Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 131

In a typical singleton gestation, maternal iron requirements (including blood volume expansion as well as fetal and placental requirements) average 1 g for the entire pregnancy, with this requirement further increased in the setting of multiple gestations. In a landmark study of healthy, nonanemic, menstruating young women who agreed to bone marrow biopsy, 66% had inadequate iron stores. For the above reasons, and because gastrointestinal side effects of oral iron supplementation (constipation, nausea, and diarrhea) are negligible with doses less than 45–60 mg, supplementation with elemental iron (30 mg/day) is recommended for all pregnant women in the United States, regardless of indices.

Supplementation should be continued until three months postpartum in areas with high prevalence of anemia. A review of randomized clinical trials (most performed in Western countries) showed that routine supplementation in nonanemic women results in higher maternal Hb levels at term and one month postpartum, higher serum ferritin levels, lower rates of anemia at term (RR = 0.26) and of iron deficiency anemia in particular (RR = 0.33), and higher serum ferritin levels in the infants (Peña‐Rosas and Viteri 2009). However, no differences are noted in most clinical outcomes, such as preterm birth, preeclampsia, or need for transfusion, birthweight, small for gestational age, perinatal mortality or need for NICU admissions.