Date Published: 
Friday, 24 May, 2013

How does iron deficiency affect clinical outcome in obstetric and gynaecological patients?

Iron deficiency is associated with a range of symptoms that are not only detrimental to women’s quality of life, but may also have a negative impact on clinical outcomes, including the health and wellbeing of offspring in the case of pregnant women1. When severe, iron deficiency can result in iron deficiency anaemia, which has a negative effect on patient vitality that is comparable with chronic diseases including clinical depression and chronic kidney disease (see figure below).

Iron deficiency can lead to symptoms of fatigue, reduced physical performance and impaired capacity for work2. Other symptoms include restless leg syndrome, pica and cold intolerance2. Iron supplementation has been shown to provide significant improvement in the symptoms of iron deficiency including fatigue and physical performance1,3.

Figure 3. Comparison of patient vitality in iron deficiency anaemia with other health states2

Iron deficiency in pregnancy is associated with maternal and infant complications, including premature birth, reduced birth weight, perinatal mortality, increased risk of maternal infections and decreased tolerance of infections or bleeding4. Women with iron deficiency anaemia at the time of delivery may require special precautions, including delivery in a hospital setting, available intravenous access, active management of the third stage of labour and plans to deal with potential excessive bleeding5.

Iron deficiency may contribute to disturbances of postpartum cognition and emotions that impair mother–child interactions (see figure below)6. Postpartum iron treatment provides significant protection against these negative effects (figure below). Low maternal iron status at delivery is also associated with negative effects on children’s cognitive function, concentration and memory1,7. Evidence suggests that delayed versus early cord clamping reduces the risk of iron deficiency in neonates8.

Figure 4. Emotional Availability Scale scores (mean) at 9 months postpartum6