Pharmacists Can Counsel Pregnant Individuals Seeking Iron Supplementation

New study findings from Oregon Health & Science University (OHSU) found that during the average pregnancy, additional iron supplementation that often leads to nausea and constipation may not be necessary. The findings displayed that there is no significant impact on maternal or infant health outcomes, despite previous knowledge of prenatal irons supplementation reducing the incidence of iron deficiency and related anemia during pregnancy, according to study authors.¹

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“There’s a lot of marketing out there targeting various vitamins and supplements for pregnant people, and it can be overwhelming,” Amy G Cantor, MD, MPH, professor of medical informatics and clinical epidemiology, family medicine, and obstetrics and gynecology in the OHSU School of Medicine, said in a news release. “It’s best to keep it simple: If you don’t have any risk factors outlined by your clinician, then a standard prenatal vitamin should be sufficient to ensure a healthy pregnancy.”¹

Iron deficiency is reported to be a leading cause of anemia during pregnancy because of higher iron needs and physiologic changes. Anemia is a condition in which there are lower levels of healthy red blood cells accessible to carry oxygen throughout the body. The ailment has a higher prevalence among those at lower income levels due to lack of access to iron rich foods, as well as non-Hispanic Black and Mexican American individuals. According to the release, nearly 18% of pregnant individuals experience iron deficiency with a 5% prevalence of iron deficiency anemia.^1,2

The study authors noted that in 2015 The US Preventive Services Task Force (USPSTF) found insufficient evidence to evaluate the benefits and harms of routine screening and supplementation among iron deficiency during pregnancy. The current study aimed to update the 2015 USPSTF review, analyzing 17 trials on maternal iron supplementation.^1,2

“Clinically, the question we wanted to address was if iron supplementation improves maternal and infant health outcomes, and there was actually very limited evidence in both of these areas,” Cantor said in the news release. “We hope clinicians can use this information to improve discussions with patients around symptoms and health history, so treatment can be optimized and tailored to the individual.”¹

The results found that when iron supplementation was compared with a placebo or no supplementation there was a lack of significant health outcomes pre- or post-birth for the baby and the parents. The study authors noted that the outcomes included maternal quality of life, rates of gestational diabetes, maternal hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, preterm birth and infant low birth weight. However, maternal iron supplementation was also connected with a decreased risk of iron deficiency anemia at term^.1,2

The study authors noted that the results apply to asymptomatic, average-risk pregnant individuals and do not address individuals with severe symptoms of iron deficiency.¹

The findings suggest that due to the drastic impact of maternal iron supplementation, pharmacists and health care providers can counsel patients that are interested in taking iron supplements in addition to prenatal vitamins, based on their risks and symptoms. Additionally, the study authors noted iron is included in most prenatal vitamins and rather than taking an iron supplement, they can consume iron rich foods. This includes lean meat and seafood, spinach, as well as white beans and kidney beans.¹

“What this reinforces is that prenatal care should be individualized because each patient is unique and how they experience pregnancy will also be unique,” Cantor said in a news release. “Prenatal care shouldn’t be one-size-fits-all, and we hope this review sparks more individualized discussions between patients and providers about health during pregnancy.”¹

REFERENCES

1. Extra iron supplements have no effect on maternal, infant health, OHSU study reveals. EurekAlert!. News release. August 20, 2024. Accessed September 5, 2024. https://www.eurekalert.org/news-releases/1055327.

2. Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy. JAMA Network. News release. August 20, 2024. Accessed September 5, 2024. https://jamanetwork.com/journals/jama/fullarticle/2822560?guestAccessKey=4b76493f-b8de-491d-bdfc-0171f5d363b0&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=082024.