Effect of postpartum iron supplementation on red cell and iron parameters in non-anaemic iron-deficient women: a randomised placebo-controlled study

BJOG. 2005 Apr;112(4):445-50. doi: 10.1111/j.1471-0528.2005.00301.x.

Abstract

Objective: To investigate the effect of oral iron on postpartum red cell and iron parameters in non-anaemic women with iron deficiency.

Design: Randomised study of supplementation with oral iron sulphate 80 mg daily or placebo for 12 weeks starting 24-48 hours after delivery, with visits antepartum and 1, 4, 6 and 12 weeks postpartum.

Setting: Swiss university hospital obstetric unit.

Participants: Fifty-two women with antenatal iron deficiency (serum ferritin <15 microg/L) and no antenatal or postnatal anaemia (haemoglobin >11 g/dL up to 48 hours before delivery, and >10 g/dL postpartum), divided into two groups comparable in antenatal iron status.

Methods: Supplementation was started 24-48 hours after delivery (visit 1:V1). Additional tablets were issued one week after V1 (V2), four weeks after V1 (V3) and six weeks after V1 (V4). The last visit took place 12 weeks after visit 1 and 6 weeks after visit 4 (V5). Patients were required to return blisters and boxes whether they were used and unused at each visit and compliance was assessed by counting the tablets. Blood samples for haematology and iron status testing were taken before delivery and at each visit.

Main outcome measures: Iron status (serum ferritin, hypochromic red cells, iron, transferrin saturation, soluble transferrin receptor concentration); erythropoiesis (standard parameters, including reticulocyte indices); and inflammatory response (serum neopterin, C-reactive protein, white cell count) in five-datapoint profiles.

Results: Increased ferritin (P= 0.0004) and transferrin saturation (P= 0.03), decreased soluble transferrin receptors (P= 0.02); increased haemoglobin (P= 0.02) and decreased hypochromic red cells (P= 0.04) compared with placebo at 12 weeks, with no differences in other red cell or reticulocyte parameters. There was a positive correlation between C-reactive protein and postpartum ferritin. No correlation was observed in the puerperium between C-reactive protein and hypochromic red cells or soluble transferrin receptors.

Conclusions: Haemoglobin levels and iron stores in women with term gestational iron deficiency benefit significantly from iron supplementation compared with placebo, even in an industrialised population.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • C-Reactive Protein / metabolism
  • Erythrocytes / chemistry
  • Erythrocytes / cytology*
  • Erythropoiesis / drug effects*
  • Female
  • Ferritins / metabolism
  • Hemoglobins / metabolism
  • Humans
  • Iron / administration & dosage*
  • Iron Deficiencies*
  • Leukocyte Count
  • Neopterin / blood
  • Puerperal Disorders / blood
  • Puerperal Disorders / drug therapy*
  • Tablets
  • Transferrin / metabolism

Substances

  • Hemoglobins
  • Tablets
  • Transferrin
  • Neopterin
  • C-Reactive Protein
  • Ferritins
  • Iron