IRON SUPPLEMENTATION IN PREGNANCY
[Refs 25,26]
Haemoglobin value is a measure of the haemodilution and should be followed independently of the question of iron supplement.
Serum ferritin must be measured early in pregnancy (before 15 weeks gestation).
First antenatal visit:
- S-ferritin < 20 µg/L: iron supplement from start or from week 12 -14
- S-ferritin 20-60 µg/L: iron supplement from week 20
- S-ferritin > 60 µg/L: no extra iron
The iron supplement should be as small as possible, in the order of 30-50 mg Fe++ per day as sulfate or fumarate.
In cases of iron deficiency anaemia (Hb < 110 g/L + serum ferritin < 20 µg/L) therapeutic iron doses are needed (up to 100 mg per day).
The guidelines have been evaluated: Sandstad B, Borch-Iohnsen B et al. Selective iron supplementation based on serum ferritin values early in pregnancy: are the Norwegian recommendations satisfactory? Acta Obstet Gynecol Scand 2003;82: 537-42. [Ref 27]