Prophylactic Iron Supplementation in Pregnancy
and its Implications in Development of
Pre-eclampsia: A Case-control Study
Published: October 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/50696.15530
Lakbir Singh, Ajit Thakur, Fayyaz Mukarab Khan, Minakshi Misra, Saurabh Singh
1. PhD Student, Department of Biochemistry, School of Life and Basic Sciences, Jaipur National University, Jaipur, Rajasthan, India.
2. Assistant Professor, Department of Biochemistry, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, Rajasthan, India.
3. Associate Professor, Department of Pathology, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, Rajasthan, India.
4. Associate Professor, Department of Obstetrics and Gynaecology, Esic Medical College and Hospital, Alwar, Rajasthan, India.
5. Assistant Professor, Department of Biochemistry, School of Life and Basic Sciences, Jaipur National University, Jaipur, Rajasthan, India.
Correspondence
Dr. Saurabh Singh,
Department of Biochemistry, School of Life and Basic Sciences, Seedling Institute
of Integrated Learning of Advanced Sciences (SIILAS), Jaipur National University,
Jagatpura, Jaipur, Rajasthan, India.
E-mail: saurabhsingh@jnujaipur.ac.in
Introduction: Pre-eclampsia is a serious complication of pregnancy and is associated with increased maternal and perinatal morbidity and mortality. Increased iron and ferritin concentration is associated to a higher risk of pre-eclampsia and prophylactic iron supplementation can sometimes be harmful to pregnant women who are otherwise not iron deficient.
Aim: To analyse serum iron, serum ferritin, serum Transferrin Receptor (sTFR) levels, Total Iron Binding Capacity (TIBC) among iron supplemented pre-eclamptic cases and normotensive pregnant controls.
Materials and Methods: This prospective, observational, case-control study was conducted in Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India for a period of one year from (February 2019-January 2020). A total of 200 pregnant females, all on iron supplementation during the course of their pregnancy, 100 in pre-eclampsia group (case group); 100 in normotensive group (control group), in third trimester and between 18-45 years of age were enrolled in the study. Serum iron, serum ferritin, sTFR and TIBC were estimated using fully automated analysers.
Results: Median Interquartile Range (IQR) of serum ferritin levels in cases were higher than the controls [41 (30-70) vs 24 (17-44); p<0.001]. Serum ferritin in cases were also found to correlate positively with systolic (r=0.37, p=0.001) Blood Pressure (BP) whereas TIBC correlated negatively with diastolic BP (r=-0.238, p-value=0.017). The median IQR differences of TIBC values among cases and controls were insignificant {485 (404-523) vs 493 (448-544)} and differences of median IQR of sTFR values among cases and controls were significant {8.5 (7-9) vs 8.9 (8-10)}. Subjects with serum feritin levels >40 ng/mL had three times increased risk of PE (Odds ratio=3, 95% Cl=1.571-5.157).
Conclusion: Elevated serum ferritin, decreased sTFR levels and correlation of Ferritin and TIBC to BP in pre-eclampsia compels us to put cautionary remarks over testing these parameters before continuing with iron supplements. This may prevent a possible iron related added complications in pre-eclampsia and help clinicians decide about restricting/lowering iron supplement doses in case a situation of iron overload arise.
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