Iron Overdose in Non-Anaemic Women Can Affect Pregnancy
She may be anaemic or not, but the good news about pregnancy anyway comes with large doses of iron supplement pills being prescribed - often as much as 100 mg per day. Although well-meaning, considering the huge national burden of anaemia among women - especially in rural areas - this practice may not actually be a good idea for healthy pregnant women after all!
A recent study by a group of doctors and students at St John's Medical College in Bengaluru revealed that excessive iron dosage among healthy, non-anaemic women could have an adverse effect not just on the pregnancy but also on the baby, born or unborn.
They say problems like low birth weight, premature birth and poor growth of the baby while in the womb (also called intrauterine growth restriction) may occur due to excess intake of iron. Dosage of iron, regardless of the haemoglobin level, was increased since 2013 by the Ministry of Health and Family Welfare as part of the National Plus initiative because large number of women were diagnosed with anaemia especially in rural areas, leading to several maternal and child deaths.
The study was conducted on a sample size of 1,196 non-anaemic, healthy women. It was a part of the Obama-Singh Fellowship programme at St John's Hospital and has been published in the European Journal of Clinical Nutrition which is part of the Nature Group.
A cohort of non-anaemic pregnant women, who came to St John's Hospital, was studied. The women were aged between 17 and 40 and were free from any chronic illnesses like diabetes, hypertension, heart and thyroid diseases.
The principal investigators for the study were two final-year MBBS students, Pooja Mishra and Lisha Shastri from St John's Medical College who were among the first batch of students who were part of the research programme. They were guided by Dr Pratibha Dwarkanath, lecturer, division of nutrition, Dr A V Kurpad, professor and head, department of nutrition, St John's Research Institute.
The students were also invited to Harvard's School of Public Health as part of the exchange programme where they further analysed the study for three months.
The other investigators for the study included T Thomas, C Duggan, C M McDonald and A V Thomas.
Explaining the motive behind the study, Mishra said, "In India, there's a large burden of anaemia, which is why as per the national guidelines it was decided on a high dosage and all the doctors have to go by that rule. But the WHO (World Health Organisation) recommends a dosage of 60 mg and the same is followed in European countries and the level of iron is very good for women in these countries. The supplements are usually started in the second trimester (between third and sixth month) of pregnancy." The dosage was measured by interviewing the women on the amount they consumed and the study had some interesting revelations.
Based on the outcome it was seen that women who took their iron tablets dedicatedly without missing them were twice at risk of having babies with low birth weight as compared to people who took a lower dosage.
Shastri said, "There have been studies done across the world and in All India Institute of Medical Sciences (AIIMS), Delhi, where the results are similar. That suggests that there is a need to decrease the dosage of iron among non-anaemic women. Iron in high daily doses could be responsible for cellular damage through oxidative stress. This needs to be balanced with sufficient anti-oxidants which can be obtained from fruits rich in Vitamin C. The dosage of iron varies from one individual to another which is why there cannot be a standardised dosage that can be fixed for everyone."