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Iron deficiency in pregnancy

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Georgieff, Michael K.·2020·American Journal of Obstetrics and Gynecology

DOI 10.1016/j.ajog.2020.03.006PMC PMC7492370

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Abstract

Iron is essential for the function of all cells through its roles in oxygen delivery, electron transport, and enzymatic activity. Cells with high metabolic rates require more iron and are at greater risk for dysfunction during iron deficiency. Iron requirements during pregnancy increase dramatically, as the mother's blood volume expands and the fetus grows and develops. Thus, pregnancy is a condition of impending or existing iron deficiency, which may be difficult to diagnose because of limitations to commonly used biomarkers such as hemoglobin and ferritin concentrations. Iron deficiency is associated with adverse pregnancy outcomes, including increased maternal illness, low birthweight, prematurity, and intrauterine growth restriction. The rapidly developing fetal brain is at particular risk of iron deficiency, which can occur because of maternal iron deficiency, hypertension, smoking, or glucose intolerance. Low maternal gestational iron intake is associated with autism, schizophrenia, and abnormal brain structure in the offspring. Newborns with iron deficiency have compromised recognition memory, slower speed of processing, and poorer bonding that persist despite postnatal iron repletion. Preclinical models of fetal iron deficiency confirm that expected iron-dependent processes such as monoamine neurotransmission, neuronal growth and differentiation, myelination, and gene expression are all compromised acutely and long term into adulthood. This review outlines strategies to diagnose and prevent iron deficiency in pregnancy. It describes the neurocognitive and mental health consequences of fetal iron deficiency. It emphasizes that fetal iron is a key nutrient that influences brain development and function across the lifespan.

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Authors: Georgieff, M. K.
Affiliations: University of Minnesota (US)
Corresponding author: Georgieff, Michael K.
ORCID: Georgieff, Michael K.
Venue: American Journal of Obstetrics and Gynecology
Publisher: Elsevier BV
Published: 2020-10
Volume: 223
Issue: 4
Pages: 516-524
ISSN: 0002-9378 (ISSN-L)
DOI: 10.1016/j.ajog.2020.03.006
PMC: PMC7492370
OpenAlex: W3010653102
Cited by: 580
References: 85
Citations by year: 2026: 83 · 2025: 120 · 2024: 110 · 2023: 118 · 2022: 69 · 2021: 66 · 2020: 10
FWCI: 10.32
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Journal of Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
Topics: Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
Life Sciences › Neuroscience › Neurology › Neurological diseases and metabolism
Keywords: iron deficiency, pregnancy, maternal iron intake, fetal brain development, neuropsychological outcomes, autism spectrum disorder, schizophrenia, low birth weight, preterm birth, fetal growth restriction, iron status biomarkers, iron supplementation, offspring mental health
MeSH terms: Iron Deficiencies, Mental Disorders, Brain, Female, Humans, Iron, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Trace Elements, Iron Metabolism Disorders, Fetal Development, Neurodevelopmental Disorders

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