Effect of iron supplementation in pregnant women with high hemoglobin on neonatal jaundice: A randomized double-blind clinical trial

Document Type : Original Article

Authors

1 Instructor, Department of Midwifery, Ardabil Branch, Islamic Azad University, Ardabil, Iran.

2 Associate Professor, Department of Health Education and Health Development, Health, Safety and Environment Research Center, School of Health, Alborz University of Medical Sciences, Karaj, Iran.

3 PhD Student of Reproductive Biology, Ardabil Branch, Islamic Azad University, Ardabil, Iran.

4 Professor, Department of Blood and Oncology, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Introduction: Prescribing routine Iron supplementation during pregnancy has been done regardless of their need for many years. Considering the possibility of adverse pregnancy outcomes with unnecessary consumption of iron supplementation in pregnant women, this study was performed with aim to assess the effect of iron supplementation in pregnant women with high hemoglobin on neonatal jaundice.
Methods: This double-blind controlled randomized clinical trial was performed on 140 nonsmoker healthy pregnant women with gestational age of 14-18weeks and singleton pregnancy with Hb > 13.2 g/dL and ferritin > 15 μg/l in Ardabil during 2016-17. Mothers were randomly assigned to 50 mg ferrous sulfate and placebo groups from 20th weeks of pregnancy. Also, 24 hour after delivery, the neonates were assessed in terms of bilirubin level (by photometric method using BT3500 device) and jaundice. Data were analyzed by SPSS software (version 16) and independent t-test, Chi-square, and exact fisher test. P < 0.05 was considered statisti­cally significant.
Results: There was significant difference between two groups in Hb (P = 0.03) and ferritin (P = 0.04) levels after the intervention, but no significant difference was found between two groups in the incidence of anemia (Hb<11 g/dl) (P < 0.001). In addition, the incidence of neonatal jaundice was more in interventional group than placebo (P=0.005). The incidence of neonatal jaundice was associated with first-trimester ferritin (P=0.01).
Conclusion: Iron supplementation in pregnant women with Hb > 13.2 g/dl is associated with increased risk of neonatal jaundice; therefore, routine prescribing of iron supplementation should be done with caution in pregnancy.

Keywords

References

  1. Stable D, Rankin J. Physiology in childbearing. 4th. St. Louis: Mosby Elsevier; 2017. P. 164.
  2. Bodnar LM, Siega-Riz AM, Arab L, Chantala K, McDonald T. Predictors of pregnancy and postpartum hemoglobin concentrations in low-income women. Public Health Nutr 2004; 7(6):701-11.
  3. World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.
  4. Shobeiri F, Begum K, Nazari M. A prospective study of maternal hemoglobin status of Indian women during pregnancy and pregnancy outcome. Nutr Res 2006; 26(5):209-13.
  5. Ziaei S, Janghorban R, Shariatdoust S, Faghihzadeh S. The effects of iron supplementation on serum copper and zinc levels in pregnant women with high-normal hemoglobin. Int J Gynaecol Obstet 2008; 100(2):133-5.
  6. Ziaei S, Mehrnia M, Faghihzadeh S. Iron status markers in nonanemic pregnant women with and without iron supplementation. Int J Gynaecol Obstet 2008; 100(2):130-2.
  7. Chang SC, O'Brien KO, Nathanson MS, Mancini J, Witter FR. Hemoglobin concentrations influence birth outcomes in pregnant African-American adolescents. J Nutr 2003; 133(7):2348-55.
  8. Iannotti LL, Zavaleta N, Leon Z, Shankar AH, Caulfield LE. Maternal zinc supplementation and growth in Peruvian infants. Am J Clin Nutr 2008; 88(1):154-60.
  9. Gonzales GF, Steenland K, Tapia V. Maternal hemoglobin level and fetal outcome at low and high altitudes. Am J Physiol Regul Integr Comp Physiol 2009; 297(5):R1477-85.
  10. Kilinc M, Coskun A, Bilge F, Imrek SS, Atli Y. Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey. J Trace Elem Med Biol 2010; 24(3):152-6.
  11. Alizadeh L, Salehi L. Is routine iron supplementation necessary in pregnant women with high hemoglobin? Iran Red Crescent Med J 2016; 18(1):e22761.
  12. Steer PJ. Healthy pregnant women still don't need routine iron supplementation. BMJ 2013; 347:f4866.
  13. Krafft A. Iron supplementation in pregnancy. BMJ 2013; 347:f4399.
  14. Moghimi MA, Malekzadeh J, Moghimi M. An assessment of the relationship between maternal iron supplementation and hyperbilirubinemia in neonates: a nested case-control study. Int J Adv Bio Technol Res 2017; 8(4):1573-78.
  15. Hoseini BZ, Ziaei S. Considering the effect of iron supplementation on infant status of pregnant women with hemoglobin higher than 13.2 g/dl. Daneshvar Med 2009; 16(83):27-34. (Persian).
  16. Boskabadi H, Maamouri GH, Mafinejad S. The effect of traditional remedies (camel's thorn, flixweed and sugar water) on idiopathic neonatal Jaundice. Iran J Pediatr 2011; 21(3):325-30. (Persian).
  17. Richard B, Rabert K, Hall J. Nelson textbook of pediatric. Trans: Norani F. 1st ed. Tehran: Eshtiag; 2016. P. 85. (Persian).
  18. Boskabadi H, Zakerihamidi M, Godarzi M. Investigating the effect of maternal risk factors in incidence of neonatal jaundice. Iran J Obstet Gynecol Infertil 2013; 15(34):1-6. (Persian).
  19. Boo NY, Ishak S. Prediction of severe hyperbilirubinaemia using the Bili check transcutaneous bilirubinometer. J Paediatr Child Health 2007; 43(4):297-302.
  20. O'Brien KO, Zavaleta N, Abrams SA, Caulfield LE. Maternal iron status influences iron transfer to the fetus during the third trimester of pregnancy. Am J Clin Nutr 2003; 77(4):924-30.
  21. Rao R, Georgieff MK. Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med 2007; 12(1):54-63.
  22. Alizadeh L, Akbarzade M, Ramzi M, Mirershadi F. Birth outcome in pregnant women with normal level of hemoglobin in the first trimester. J Health 2011; 2(2):27-35. (Persian).
  23. Moghimi M, Malekzadeh J. Moghimi M. An assessment of the relationship between maternal iron supplementation and hyperbilirubinemia in neonates: a nested case-control study. Inter J Adv Biotech Res 2017; 8(4):1573-78.
  24. Rasmussen S, Bergsjo P, Jacobsen G, Haram K, Bakketeig LS. Hemoglobin and serum ferritin in pregnancy--correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol 2005; 123(1):27-34.
  25. Adebisi OY, Strayhorn G. Anemia in pregnancy and race in the United States: blacks at risk. Fam Med 2005; 37(9):655-62.
  26. Gayton A, Hall L. Textbook of physiology. Trans: Niavarani A. Tehran: Samat; 2016. P. 642. (Persian).
  27. Haram K, Nilsen ST, Ulvik RJ. Iron supplementation in pregnancy--evidence and controversies. Acta Obstet Gynecol Scand 2001; 80(8):683-91.
  28. Alizadeh L, Raoofi A, Salehi L, Ramzi M. Impact of maternal hemoglobin concentration on fetal outcomes in adolescent pregnant women. Iran Red Crescent Med J 2014; 16(8):e19670.
  29. Salimi S, Nokhostin B, Alijahan R, Hazrati S. Investigating the relationships between maternal hemoglobin concentration and maternal body mass index in pregnancy and neonatal birth weight. Iran J Obstet Gynecol Infertil 2012; 15(14):14-20.
  30. Alsafadi TR, Hashmi SM, Youssef HA, Suliman AK, Abbas HM, Albaloushi MH. Polycythemia in neonatal intensive care unit, risk factors, symptoms, pattern, and management controversy. J Clin Neonatol 2014; 3(2):93-8.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 4
June 2019
Pages 18-24

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