Iron is an element necessary for several cellular processes, either for the pregnant woman and the fetus. Firstly, being part of the hemoglobin structure in the red blood cells, it serves for the proper oxygen transfer across the living tissues. It is represented also in the structure of myoglobin, a muscle cell protein carrying oxygen as well; this is why pregnant women which lack iron could fell more easily tired than normal. More generally, iron is the cofactor of an enzyme, ribonucleotide diphosphate reductase (RDPR), needed to build up purines and pyrimidines, also known as DNA bases. This makes it essential for all tissues in fast growth and with high cell replication rates, in this case foetal tissue but skin, epithelia and bone marrow as well. Recommendations for folic acid and vitamin B12 supplements intake during pregnancy is current and for some reasons: gynecologists aid mothers to prevent possible brain defects or nervous system malformations in the foetus, if mothers has low levels of these vitamins. Nonethless, there are little efforts to prescribe iron as a pregnancy supplement, perhaps for the low awareness of clinical practicers and the fear for a possible toxicity of this element. Ferritin is a blood cell protein that contains iron and serves as carrier for this metal. Ferritin tests can help obstetricians understand how much iron is being stored in the body. If not treated, iron deficiency can cause serious health consequences, including anemia, early labour and low birth weight
These may derive from the low oxygen deliver in the growing foutus and placenta and may imply long-term developmental issues in the child as well. Screening for iron deficiency in pregnancy is recommended by health agencies but with low awareness of its implications and competing priorities in busy obstetric clinics, it doesn’t happen as often as it should. Iron status in the body is usually investigated by dosing three parameters in the regular bloodwork: sideremia (that is the real iron concentration), ferritin (the blood protein carrying iron across bodily tissues) and transferrin, another protein that serve as index for the bodily iron storage. Though their measurement through bloodwork is relatively accurate, this may suffer for bias and it is not very practical for repeated assays as well. The implementation of a novel quality improvement toolkit has shown to enhance early detection and treatment of iron deficiency in pregnancy, according to a study led by St. Michael’s Hospital. IRON Deficiency in Pregnancy with Maternal IrOn OptiMization (IRON MOM) is a paper-based toolkit that includes clinical pathways and educational resources to guide clinicians and expectant mothers through diagnosis and management of iron deficiency. The research, published today in PLOS Medicine, compares rates of ferritin testing in the obstetric clinics at Toronto’s St. Michael’s Hospital before and after the implementation of the IRON MOM toolkit.
Research was led by Dr. Michelle Sholzberg, Hematologist at St. Michael’s and also a scientist at the hospital’s Li Ka Shing Knowledge Institute. One year after implementation of the IRON MOM toolkit, the team found an almost 10 times increase in the average monthly rate of ferritin testing in the obstetric clinics at St. Michael’s. They also found a significant decrease in the risk of anemia and those who required blood transfusions before and after pregnancy to improve their red blood cell count. IRON MOM demonstrated that priority setting and simple process changes in patient management can have a large impact on key clinical outcomes. The researchers said these results provide support for expanding IRON MOM into other clinics and institutions. Currently, the team is working on an IRON MOM smartphone application that would make the toolkit available to women and clinicians across the country. Dr. Sholzberg commented: “That was the impetus for the development of IRON MOM, which provides guidance and supports for women to feel empowered to speak to their care providers to ensure they’re receiving enough iron. It’s widely accepted that many women will develop anemia in pregnancy as the result of iron deficiency. But this doesn’t have to be the case. Treating iron deficiency requires a culture change and IRON MOM addresses that need”.
- Edited by Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
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