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ORIGINAL RESEARCH |
From the Institute of Environmental Medicine, Division of Metals and Health, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Chemistry, and Department of Women and Child Health, Division of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden.
Address reprint requests to: Agneta Åkesson, PhD, MPH, Karolinska Institutet, Division of Metals and Health, Institute of Environmental Medicine, Box 210, Stockholm 171 77, Sweden; E-mail: Agneta.Akesson{at}imm.ki.se.
OBJECTIVE: To assess the impact of pregnancy and lactation on iron status and erythropoiesis as measured by the soluble transferrin receptor (sTfR).
METHODS: We recruited women in early pregnancy to be followed for 2 years. We determined sTfR and sTfR/serum ferritin (sTfR/Fer) during puerperium (n = 77), lactation (n = 111), and postlactation (n = 57), with comparison to data obtained during pregnancy (n = 224). Data were evaluated using analysis of variance for repeated measures as the women continuing the study were found to be representative of those entering the study.
RESULTS: We found that sTfR and sTfR/Fer were significantly higher at all sampling occasions compared with early pregnancy (P < .001). Iron status markers did not regain first-trimester levels postpartum. Postlactation, 20% of the women had depleted iron stores (sTfR/Fer greater than 500), and 10% had tissue iron deficiency (sTfR greater than 8.3 mg/L). Iron status worsened with increasing parity and was significantly correlated to blood loss at delivery. In a subgroup of women with persistent adequate iron stores, first-trimester sTfR was similar to that in the puerperium but significantly lower than that postlactation. Cord sTfR (n = 32) was twice maternal sTfR and not correlated to maternal serum ferritin, gestational age, or other birth variables.
CONCLUSION: Our data show decreased erythropoiesis in early gestation and during the first week of the puerperium. To prevent a negative effect of childbearing on iron status, postpartum iron supplementation should be considered in women who bleed excessively at parturition and in those who choose to take a low dose of iron or none at all during pregnancy.
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