Are Pregnant Women Who Are Living with Overweight or Obesity at Greater Risk of Developing Iron Deficiency/Anaemia?

Abstract

Low-grade inflammation is often present in people living with obesity. Inflammation can impact iron uptake and metabolism through elevation of hepcidin levels. Obesity is a major public health issue globally, with pregnant women often affected by the condition. Maternal obesity is associated with increased pregnancy risks including iron deficiency (ID) and iron-deficiency anaemia (IDA)-conditions already highly prevalent in pregnant women and their newborns. This comprehensive review assesses whether the inflammatory state induced by obesity could contribute to an increased incidence of ID/IDA in pregnant women and their children. We discuss the challenges in accurate measurement of iron status in the presence of inflammation, and available iron repletion strategies and their effectiveness in pregnant women living with obesity. We suggest that pre-pregnancy obesity and overweight/obese pregnancies carry a greater risk of ID/IDA for the mother during pregnancy and postpartum period, as well as for the baby. We propose iron status and weight gain during pregnancy should be monitored more closely in women who are living with overweight or obesity.

Keywords: anaemia; inflammation; iron deficiency; obesity; overweight; pregnancy.

Figure 1

Percent plasma volume expansion across gestation compared to non-pregnant state, reported in a systematic review by Aguree and Gernard [8], used with permission of the original publisher, Springer Nature Group, “Dots represent data from individual studies; solid line represents prediction based on all data; short dashed line represents the 95% CI around the prediction”.

Figure 2

Interplay between obesity and iron metabolism. Figure adapted from Aigner et al. [82].