Background: The need for prophylactic iron during pregnancy is uncertain. Objective: We tested the hypothesis that administration of a daily iron supplement from enrollment to 28 wk of gestation to initially iron-replete, nonanemic pregnant women would reduce the prevalence of anemia at 28 wk and increase birth weight. Design: Between June 1995 and September 1998, 513 low-income pregnant women in Cleveland were enrolled in the study before 20 wk of gestation. Of these, 275 had a hemoglobin concentration ≥ 110 g/L and a ferritin concentration ≥ 20 μg/L and were randomly assigned to receive a monthly supply of capsules containing either 30 mg Fe as ferrous sulfate or placebo until 28 wk of gestation. At 28 and 38 wk of gestation, women with a ferritin concentration of 12 to < 20 μg/L or < 12 μg/L received 30 and 60 mg Fe/d, respectively, regardless of initial assignment. Almost all the women received some supplemental iron during pregnancy. We obtained infant birth weight and gestational age at delivery for 117 and 96 of the 146 and 129 women randomly assigned to receive iron and placebo, respectively. Results: Compared with placebo, iron supplementation from enrollment to 28 wk of gestation did not significantly affect the overall prevalence of anemia or the incidence of preterm births but led to a significantly higher mean (± SD) birth weight (206 ± 565 g; P = 0.010), a significantly lower incidence of low-birth-weight infants (4% compared with 17%; P = 0.003), and a significantly lower incidence of preterm low-birth-weight infants (3% compared with 10%; P = 0.017). Conclusion: Prenatal prophylactic iron supplementation deserves further examination as a measure to improve birth weight and potentially reduce health care costs.

Population screening for hemochromatosis done by using the transferrin saturation test has been advocated by experts to permit the initiation of therapeutic phlebotomy before the onset of clinical disease.The discovery of a gene associated with hemochromatosis has made DNA testing another option for screening and diagnosis. In this paper, U.S. Preventive Services Task Force criteria are used to evaluate the evidence for the usefulness of population screening done by using iron measures or genetic testing. Published clinical research offers little evidence to suggest that population screening for hemochromatosis done by using genetic testing improves clinical outcomes.Although one recently discovered mutation, C282Y, accounts for 60% to 92% of cases of the disease in series of patients with hemochromatosis, uncertainties remain about the clinical penetrance of various genotypes; the accuracy of genetic testing; and the ethical, legal, and social effects of genetic testing. Before population screening for hemochromatosis done by using transferrin saturation testing can be recommended, laboratory standardization needs to be addressed and questions about risk for clinical disease in asymptomatic persons with mutations or early biochemical expression of disease require resolution. Evidence from case series suggests that hemochromatosis may be associated with liver cancer, other liver disease, diabetes, bradyarrhythmias, and arthritis. In all studies but one, however, estimation of the magnitude and significance of this risk is limited by lack of adequate comparison groups. The need for population data to answer questions about penetrance among asymptomatic persons should not impede efforts to increase the detection and treatment of hemochromatosis in persons found to have elevated iron measures, a family history of hemochromatosis, or consistent early signs and symptoms of the disease.

We estimated the prevalence of postpartum iron deficiency, anemia and iron deficiency anemia in the United States and compared risk of iron deficiency between women 0–24 mo postpartum (n = 680) and never-pregnant women, 20–40 y old (n = 587). We used data from National Health and Nutrition Examination Survey, 1988–1994. Iron deficiency was defined as abnormal values for ≥ 2 of 3 iron status measures (serum ferritin, free erythrocyte protoporphyrin, transferrin saturation). Iron deficiency prevalences for women 0–6, 7–12 and 13–24 mo postpartum were 12.7, 12.4 and 7.8%, respectively, and 6.5% among never-pregnant women. After adjustment for confounding, the risk of iron deficiency among women with a poverty index ratio ≤ 130% who were 0–6, 7–12 and 13–24 mo postpartum was 4.1 (95% confidence interval 2.0, 7.2), 3.1 (1.3, 6.5) and 2.0 (0.8, 4.1) times as great, respectively, as never-pregnant women with a poverty index ratio > 130%, but risk was not elevated for never-pregnant women with a poverty index ratio ≤ 130%. Compared with the same referent, the risk of iron deficiency was not meaningfully different for women with a poverty index ratio > 130% who were 0–6, 7–12 or 13–24 mo postpartum. Given that low income postpartum women bear a substantially greater iron deficiency risk than never-pregnant women, more attention should be given to preventing iron deficiency among low income women during and after pregnancy.

This literature review examines whether smoking or alcohol use during pregnancy increases maternal micronutrient requirements and whether smoking or alcohol use interacts with micronutrient deficiencies to affect pregnancy outcomes. Studies suggest that vitamin C requirements increase for pregnant smokers. Studies also indicate that β-carotene, vitamin B-12, vitamin B-6 and folate concentrations appear lower in pregnant smokers than in pregnant nonsmokers, although it is unclear whether lower serum concentrations are due to increased requirements, lower dietary or supplement intakes or other factors. Experimental animal studies suggest that iron supplementation partially ameliorates impaired fetal growth caused by cadmium, a heavy metal inhaled from cigarette smoke, but studies in humans have not substantiated cadmium's effect on fetal growth. Animal studies also suggest chronic alcohol consumption at levels of 20–50% of energy intake during pregnancy may mobilize fetal vitamin A concentration from the liver and result in increases in vitamin A in fetal organs and subsequent defects. Evidence is lacking, however, on whether zinc metabolism is altered by alcohol intake during pregnancy. Health care practitioners should consider increasing nutrient levels in pregnant women who do not meet the Recommended Dietary Allowances through their diet. Future studies that examine the nutrient levels of women exposed to cigarette smoke and alcohol should control for dietary intake. In addition, randomized controlled studies of the health impact of micronutrient supplementation in pregnant women should consider stratification by exposure to cigarette smoke and alcohol use.

Background: As part of a healthy diet, limiting intakes of excess sodium, added sugars, saturated fat, and trans fat has been recommended. The American Heart Association recommends that children aged <2 y should avoid added sugars.

The use of iron supplements is an accepted treatment for nonhereditary anemia. The use of iron supplements as prophylaxis is more controversial. We estimated the proportion of persons who consumed supplements that contain iron among the following groups: nonpregnant, nonlactating adolescents, aged 14–18 y (n = 992); women aged 19–50 y (n = 5,062); women aged 51 y and older (n = 3,593); pregnant women (n = 295); and lactating women (n = 97) using data from the National Health and Nutrition Examination Survey, 1988–1994. We found that the proportion (% ± SE) of U.S. women consuming supplements containing iron in the previous month was 9 ± 2% among nonpregnant, nonlactating adolescents; 23 ± 1% among women aged 19 y and older; 72 ± 4% among pregnant women; and 60 ± 8% among lactating women. Low income women were less likely to consume supplements containing iron. Minority women were less likely to consume supplements containing iron in all groups except adolescents. Among consumers of supplements that contain iron, the median intake of iron was 11 mg/d among nonpregnant adolescents, ∼17 mg/d among nonpregnant women, 58 mg/d among pregnant women and 57 mg/d among lactating women. Use of supplements that contain iron was associated with a significantly reduced prevalence of iron deficiency among women 19–50 y but not among other groups. Groups at highest risk of iron deficiency (e.g., low income and minority women) are often least likely to consume supplements containing iron, suggesting that supplement use is unrelated to actual need.