Iron deficiency in women with early pregnancy loss and its correction
Objective: To determine the frequency of iron deficiency in the pre-pregnancy period in Moscow residents with the previous history of early pregnancy losses.Solovyеva A.V., Aleynikova E.Yu., Chegus L.A., Ermolenko K.S., Kuznetsova O.A.
Materials and methods: The study included 98 women of reproductive age (18-39 years old) who presented to the clinic with the history of early pregnancy loss. A retrospective study was performed during six months in 2019-2020 at a multidisciplinary clinic in Moscow, Russia. The patients were evaluated for hemoglobin, serum iron and ferritin.
Results: The histories of 42 (42.85%) women with early pregnancy losses showed iron deficiency (according to the criteria of the WHO – ferritin 15 mcg/ml or less) and 32 (32.7%) patients had iron deficiency anemia (IDA), i.e. 2/3 of women, namely 75 (75.5%), planned their pregnancy without any iron stores in the body. The medication Ferretab comp. was chosen as an iron supplement. This medication contains 50 mg of elemental iron (152 mg of ferrous fumarate) and 500 mcg of folic acid. During three months, all women who had preconception care took one capsule a day with increased dose of ferritin to 30 mcg/ml or more; no side effects were reported. Two capsules of Ferretab comp. were taken in the morning by 41 women; 2/3 of them demonstrated the restored level of hemoglobin within 4–5 weeks, all the rest women had it within 8–9 weeks. One woman did not have any effect from taking the medication Ferretab comp.; a thorough examination revealed gastritis and colitis, and appropriate therapy was prescribed. All patients became pregnant, four of them (4.08%) had pregnancy following assisted reproductive technologies. The level of ferritin during pregnancy was not assessed, IDA was detected in four cases (4.1%). These pregnant women had bloody vaginal discharge (threatened miscarriage, placenta previa).
Conclusion: Iron deficiency and IDA are common in patients with a history of early pregnancy loss. In order to restore the level of the microelement in the organism of a woman before the onset of pregnancy, it is necessary to determine the level of ferritin and hemoglobin. Ferretab comp. is a medication containing 50 mg of iron (iron fumarate) and 500 mcg of folic acid; it is released during the passage of the gastrointestinal tract, it has a minimal number of side effects, and effectively replenishes iron stores.
Keywords
women with the history of pregnancy loss
iron deficiency
iron deficiency anemia
ferrous fumarate
folic acid
Ferretab comp
References
- Sun Y., Shen Z.Z., Huang F.L., Jiang Y., Wang Y.W., Zhang S.H., Ma S., Liu J.T., Zhan Y.L., Lin H., Chen Y.L., Shi Y.J., Ma L.K. Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study. World J Clin Cases. 2021; 9(27): 8008-19. https://dx.doi.org/10.12998/wjcc.v9.i27.8008.
- Young M.F., Oaks B.M., Tandon S., Martorell R., Dewey K.G., Wendt A.S. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci. 2019; 1450(1): 47-68. https://dx.doi.org/10.1111/nyas.14093.
- WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations, 2020; https://creativecommons.org/licenses/by-nc-sa/3.0/igo
- Радзинский В.Е., Князев С.А., Костин И.Н., ред. Предиктивное акушерство. М.: Status Praesens; 2021. 520 c. [Radzinsky V.E., Knyazev S.A., Kostin I.N., ed. Predictive obstetrics. M.: Status Praesens; 2021. 520 p. (in Russian)].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации «Нормальная беременность». 2019. [Ministry of Health of the Russian Federation. Clinical guidelines "Normal pregnancy". 2019. (in Russian)].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации «Аномальные маточные кровотечения». 2021. [Ministry of Health of the Russian Federation. Clinical guidelines "Abnormal uterine bleeding". 2021. (in Russian)].
- Министерство здравоохранения Российской Федерации. Клинические рекомендации «Гиперплазия эндометрия». 2021. [Ministry of Health of the Russian Federation. Clinical guidelines "Endometrial hyperplasia". 2021. (in Russian)].
- ESHRE. Guideline on the management of recurrent pregnancy loss. November 2017. Available at: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Recurrent-pregnancy-loss.aspx
- Solovyeva A.V., Gace V., Gerasimova O.P. Therapy in women with recerrent miscarriage depending on morphological characteristics of the endometrium. J Gynec Women’s Health. 2017; 7(5): JGWH.MS.ID.555724(2017). https://dx.doi.org/10.19080/ JGWH.2017.07.555724.
- Соловьева А., Ермоленко К., Герасимова О. Оценка состояния эндометрия у женщин с привычным невынашиванием. Врач. 2018; 1: 48-51. [Solovyeva A., Ermolenko K., Gerasimova O. Evaluation of the endometrium in women with recurrent miscarriage. Vrach/ Doctor Journal. 2018; 1: 48-51. (in Russian)]. https://dx.doi.org/10.29296/25877305-2018-01-14.
- Клинические рекомендации. Железодефицитная анемия. Утверждены Минздравом РФ. 2020. [Clinical guidelines. Iron deficiency anemia. Approved by the Ministry of Health of the Russian Federation. 2020. (in Russian)].
- Регистр лекарственных средств, код EAN: 9088881253150, № П N013723/01, 2015-11-22, http://www.rlsnet.ru/tn_index_id_609.htm [Register of medicines, EAN code: 9088881253150, No. P N013723/01, 2015-11-22, http://www.rlsnet.ru/tn_index_id_609.htm (in Russian)].
- FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Micronutrients in the periconceptional period and pregnancy. Int J Gynecol Obstet. 2019; 144(3): 317-21. https://dx.doi.org/10.1002/ijgo.12739.
- Соловьева А.В., Стуров В.Г. Анемии и репродуктивное здоровье. Под ред. В.Е. Радзинского. М: Status Praesens. 2019. 200 с. [Solovyeva A.V., Sturov V.G. Anemia and reproductive health. Ed. V.E. Radzinsky. М: Status Praesens. 2019. 200 p. (in Russian)].
- Munro M.G., Critchley H.O.D., Fraser I.S. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018; 143(3): 393-408. https://dx.doi.org/10.1002/ijgo.12666.
- Дубровина С.О., Киревнина Л.В., Лесной М.Н. Аномальное маточное кровотечение: Причины, диагностика и лечение. Акушерство и гинекология. 2021; 1: 170-7. [Dubrovina S.O., Kirevnina L.V., Lesnoy M.N. Abnormal uterine bleeding: causes, diagnosis, and treatment. Obstetrics and Gynecology. 2021; 1: 170-7. (in Russian)]. https://doi.org/10.18565/aig.2021.l.170-177.
- Резолюция совета экспертов по профилактике и лечению железодефицитной анемии. Акушерство и гинекология. 2020; 4: 230-2. [Expert Council Resolution on Prevention and Treatment of Iron Deficiency Anemia in Pregnant Women. Obstetrics and Gynecology. 2020; 4: 230-2. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.4.230-232.
- Malinowski A.K., Murji A. Iron deficiency and iron deficiency anemia in pregnancy. CMAJ. 2021; 193: E1137-8. https://dx.doi.org/10.1503/cmaj.210007.
- Soares M.J., Iqbal K., Kozai K. Hypoxia and Placental Development. Birth Defects Res. 2017; 109(17): 1309-29. https://dx.doi.org/10.1002/bdr2.1135.
- Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008; 87(12): 949-59. https://dx.doi.org/10.1007/s00277-008-0518-4.
- Low M.S.Y., Speedy J., Styles C.E., De-Regil L.M., Pasricha S.-R. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev. 2016; 4: CD009747. https://dx.doi.org/10.1002/14651858.CD009747.pub2.
- Morreti D., Goede J.S., Zeder C., Jiskra M., Chatzinakou V., Tjalsma H. et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. 2015; 126(17): 1981-9. https://dx.doi.org/10.1182/blood-2015-05-642223.
- Jalambo M., Karim N., Naser I., Sharif R. Effects of iron supplementation and nutrition education on haemoglobin, ferritin and oxidative stress on iron-deficient female adolescents in Palestine: randomized control trial. East Mediterr Health J. 2018; 24(6): 560-8. https://dx.doi.org/10.26719/2018.24.6.560.
- Viteri F.E., Ali F., Tujague J. Long-term weekly iron supplementation improves and sustains nonpregnant women’s iron status as well or better than currently recommended short-term daily supplementation. J Nutr. 1999; 129(11):2013-20. https://dx.doi.org/10.1093/jn/129.11.2013.
- Fernández‐Gaxiola A.C., De-Regi L.M. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019; 1(1): CD009218. https://dx.doi.org/10.1002/14651858.CD009218.pub3.
- Торшин И.Ю., Громова О.А., Лиманова О.А., Гришина Т.Р., Башмакова Н.В., Керимкулова Н.В., Серова О.Ф., Крапошина Т.П., Косенко И.М. Метаанализ клинических исследований по применению фумарата железа с целью профилактики и терапии железодефицитной анемии у беременных. Гинекология. 2015; 17(5): 24-31. [Torshin I.Yu., Gromova O.A., Limanova O.A., Grishina T.R., Bashmakova N.V., Kerimkulova N.V., Serova O.F., Kraposhina T.P., Kosenko I.M. A meta-analysis of clinical studies on the use of iron fumarate for the prevention and treatment of iron deficiency anemia in pregnant women. Gynecology. 2015; 17(5): 24-31. (in Russian)].
Received 12.04.2022
Accepted 20.04.2022
About the Authors
Alina V. Solovyeva, Dr. Med. Sci., Associate Professor at the Department of Obstetrics and Gynecology with the course of perinatology, RUDN University, Medical Institute, +7(985)447-79-28, av_soloveva@mail.ru, https://orcid.org/0000-0001-6711-1563, 117198, Russia, Moscow, Miklukho-Maklaya str., 8.Ekaterina Yu. Aleynikova, Resident of the Department of Obstetrics and Gynecology with the course of perinatology, RUDN University, Medical Institute, ketall@mail.ru, https://orcid.org/0000-0002-1434-0386, 117198, Russia, Moscow, Miklukho-Maklaya str., 8.
Larisa A. Chegus, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Khanty-Mansiysk State Medical Academy, lchegus@mail.ru,
https://orcid.org/0000-0002-9698-8038, 628011, Russia, Khanty-Mansiysk, Yamskaya str., 12/91.
Kristina S. Ermolenko, PhD, Assistant at the Department of Obstetrics and Gynecology with the course of perinatology, RUDN University, Medical Institute,
+7(919)766-49-84, z.kristinast@yandex.ru, 117198, Russia, Moscow, Miklukho-Maklaya str., 8.
Olga A. Kuznetsova, PhD, Associate Professor at Department of Obstetrics and Gynecology with the course of perinatology, RUDN University, Medical Institute,
koa.15@mail.ru, https://orcid.org/0000-0002-7093-877X, 117198, Russia, Moscow, Miklukho-Maklaya str., 8.
Authors’ contributions: Solovyova A.V. – development of the study design, search for publications on the subject, writing the manuscript; Aleynikova E.Yu. – collection of material on the subject of the study, data processing, writing the manuscript; Chegus L.A., Ermolenko K.S., Kuznetsova O.A. – collection of material on the subject of the study, search for publications on the subject of the article, writing the manuscript.
Conflicts of interest: The authors declare that they have no competing interests.
Funding: The study was performed without external funding.
Ethical Approval: The study was approved by the Ethical Review Board of Peoples’ Friendship University of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Solovyeva A.V., Aleynikova E.Yu., Chegus L.A., Ermolenko K.S., Kuznetsova O.A. Iron deficiency in women with early pregnancy loss and its correction.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 4: 155-162 (in Russian)
https://dx.doi.org/10.18565/aig.2022.4.155-162
Similar Articles
