임신시 선택적 철분 투여의 유용성
Is Selective Iron Supplementation Needed During Gestation?
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목적 : 임신 기간 동안 전반적 혹은 선택적 철분 투여에 대하여 논란의 여지가 있다. 이 연구의 목적은 임신 첫 삼분기의 ferritin치 측정이 예방적 철분 투여가 필요한 산모의 선별검사에 이용될 수 있는 지 알아보기 위한 것이다. 연구 방법 : 임신 첫 삼분기의 ferritin치 30 ug/L와 또한 철분 투여 여부를 기준으로 연구 대상을 4군으로 나누었다. Ferritin치 30 ug/L 이하인 군을 철분 투여한 22명과 투여하지 않은 13명으로 나누었고, ferritin치 30 ug/L를 초과한 군에서 철분 투여한 40명과 투여하지 않은 15명으로 나누었다. 임신 14주 전과 임신 34 이후에 빈혈 검사와 관련된 혈액학적 지표들을 측정하였다. 결과 : 모든 혈액학적 지표들은 임신 전반기에 비해서 임신 후반기에 유의한 빈혈 상태를 나타내고 있었다. 임신 첫 삼분기의 ferritin치가 30 ug/L 미만인 경우에 철분 투여의 효과가 있었다. 철분투여와 관계없이 임신 첫 삼분기의 ferritin치가 30 ug/L 이상인 경우 임신 후반기에 ferritin측정치가 비교적 높았다. 결론 : 임신 첫 삼분기의 ferritin 30 ug/L을 기준치가 예방적 철분 투여가 필요한 산모의 선별에 도움을 줄 수 있음을 암시한다.
Abstract
Objective : It is controversial whether routine or selective iron supplementation during gestation is needed. The aim of this study is to evaluate whether screening with serum ferritin during the first trimester of pregnancy could be identify women who need prophylactic iron supplementation. Methods : According to the serum ferritin level of cut-off point of 30 µg/L during the first trimester of pregnancy and the presence of iron supplementation during gestation, the subject was divided into 4 group that were as follows: serum ferritin level of ≤30 µg/L and iron-supplemented group (n=22), serum ferritin level of ≤30 µg/L and non iron-supplemented group (n=13), serum ferritin level of >30 µg/L and iron- supplemented group (n=40), serum ferritin level of >30 µg/L and non iron-supplemented group (n=15). Maternal serum ferritin, TIBC, iron, hemoglobin, hematocrit, red cell indices (MCV, MCH, MCHC, RDW) were measured before 14 weeks of gestation and after 34 weeks of gestation. Results : All hematologic and biochemical markers indicated more severe anemic status in the late pregnancy than during the first trimester of pregnancy. The effect of iron supplementation was profounder on the pregnant woman whose ferritin levels were below 30 µg/L during the first trimester of pregnancy. Regardless of iron supplementation, the group (ferritin >30 µg/L during the first trimester of pregnancy) showed relatively higher ferritin level in late pregnancy. Conclusion : The screening with serum ferritin level of cut-off point of 30 µg/L during the first trimester of pregnancy may be useful to identify women who need prophylactic iron supplementation.
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