problems
• Side effects
• GI Issues
• Constipation
• Non-Compliance
• Supplements are not created equally
• Some ’Iron Supplements’ have a negligible iron content
• Bioavailability varies hugely
• Iron Compound v Elemental iron
• Iron is absorbed via a carrier mechanism (DMT -1)
Bioavailability
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Deficiency is progressive: A Sliding Scale
WHO. (2017) Nutritional Anaemias: Tools for Effective Prevention and Control. World Health Organization, Geneva.
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Treating Iron Deficiency In Pregnancy
- Iron Deficiency Anaemia has enormous health implications for mum and baby
- High Dose Oral Treatment = Increased Side effects
- If that fails, IV Iron Treatment
- Uncomfortable, Costly and challenging for Mum and Healthcare provider
- Preventative supplementation can decrease Maternal Anaemia at term by 70%
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Solution: Health Optimisation‘Prevention is better than Cure’
- Increasing body of evidence suggests lower dosage Iron supplementation could be key
- Preventing the deficiency in the 1st instance
- Ensuring Iron stores can cope with increased demand in Pregnancy
- Less side effects for Mums= increased compliance
- Midwives have key role in information dissemination
- Could ensure less intervention and less women becoming ‘Medical Patients’
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Active Iron Vs Traditional Iron SupplementsActive Iron is clinically proven to
have x2 the absorption compared to standard ferrous
sulfate
Active Iron user studies show 9 out of 10 users report no side effects
compared to 1 out of 10 with ferrous sulfate
The Active Iron formulation helps provide gut cell protection, allowing lower doses to be
administered and improved gut tolerability
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Conclusions• Iron Deficiency, and the possible resulting Anaemia, have far reaching
health consequences for mum, baby and wider global community
• Getting the optimum Iron intake in pregnancy can be challenging
• Early intervention to encourage maintenance of iron levels throughout pregnancy may preclude the need for much more expensive, risky & uncomfortable treatments
• Preventing the deficiency in the 1st instance should be a key objective of maternity provision
• Midwives have a key role in health optimisation & education, providing holistic, women centred care
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