OJOG  Vol.8 No.6 , June 2018
Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy
ABSTRACT
Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with a single pregnancy not exceeding 19 weeks without obvious pathology, regardless of age and parity, were eligible for inclusion in the study. Conclusion: This study is expected to assess consequences of oral iron supplementation during pregnancy in terms of obstetrical outcomes associated with oxidative stress linked to unabsorbed iron.
Cite this paper
Mbangama, A. , Tandu-Umba, B. and Mbungu, R. (2018) Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy. Open Journal of Obstetrics and Gynecology, 8, 598-609. doi: 10.4236/ojog.2018.86066.
References
[1]   Pang, W.W. and Schrier, S.L. (2012) Anemia in the Elderly. Current Opinion in Hematology, 19, 133-140.
https://doi.org/10.1097/MOH.0b013e3283522471

[2]   Westerlind, B., Ostgren, C.J., Molstad, S. and Midlov, P. (2016) Prevalence and Predictive Importance of Anemia in Swedish Nursing Home Residents—A Longitudinal Study. BMC Geriatrics, 16, 206.
https://doi.org/10.1186/s12877-016-0375-2

[3]   Mangla, M. and Singla, D. (2016) Prevalence of Anemia among Pregnant Women in Rural India: A Longitudinal Observational Study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5, 3500-3505.

[4]   Tandu-Umba, B. and Mbangama, M.A. (2015) Association of Maternal Anemia with Other Risk Factors in Occurrence of Great Obstetrical Syndromes at University Clinics, Kinshasa, DR Congo. BMC Pregnancy and Childbirth, 15, 183.
https://doi.org/10.1186/s12884-015-0623-z

[5]   Patel, K.V. (2008) Epidemiology of Anemia in Older Adults. Seminars in Hematology, 45, 210-217.
https://doi.org/10.1053/j.seminhematol.2008.06.006

[6]   International Anemia Consultative Group (INACG) (2002) Why Is Iron Important and What to Do about It: A New Perspective. Report of the 2001 INACG Symposium, Hanoi, Vietnam, 15-16 February 2002, 1-50.

[7]   World Health Organization (2006) Integrated Management of Pregnancy and Childbirth (IMPAC) Vol. 1.8. World Health Organization. Department of Making Pregnancy Safer (MPS); Geneva, Switzerland. Iron and Folate Supplementation. Standards for Maternal and Neonatal Care, 1-6.

[8]   EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2015) Scientific Opinion on Dietary Reference Values for iron. EFSA Journal, 13, 115.
https://doi.org/10.2903/j.efsa.2015.4254
http://www.efsa.europa.eu/en/publications

[9]   Paquet, I. (2011) Formation continue—Pour une santé de fer—La nutrition active pour prévenir et traiter l’anémie par déficience en fer. L’actualité pharmaceutique, 19, 1-4.
http://www.professionsante.ca/files/2011/03/LPharmMar2011.pdf

[10]   Schrier, S.L. and Auerbach, M. (2013) Treatment of the Adult with Iron Deficiency Anemia (à jour au 25 mars 2013).
http://www.uptodate.com

[11]   Association des pharmaciens du Canada (2013) Monographie des préparations orales de fer. Compendium des produits et spécialités pharmaceutiques. Ottawa, version en ligne e-CPS.

[12]   Pharmacist’s Letter (2008) Comparison of Oral Iron Supplements. Prescriber’s Letter, 24, 1-4.

[13]   Bjorn-Rasmussen, E. (1974) Iron Absorption from Wheat Bread: Influence of Various Amounts of Bran. Nutrition & Metabolism, 16, 101-110.
https://doi.org/10.1159/000175478

[14]   Callender, S.T., Marney Jr., S.R. and Warner, G.T. (1970) Eggs and Iron Absorption. British Journal of Haematology, 19, 657-663.
https://doi.org/10.1111/j.1365-2141.1970.tb07010.x

[15]   Disler, P.B., Lynch, S.R., Charlton, R.W., Torrance, J.D., Bothwell, T.H., Walker, R.B. and Mayet, F. (1975) The Effect of Tea on Iron Absorption. Gut, 16, 193-200.
https://doi.org/10.1136/gut.16.3.193

[16]   Inder, T.E., Clemett, R.S., Austin, N.C., Graham, P. and Darlow, B.A. (1997) High Iron Status in Very Low Birth Weight Infants Is Associated with an Increased Risk of Retinopathy of Prematurity. Journal of Pediatrics, 131, 541-544.
https://doi.org/10.1016/S0022-3476(97)70058-1

[17]   Hirano, K., Morinobu, T., Kim, H., Hiroi, M., Ban, R., Ogawa, S., Ogihara, H., Tamai, H. and Ogihara, T. (2001) Blood Transfusion Increases Radical Promoting Non-Transferrin Bound Iron in Preterm Infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 84, F188-F193.
https://doi.org/10.1136/fn.84.3.F188

[18]   Pollak, A., Hayde, M., Hayn, M., Herkner, K., Lombard, K.A., Lubec, G., Weninger, M. and Widness, J.A. (2001) Effect of Intravenous Iron Supplementation on Erythropoiesis in Erythropoietin-Treated Premature Infants. Pediatrics, 107, 78-85.
https://doi.org/10.1542/peds.107.1.78

[19]   Ohlsson, A. and Aher, S.M. (2006) Early Erythropoietin for Preventing Red Blood Cell Transfusion in Preterm and/or Low Birth Weight Infants. The Cochrane Database of Systematic Reviews, 19, CD004863.
https://doi.org/10.1002/14651858.CD004863.pub2

[20]   Favier, A. (2003) Le stress oxydant: Intérêt conceptuel et expérimental dans la compréhension des mécanismes des maladies et potentiel thérapeutique. L’actualité chimique, 108-115.

[21]   Miller, C.J., Rose, A.L. and Waite, T.D. (2016) Importance of Iron Complexation for Fenton-Mediated Hydroxyl Radical Production at Circumneutral pH. Front in Marine Science, 3,134.
https://doi.org/10.3389/fmars.2016.00134

[22]   Cadenas, E. (1989) Biochemistry of Oxygen Toxicity. Annual Review of Biochemistry, 58, 79-110.
https://doi.org/10.1146/annurev.bi.58.070189.000455

[23]   Fulbert, J.C. and Cals, M.J. (1992) Les Radicaux libres en biologie clinique. Pathologie Et Biologie, 49, 66-77.

[24]   Nadal, M., Le Guyader, N., Arlet, J.B. and Husson, M.C. (2009) Chélateurs du fer et hémosidérose post-transfusionnelle. Dossier du CNHIM, Tome XXX, 4, 11-17.

[25]   Zaretsky, M.V., Alexander, J.M., Byrd, W. and Bawdon, R.E. (2004) Transfer of Inflammatory Cytokines across the Placenta. Obstetrics & Gynecology, 103, 546-550.
https://doi.org/10.1097/01.AOG.0000114980.40445.83

[26]   Gupta, S., Agarwal, A., Banerjee, J. and Alvarez, J.G. (2007) The Role of Oxidative Stress in Spontaneous Abortion and Recurrent Pregnancy Loss: A Systematic Review. Obstetrical & Gynecological Survey, 62, 335-347.
https://doi.org/10.1097/01.ogx.0000261644.89300.df

[27]   Class, Q.A., Lichtenstein, P., Longstrom, N. and D’Onofrio, B.M. (2011) Timing of Prenatal Maternal Exposure to Severe Life Events and Adverse Pregnancy Outcomes: A Population Study of 2.6 Million Pregnancies. Psychosomatic Medicine, 73, 234-241.
https://doi.org/10.1097/PSY.0b013e31820a62ce

[28]   Dole, N., Savitz, D.A., Hertz-Picciotto, I., Siega-Riz, A.M., McMahon, M.J. and Buekens, P. (2003) Maternal Stress and Preterm Birth. American Journal of Epidemiology, 157, 14-24.
https://doi.org/10.1093/aje/kwf176

[29]   Grote, N.K., Bridge, J.A., Gavin, A.R., Melville, J.L., Iyengar, S. and Katon, W.J. (2010) A Meta-Analysis of Depression during Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Arch Gen Psychiatry, 67, 1012-1024.
https://doi.org/10.1001/archgenpsychiatry.2010.111

[30]   Khasan, A.S., McNamee, R., Abel, K.M., Pedersen, M.G., Webb, R.T., Kenny, L.C., Mortensen, P.B. and Baker, N.P. (2008) Reduced Infant Birth Weight Consequent upon Maternal Exposure to Severe Life Events. Psychosomatic Medicine, 70, 688-694.
https://doi.org/10.1097/PSY.0b013e318177940d

[31]   Tegethoff, M., Greene, N., Olsen, J., Meyer, A.H. and Meinlschmidt, G. (2010) Maternal Psychosocial Adversity during Pregnancy Is Associated with Length of Gestation and Offspring Size at Birth: Evidence from a Population-Based Cohort Study. Psychosomatic Medicine, 72, 419-426.
https://doi.org/10.1097/PSY.0b013e3181d2f0b0

[32]   Latendresse, G., Ruiz, R.J. and Wong, B. (2013) Psychological Distress and SSRI Use Predict Variation in Inflammatory Cytokines during Pregnancy. Open Journal of Obstetrics and Gynecology, 3, 184-191.
https://doi.org/10.4236/ojog.2013.31A034

[33]   Lee, S.Y., Park, K.H., Jeong, E.H., Oh, K.J., Ryu, A. and Park, K.U. (2012) Relationship between Maternal Serum C-Reactive Protein, Funisitis and Early-Onset Neonatal Sepsis. Journal of Korean Medical Sciences, 27, 674-680.
https://doi.org/10.3346/jkms.2012.27.6.674

[34]   Sorokin, Y., Romero, R., Mele, L., Wapner, R.J., Iams, J.D., et al. (2010) Maternal Serum Interleukin-6, C-Reactive Protein, and Matrix Metalloproteinase-9 Concentrations as Risk Factors for Preterm Birth < 32 Weeks and Adverse Neonatal Outcomes. American Journal of Perinatology, 27, 631-640.
https://doi.org/10.1055/s-0030-1249366

[35]   Sykes, L., MacIntyre, D.A., Yap, X.J., Teoh, T.G. and Bennett, P.R. (2012) The Th1:Th2 Dichotomy of Pregnancy and Preterm Labour. Mediators of Inflammation, 2012, Article ID: 967629.
https://doi.org/10.1155/2012/967629

[36]   Walsh, S.W. (1998) Maternal-Placental Interactions of Oxidative Stress and Antioxidants in Preeclampsia. Seminars in Reproductive Endocrinology, 16, 93-104.
https://doi.org/10.1055/s-2007-1016256

[37]   Morris, J.M., Gopaul, N.K., Enderesen, M.J., Knight, M., Linton, E.A., Dhir, S., Anggard, E.E. and Redman, C.W. (1998) Circulating Markers of Oxidative Stress Are Raised in Normal Pregnancy and Pre-Eclampsia. British Journal of Obstetrics and Gynaecology, 105, 1195-1199.
https://doi.org/10.1111/j.1471-0528.1998.tb09974.x

[38]   Mutlu-Turkoglu, U., Ademoglu, E., Ibrahimoglu, L., Aykac-Toker, G. and Uysal, M. (1998) Imbalance between Lipid Peroxidation and Antioxidant Status in Preeclampsia. Gynecologic and Obstetric Investigation, 46, 37-40.
https://doi.org/10.1159/000009994

[39]   Shaarawy, M., Aref, A., Salem, M.E. and Sheiba, M. (1998) Radical-Scavenging Antioxidants in Pre-Eclampsia and Eclampsia. International Journal of Gynecology & Obstetrics, 60, 123-128.
https://doi.org/10.1016/S0020-7292(97)00256-7

[40]   Poranen, A.K., Eklad, U., Uotila, P. and Ahotupa, M. (1996) Lipid Peroxidation and Antioxidants in Normal and Pre-Eclampsia Pregnancies. Placenta, 17, 401-405.
https://doi.org/10.1016/S0143-4004(96)90021-1

[41]   Stein, P., Scholl, T.O., Schluter, M.D., Leskiw M.J., Chen, X., Spur, B.W. and Rodriguez, A. (2008) Oxidative Stress Early in Pregnancy and Pregnancy Outcome. Free Radical Research, 42, 841-848.
https://doi.org/10.1080/10715760802510069

[42]   Zein, S., Rachidi, S. and Hininger-Favier, I. (2013) Fer, stress oxydant et diabète gestationnel. Médecine des Maladies Métaboliques, 7, 144-148.
https://doi.org/10.1016/S1957-2557(13)70511-X

[43]   Leverve, X. (2003) Hyperglycemia and Oxidative Stress: Complex Relationships with Attractive Prospects. Intensive Care Medicine, 29, 511-514.
https://doi.org/10.1007/s00134-002-1629-3

[44]   Berger, M.M. (2006) Nutritional Manipulation of Oxidative Stress: Review of the Evidence. Nutition Clinique et Métabolisme, 20, 48-53.
https://doi.org/10.1016/j.nupar.2005.12.005

[45]   Kasiulevicius, V., Sapoka, V. and Filipaviciūte, R. (2006) Sample Size Calculation in Epidemiological Studies. Gerontologija, 7, 225-231.

[46]   World Health Organization (2001) Iron Deficiency Anaemia: Assessment, Prevention, and Control. WHO/NHD, Genève.
http://www.who.int/iris/bitstream/10665/66914/1/WHO_NHD_01.3.pdf?ua=1

[47]   World Health Organization (2008) Worldwide prévalence of anaemia 1993-2005, WHO Global Database on Anaemia.
http://www.who.int/vmnis/publications/anaemia_prevalence/en/index.html

[48]   Berger, J. and Dillon, J.C. (2002) Stratégies de controle de la carence en fer dans les pays en développement. Cahiers Santé, 12, 22-30.

[49]   Joshi, S.R., Mehendale, S.S., Dangat, K.D., Kilari, A.S., Yadav, H.R. and Taralekar, V.S. (2008) High Maternal Plasma Antioxidant Concentrations Associated with Preterm Delivery. Annals of Nutrition and Metabolism, 53, 276-282.
https://doi.org/10.1159/000189789

 
 
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