A Cross-sectional Study of Biochemical Analysis and Assessment of Iron Deficiency by Gestational Age(II)

임신 시기별 생화학적 철분 분석 및 철분 결핍상태에 대한 횡적 조사 연구(II)

  • 유경희 (울산과학대학 호텔조리영양과)
  • Published : 1999.12.01

Abstract

The purpose of this research is to assess hematological and biochemical status and the prevalence of iron deficiency of pregnant women by gestational age to provide the primary data about iron nutritional status of pregnant women. Pregnant women visiting public health centers in Ulsan participated in study and were divided into 3 trimester by last menstrual period(LMP). Hemoglobin (Hgb), hematocrit(Hct)and mean corpuscular volume(MCV) among iron status indices were not statistically different from normal distribution, however total iron binding capacity(TIBC) and serum ferritin were skewed to left and serum iron and transferrin saturation(TS) were skewed to right. Hgb was positively correlated with Hct(r=0.93, p<0.001) but TIBC was negatively correlated with all indices. Serum ferritin was also correlated with all indices, especially in 3rd trimester but not reached to 1st trimester level. Mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), Red cell distribution width(RDW), serum iron and TS were not significantly different by trimester, however when serum serum iron was adjusted with hematocrit to correct the hemodilution, it significantly decreased in 2nd trimester. MCV increased in 2nd trimester and was maintained until late pregnancy, TIBC continued to increase throughout the trimester. The prevalence of anemic by CDC(Centers for Disease Control) Hgb criteria(Hgb <11.0g/dl in 1st and 3nd trimester, Hgb<10.5g/dl in 2nd trimester) was 2.8% in 1st trimester, 22.5% in 2nd trimester, 27.1% in 3rd trimester and was similar with prevalence by CDC Hct criteria(Hct < 33% in 1st and 3rd, Hct < 32% in 2nd). The prevalence of anemic of total subjects was 32.7% by WHO criteria(Hgb < 11.0g/dl). Although almost iron status indices increased in 3rd trimester, the prevalence of anemia by different criteria of all indices increased throughout the trimester, so iron nutritional status was considered as serious during late pregnancy. However, since factors other than iron deficiency, such as infection, infection, inflammation, other nutrient deficiency may also play a significant role, to differentiate the anemia due to mainly iron deficiency from the anemia due to other factors, serum ferritin is among the more useful indices in distinguishing the two conditions because it is depressed only in iron deficiency. Hgb<11.0g/dl and serum ferritin<12.0ug/L as the criteria of iron deficiency was suggested by CDC. 17.8% of all subjects were classified as iron deficient anemia, 14.9% as anemic from other reasons, 21.2% as iron deficiency any only 46.2% were in normal iron status.

Keywords

References

  1. Wld Hlth Statist Quart v.38 The prevalence of anemia in the world DeMaeyer E;Adiels-Tegman M
  2. Am J Obstet Synec v.159 Association of maternal hematocrit with premature labor Lieberman E;Ryan KS;Minon RR;Schoenbaum SC
  3. Lancet v.1 Relation of hemoglobin levels in first and second trimesters to outcome of pregnancy Murphy JF;O'Riordan J;Newcombe RG;Coles EC
  4. Semin in Perinatl v.5 no.2 Maternal hematologic levels and pregnancy outcomes Garn SM;Ridella SA;Petzold AS;Falkner F
  5. Adv Pediat v.35 Behavioral alterations in iron Lozoff B
  6. J Inter Med v.226 Iron deficiency: does it matter? Dallman PR
  7. Wld Rev Nutr Diet v.52 Nutrient utilization during pregnancy King JC;Bronstein MN;Fitch WL;Weininger J
  8. Human Nutr Appl Nutr v.36A Nutrition and Blood 2. The need for hematinics in pregnancy Letsky EA
  9. In Iron metabolism in man Iron Nutrition Bothwell TH;Charlton RW;Cook JD;Finch CA
  10. Am J Clin Nutr v.39 Iron deficiency Finch CA;Cook JD
  11. Physiology of pregnancy, prenatal nutrition-general issues(5th ed) Nutrition in pregnancy and lactation Worthington-Roberts B;Williams SR;Worthington-Roberts B(ed.)
  12. Korean J Nutr v.32 no.8 A cross-sectional study of nutrient intakes by gestational age and pregnancy outcome(I) Yu KH;Yoon JS
  13. Am J Clin Nutr v.27 Serum ferritin as a measure of iron stores in normal subjects Cook JD;Lipschitz DA;Miles LEM;Finch CA
  14. Br J Obstet Gynecol v.89 Effect of iron supplementation on serum ferritin levels during and after pregnancy Taylor DJ;Mallen C;McDougall N;Lind T
  15. MMWR v.39 no.5 Progress in Chronic Disease Prevention. Anemia during pregnancy in low income women-United States, 1987
  16. Acta Obstet Gynecol Scand v.95 (suppl) Serum ferritin as a measure of iron stores during and after normal pregnancy with and without iron supplements Puolakka J;Janne O;Pakarinen A;Vihko R
  17. The Obstetrics(revised edition) The Korean association of obstetricians and gynecologists
  18. Nut Rev v.53 no.9 Methods to assess iron status in various NHANES surveys Looker AC;Gunter EW;Johnson CL
  19. Wintrobe's clinical hematology(9th ed) Lee GR;Bithell TC;Foerster J;Athens JW;Lukens JN
  20. Korean J Nutr v.26 no.1 Serum folate and iron levels of pregnant, lactating and non-pregnant, non-lactating women Chang NS;Kang MH;Paik HY;Kim IH;Cho YW;Park SC;Shin YW
  21. Am J clin Nutr v.50 Serum zinc changes due to iron supplementation in teenage pregnancy Dawson EB;Albers JMcGanith WJ
  22. Fed proc v.36 The mechanism of iron absorption and its regulation Linder MC;Munro HN
  23. Korean J Nutr v.26 no.6 Iron nutriture and related dietary factors in apparently healthy young Korean women(1): Comparison and evaluation of blood biochemical indices for assessment of iron nutritional status Kye SH;Paik HY
  24. WHO Tech Rep Ser v.405 Nutritional anemia World Health Organization
  25. Am J Clin Nutr v.47 A WHO Collaborative study on iron supplementation in Burma and in Thailand Charoenlarp P;Dhanamitta S;Kaewvichit R;Silprasert A;Suwanaradd C;Na-Nakorn S;Prawatmuang P;Vatanavicharn S;Nutcharas U;Pootrakul P;anphaichitr V;Thanangkul O;Vaniyapong T;Thane Toe;Valyasevi A;Baker S;Cook J;DeMaeyer EM;Garby L;Hallberg L
  26. J Inter Med v.226 Iron deficiency: definition and diagnosis Cook JD;Skikne BS
  27. Assessment of iron status v.p181 Principles of nutritional assessment Gibson RS
  28. Nutr Rev v.53 no.11 Results of surveys to assess iron status in Europe Hallberg L
  29. Am J Clin Nutr v.42 Summary of a report on assessment of the iron nutritional status of the United States population Expert Scientific Working Group
  30. Korean J Nutr v.24 no.5 Hemoglobin, hematocrit and serum ferritin as markers of iron status Chung HR;Moon HK;Song BH;Kim MK
  31. Korean J Nutrition v.25 no.5 A survey on iron intake and nutritional status of female college students of Chungnam National University Nam HS;Ly SY
  32. J Nutr v.124 Iron deficiency: Contemporary scientific issues and international programmatic approaches Yip R
  33. Am J Clin Nutr v.48 The roles of inflammation and iron deficiency as causes of anemia Yip R;Dallman PR
  34. Nutrition during pregnancy National Academy of Sciences, Committee on Nutritional Status During Pregnancy and Lactation
  35. Am J Clin Nutr v.59(suppl) Anemia and iron-deficiency anemia: compilation of data on pregnancy outcome Scholl TO;Hediger ML
  36. Korean J Nutr v.31 no.8 The effect of weekly iron supplementation on iron and zinc nutritional status in pregnant women Yu KH;Yoon JS
  37. Am J Clin Nutr v.55 Anemia and iron deficiency:increased risk of preterm delivery in prospective study Scholl TO;Hediger ML;Fischer RL;Shearer JW