临床专科知识讲解习题考试题uirementsinregnancyandstrategiestomeetthem
5页1、 Iron requirements in pregnancy and strategies to meet them13Thomas H BothwellABSTRACTIron requirements are greater in pregnancyincreased requirements. As a result, iron supplementation duringthan in the nonpregnant state. Although iron requirements arereduced in the first trimester because of the absence of menstru-ation, they rise steadily thereafter; the total requirement of a55-kg woman is 1000 mg. Translated into daily needs, therequirement is0.8 mg Fe in the first trimester, between 4 and5
2、 mg in the second trimester, and 6 mg in the third trimester.Absorptive behavior changes accordingly: a reduction in ironabsorption in the first trimester is followed by a progressive risein absorption throughout the remainder of pregnancy. Theamounts that can be absorbed from even an optimal diet, how-ever, are less than the iron requirements in later pregnancy and awoman must enter pregnancy with iron stores of 300 mg if sheis to meet her requirements fully. This is more than most womenpossess
3、, especially in developing countries. Results of controlledstudies indicate that the deficit can be met by supplementation,but inadequacies in health care delivery systems have limited theeffectiveness of larger-scale interventions. Attempts to improvecompliance include the use of a supplement of ferrous sulfate ina hydrocolloid matrix (gastric delivery system, or GDS) and theuse of intermittent supplementation. Another approach is inter-mittent, preventive supplementation aimed at improving the
4、 ironstatus of all women of childbearing age. Like all supplementa-tion strategies, however, this approach has the drawback ofdepending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective optionpregnancy is a common practice throughout the world.In the discussion that follows, 4 topics are addressed. The firstcovers the nature and extent of iron requirements during the3 trimesters of pregnancy. The second describes iron balance inpregn
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