The association between iron deficiency and RPL is uncertain.

Introduction

Iron deficiency is considered the most common nutrient deficiency in pregnant women. Supplementation with iron reduces the risk of maternal anaemia and iron deficiency in pregnancy, although any positive effect on other maternal and infant outcomes (including birth weight and prematurity) is less clear.1

Significant blood loss can accompany miscarriage so women with RPL are susceptible to anaemia. Anaemia is associated with obstetric complications including preterm delivery, sepsis and prolonged recovery from complex delivery. Anaemia should be corrected prior to subsequent pregnancy.

The association between iron deficiency and RPL is uncertain. Observational data have found that women with RPL exhibit lower serum ferritin levels compared to women of reproductive age with no history of RPL. However, a low serum ferritin did not appear to affect the ability to conceive or the risk of pregnancy loss.2

Further studies are required to investigate the clinical significance of low ferritin in RPL and whether preconception prophylactic iron supplementation would improve live birth rates. However, anaemia due to iron, folate or vitamin B12 deficiency should be corrected in the pre-conception period.

Bullet point guidance

  • There is a lack of studies determining the potential contribution of iron deficiency to miscarriage. Currently there is no known association between iron deficiency and RPL.
  • Anaemia due to iron, folate or vitamin B12 deficiency should be corrected in the pre-conception period, as this reduces the nefarious impact of anaemia in pregnancy.

References

  1. Peña‐Rosas JP, et al. Daily oral iron supplementation during pregnancy. The Cochrane Database of Systematic Reviews 2015: CD004736.
  2. Georgsen M, et al. Serum ferritin level is inversely related to number of previous pregnancy losses in women with recurrent pregnancy loss. Fertility and Sterility 2020:S0015-0282(20)32168-3.