Milman Nils, Taylor Christine L, Merkel Joyce, Brannon Patsy M
Departments of Clinical Biochemistry and
Obstetrics, Naestved Hospital, University College Sjaelland, Naestved, Denmark.
Am J Clin Nutr. 2017 Dec;106(Suppl 6):1655S-1662S. doi: 10.3945/ajcn.117.156000. Epub 2017 Oct 25.
Understanding the iron status in pregnant women in Europe provides a foundation for considering the role of iron screening and supplementation. However, available reports and studies have used different approaches that challenge the devising of overall summaries. Moreover, data on pregnant women are limited, and thus, data on women of reproductive age provide useful background information including baseline iron stores in pregnant women. This review considered data that are available from >15 European countries including national surveys and relevant clinical studies. In European women of reproductive age, median or geometric mean serum ferritin (SF) concentrations were estimated at 26-38 μg/L. Approximately 40-55% of this population had small or depleted iron stores (i.e., SF concentration ≤30 μg/L), and 45-60% of this population had apparently replete iron stores. The prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) was 10-32% and 2-5%, respectively, depending on the cutoffs used. Approximately 20-35% of European women of reproductive age had sufficient iron stores (SF concentration >70 μg/L) to complete a pregnancy without supplementary iron. During pregnancy, European women in controlled supplementation trials who were not receiving iron supplements displayed increasing prevalences of ID and IDA during pregnancy, which peaked in the middle to late third trimester. Available evidence has suggested that, in gestational weeks 32-39, the median or geometric mean SF concentrations were 6-21 μg/L, and prevalences of ID and IDA were 28-85% and 21-35%, respectively. Women who were taking iron supplements had higher iron status and lower prevalences of ID and IDA, which were dependent on the dose of iron and compliance. The data suggest that, in Europe, the iron status of reproductive-aged women varies by region and worsens in pregnancy without iron supplementation.
了解欧洲孕妇的铁状况为考虑铁筛查和补充的作用奠定了基础。然而,现有报告和研究采用了不同的方法,这对进行总体总结提出了挑战。此外,关于孕妇的数据有限,因此,育龄妇女的数据提供了有用的背景信息,包括孕妇的基线铁储备。本综述考虑了来自15个以上欧洲国家的现有数据,包括全国性调查和相关临床研究。在欧洲育龄妇女中,血清铁蛋白(SF)浓度的中位数或几何平均数估计为26 - 38μg/L。该人群中约40 - 55%的人铁储备少或耗竭(即SF浓度≤30μg/L),45 - 60%的人铁储备明显充足。缺铁(ID)和缺铁性贫血(IDA)的患病率分别为10 - 32%和2 - 5%,具体取决于所采用的临界值。约20 - 35%的欧洲育龄妇女有足够的铁储备(SF浓度>70μg/L),无需补充铁即可完成妊娠。在孕期,未接受铁补充剂的欧洲妇女在对照补充试验中,孕期ID和IDA的患病率不断上升,在妊娠晚期达到峰值。现有证据表明,在妊娠32 - 39周时,SF浓度的中位数或几何平均数为6 - 21μg/L,ID和IDA的患病率分别为28 - 85%和21 - 35%。服用铁补充剂的妇女铁状况较好,ID和IDA的患病率较低,这取决于铁的剂量和依从性。数据表明,在欧洲,育龄妇女的铁状况因地区而异,且在孕期不补充铁的情况下会恶化。