Milman Nils, Byg Keld-Erik, Bergholt Thomas, Eriksen Lisbeth, Hvas Anne-Mette
Department of Obstetrics, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Ann Hematol. 2006 Sep;85(9):567-73. doi: 10.1007/s00277-006-0141-1. Epub 2006 May 30.
This study aims to evaluate iron prophylaxis in pregnant women from the individual aspect, i.e. according to serum ferritin levels at the beginning of pregnancy, and to assess which dose of iron would be adequate to prevent iron deficiency (ID) and iron deficiency anaemia (IDA) during pregnancy and postpartum. A randomised, double-blind study comprising 301 healthy Danish pregnant women allocated into four groups taking ferrous iron (as fumarate) in doses of 20 mg (n=74), 40 mg (n=76), 60 mg (n=77) and 80 mg (n=75) from 18 weeks gestation (inclusion) to 8 weeks postpartum. Iron status markers [serum ferritin, serum soluble transferrin receptor (sTfR), haemoglobin] were recorded at 18, 32 and 39 weeks gestation and 8 weeks postpartum. Body iron was calculated using the serum sTfR/serum ferritin ratio. ID was defined by serum ferritin <12 microg/l in pregnancy and <15 microg/l postpartum; IDA as serum ferritin <12 microg/l and haemoglobin <5th percentile in iron-replete pregnant women. Women in the iron supplement groups were stratified according to serum ferritin levels at inclusion; 50.7% had ferritin <or=30 microg/l, 37.7% ferritin 30-70 microg/l and 11.6% ferritin >70 microg/l. At 32 weeks, women with ferritin <or=30 microg/l had an ID frequency of: 20-mg group 54.1%, 40 mg 29.7%, 60 mg 24.4%, 80 mg 20.6% (p<0.001); women with ferritin >30 microg/l had an ID frequency of: 20-mg group 20.0%, 40 mg 13.9%, 60 mg 5.7%, 80 mg 5.1% (p<0.001). Women with ferritin >70 microg/l had no ID. Postpartum, ID was found in 4.7% in 20-mg group, 2.9% in group 40 mg and 0% in group 60 and 80 mg. IDA: At 32 weeks, women with ferritin <or=30 microg/l had an IDA frequency of: 20-mg group 2.7%, 40 mg 2.7%, 60 and 80 mg 0%; none of the women with ferritin >30 microg/l displayed IDA. Body iron at 18 weeks was 10.4 mg/kg, similar in the four iron groups. Later in pregnancy body iron declined significantly, being lower the 20 mg group, and similar in the 40, 60 and 80-mg groups. Postpartum body iron rose to inclusion levels being 9.3 mg/kg in the 20-mg group and 10.5 mg/kg in the 40-, 60- and 80-mg groups. This study gives an estimate of iron dosage in individual iron prophylaxis adjusted to serum ferritin levels in early pregnancy. In the prevention of ID, we suggest 80-100 mg ferrous iron/day to women having ferritin <or=30 microg/l and 40 mg ferrous iron/day to women having ferritin 31-70 mug/l. In the prevention of IDA, we suggest 40 mg ferrous iron/day to women having ferritin <or=70 microg/l. Women with ferritin >70 microg/l have no need for iron supplement.
本研究旨在从个体角度评估孕妇的铁预防措施，即根据妊娠初期的血清铁蛋白水平进行评估，并确定哪种铁剂量足以预防孕期和产后的缺铁（ID）及缺铁性贫血（IDA）。一项随机、双盲研究纳入了301名健康丹麦孕妇，她们被分为四组，从妊娠18周（纳入时间）至产后8周服用不同剂量的富马酸亚铁，剂量分别为20毫克（n = 74）、40毫克（n = 76）、60毫克（n = 77）和80毫克（n = 75）。在妊娠18、32和39周以及产后8周记录铁状态标志物[血清铁蛋白、血清可溶性转铁蛋白受体（sTfR）、血红蛋白]。使用血清sTfR/血清铁蛋白比值计算机体铁含量。ID的定义为孕期血清铁蛋白<12微克/升，产后<15微克/升；IDA为血清铁蛋白<12微克/升且血红蛋白低于铁储备充足孕妇的第5百分位数。铁补充剂组的女性根据纳入时的血清铁蛋白水平进行分层；50.7%的女性铁蛋白≤30微克/升，37.7%的女性铁蛋白为30 - 70微克/升，11.6%的女性铁蛋白>70微克/升。在32周时，铁蛋白≤30微克/升的女性中，ID发生率为：20毫克组54.1%，40毫克组29.7%，60毫克组24.4%，80毫克组20.6%（p<0.001）；铁蛋白>30微克/升的女性中，ID发生率为：20毫克组20.0%，40毫克组13.9%，60毫克组5.7%，80毫克组5.1%（p<0.001）。铁蛋白>70微克/升的女性无ID。产后，20毫克组ID发生率为4.7%，40毫克组为2.9%，60毫克组和80毫克组为0%。IDA：在32周时，铁蛋白≤30微克/升的女性中，IDA发生率为：20毫克组2.7%，40毫克组2.7%，60毫克组和80毫克组为0%；铁蛋白>30微克/升的女性均未出现IDA。18周时机体铁含量为10.4毫克/千克，四个铁剂组相似。孕期后期机体铁含量显著下降，20毫克组更低，40、60和80毫克组相似。产后机体铁含量升至纳入时水平，20毫克组为9.3毫克/千克，40、60和80毫克组为10.5毫克/千克。本研究给出了根据妊娠早期血清铁蛋白水平调整的个体铁预防中铁剂量的估计值。在预防ID方面，我们建议铁蛋白≤30微克/升的女性每日补充80 - 100毫克亚铁，铁蛋白为31 - 70微克/升的女性每日补充40毫克亚铁。在预防IDA方面，我们建议铁蛋白≤70微克/升的女性每日补充40毫克亚铁。铁蛋白>70微克/升的女性无需补充铁剂。
