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      Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

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          SUMMARY

          The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL −1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.

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          Most cited references37

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          The Measurement of Observer Agreement for Categorical Data

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            The Global Burden of Anemia.

            Anemia is an important cause of health loss. We estimated levels and trends of nonfatal anemia burden for 23 distinct etiologies in 188 countries, 20 age groups, and both sexes from 1990 to 2013. All available population-level anemia data were collected and standardized. We estimated mean hemoglobin, prevalence of anemia by severity, quantitative disability owing to anemia, and underlying etiology for each population using the approach of the Global Burden of Disease, Injuries and Risk Factors 2013 Study. Anemia burden is high. Developing countries account for 89% of all anemia-related disability. Iron-deficiency anemia remains the dominant cause of anemia.
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              Iron status during pregnancy: setting the stage for mother and infant.

              Supplementation with iron is generally recommended during pregnancy to meet the iron needs of both mother and fetus. When detected early in pregnancy, iron deficiency anemia (IDA) is associated with a > 2-fold increase in the risk of preterm delivery. Maternal anemia when diagnosed before midpregnancy is also associated with an increased risk of preterm birth. Results of recent randomized clinical trials in the United States and in Nepal that involved early supplementation with iron showed some reduction in risk of low birth weight or preterm low birth weight, but not preterm delivery. During the 3rd trimester, maternal anemia usually is not associated with increased risk of adverse pregnancy outcomes and may be an indicator of an expanded maternal plasma volume. High levels of hemoglobin, hematocrit, and ferritin are associated with an increased risk of fetal growth restriction, preterm delivery, and preeclampsia. While iron supplementation increases maternal iron status and stores, factors that underlie adverse pregnancy outcome are considered to result in this association, not iron supplements. On the other hand, iron supplements and increased iron stores have recently been linked to maternal complications (eg, gestational diabetes) and increased oxidative stress during pregnancy. Consequently, while iron supplementation may improve pregnancy outcome when the mother is iron deficient it is also possible that prophylactic supplementation may increase risk when the mother does not have iron deficiency or IDA. Anemia and IDA are not synonymous, even among low-income minority women in their reproductive years.
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                Author and article information

                Contributors
                j.daru@qmul.ac.uk
                Journal
                Transfus Med
                Transfus Med
                10.1111/(ISSN)1365-3148
                TME
                Transfusion Medicine (Oxford, England)
                Blackwell Publishing Ltd (Oxford, UK )
                0958-7578
                1365-3148
                20 April 2017
                June 2017
                : 27
                : 3 ( doiID: 10.1111/tme.2017.27.issue-3 )
                : 167-174
                Affiliations
                [ 1 ] Women's Health Research Unit Centre for Primary Care and Public Health, Queen Mary University of London London UK
                [ 2 ] Evidence and Programme Guidance, Department of Nutrition for Health and Development World Health Organization Geneva Switzerland
                Author notes
                [*] [* ] Correspondence: Jahnavi Daru, Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, UK.

                Tel.: +44 20 7882 2525; fax: +44 20 7882 6047; e‐mail: j.daru@ 123456qmul.ac.uk

                Author information
                http://orcid.org/0000-0001-5816-2609
                Article
                TME12408
                10.1111/tme.12408
                5763396
                28425182
                6e47a1f1-19da-41b0-a695-80071c3a1000
                © 2017 World Health Organization licensed by Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 December 2016
                : 02 March 2017
                : 03 March 2017
                Page count
                Figures: 4, Tables: 0, Pages: 8, Words: 9654
                Funding
                Funded by: Royal Society of Medicine
                Funded by: International Micronutrient Malnutrition Prevention and Control Program
                Funded by: Centers for Disease Control and Prevention (CDC)
                Funded by: World Health Organization
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                tme12408
                June 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:11.01.2018

                Hematology
                iron deficiency,pregnancy,serum ferritin
                Hematology
                iron deficiency, pregnancy, serum ferritin

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