Prophylactic Iron Supplementation in Pregnancy and its Implications in Development of Pre-eclampsia: A Case-control Study

Abstract

Introduction: Pre-eclampsia is a serious complication of pregnancy and is associated with increased maternal and perinatal morbidity and mortality. Increased iron and ferritin concentration is associated to a higher risk of pre-eclampsia and prophylactic iron supplementation can sometimes be harmful to pregnant women who are otherwise not iron deficient. Aim: To analyse serum iron, serum ferritin, serum Transferrin Receptor (sTFR) levels, Total Iron Binding Capacity (TIBC) among iron supplemented pre-eclamptic cases and normotensive pregnant controls. Materials and Methods: This prospective, observational, case-control study was conducted in Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India for a period of one year from (February 2019- January 2020). A total of 200 pregnant females, all on iron supplementation during the course of their pregnancy, 100 in pre-eclampsia group (case group); 100 in normotensive group (control group), in third trimester and between 18-45 years of age were enrolled in the study. Serum iron, serum ferritin, sTFR and TIBC were estimated using fully automated analysers. Results: Median Interquartile Range (IQR) of serum ferritin levels in cases were higher than the controls [41 (30-70) vs 24 (17-44); p40 ng/mL had three times increased risk of PE (Odds ratio =3, 95% Cl=1.571- 5.157). Conclusion: Elevated serum ferritin, decreased sTFR levels and correlation of Ferritin and TIBC to BP in pre-eclampsia compels us to put cautionary remarks over testing these parameters before continuing with iron supplements. This may prevent a possible iron related added complications in pre-eclampsia and help clinicians decide about restricting/lowering iron supplement doses in case a situation of iron overload arise.

Keywords

• hypertension
• serum ferritin
• serum transferrin receptor