Iron Deficiency during Pregnancy: Blessing or Curse?

Iron deficiency is the most common micronutrient deficiency and the most common cause of anemia among pregnant women worldwide [1]. Pregnancy may require as much as 1000 mg of elemental iron to meet the demands for maternal red blood cell expansion and fetal erythropoiesis and to account for blood lost at delivery [2]. As part of its standards for maternal and neonatal care, the World Health Organization recommends routine iron supplementation of 60 mg daily for pregnant women living in areas where malnutrition is prevalent [3]. The rationale underlying this policy is the observed association of anemia with adverse pregnancy outcomes. Specifically, anemia has been linked with low birth weight, preterm birth, decreased infant iron stores, and consequent impaired cognition and growth of the child [4-7] . For the mother, severe anemia may increase the risks of cardiac failure or death from peripartum hemorrhage [7, 8]. In a recent review of 40 trials involving > 12,000 women, routine daily iron supplementation increased hemoglobin levels by -7.5 g/dL and was associated with a decreased risk for anemia at term (relative risk, 0.56; 95% con-