Wonder Iron?

Iron-deficiency anemia is the number one complication after all forms of weight loss surgery, but more so with RNY gastric bypass – the most popular form of WLS to date.  With more and more women turning to WLS to conceive, it can be a scary statistic, given that women are prone to anemia to begin with.

JAMA recently published a study regarding prenatal micronutrient supplementation in Nepal, a country rife with iron-deficient anemia.  This study looked at the impact of various supplements and their affects on motor and intellectual affects a few years after birth.  It reveals that prenatal iron and folate are absolutely critical.

A few key points from the full study, abstract to follow:

  • early iron deficiency can alter neuroanatomy, biochemistry, and metabolism leading to changes in neurophysiologic processes that support cognitive and sensorimotor development
  • early iron deficiency also has an adverse effect on neurogenesis, altering brain morphology in specific regions such as the hippocampus (long-term memory and navigation part of brain) and striatum (movement)
  • iron is important for energy metabolism in the brain
  • in rhesus monkeys, infants prenatally deprived of iron exhibited 20% reduced activity level, lower inhibitory response to new environments and frequent behavioral changes
  • human infants with cord serum ferritin 35 mcg/L had lower auditory recognition memory

How the study was done:

  • 177 in control group (biannual vitamin A doses of 200,000 IU only), 103 in iron / folic acid group, 178 in iron / folic acid / zinc group, 218 in multiple micronutrient group
  • 88% supplement adherence
  • micronutrients used in study
    • control: 1000 mcg vitamin A (200,000 IU) biannually
    • folic acid / iron: above plus 400mcg folic acid, 60mg iron
    • folic acid / iron / zinc: above plus 30mg zinc
    • multiple: above plus vitamins D (10 mcg), E (10mg), B1 (1.6mg), B2 (1.8mg), B6 (2.2mg), B12 (2.6mcg), C (100mg), K (65 mcg), niacin (20mg), copper (2.0mg)


  • In a rural South Asian population, overall outcomes of general intellectual test performance and aspects of executive motor function in 7-9 year old children were better among those whose mothers received prenatal iron and folic acid compared with controls
  • Evidence linking prenatal iron/folic acid supplementation w/working memory and inhibitory control test results
  • general intellectual functioning was higher with prenatal iron/folic acid supplementation

The amount of change with the additional zinc and the multiple supplements was negligible.  The major change was with the iron and folic acid.

While I’ve put this out here for us to learn from, this does not mean that multivites are negligible.  We must still take them while pregnant.  It simply meant that the iron and folate were most important in THIS study.  Remember, there are no studies on US.

Get your blood draws regularly (8 weeks while pregnant) to verify that you and baby are doing well.

The abstract:

Context Iron and zinc are important for the development of both intellectual and motor skills. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children’s later functioning.

Objective To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy.

Design, Setting, and Participants Cohort follow-up of 676 children aged 7 to 9 years in June 2007–April 2009 who had been born to women in 4 of 5 groups of a community-based, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial.

Interventions Women whose children were followed up had been randomly assigned to receive daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A, vs a control group of vitamin A alone from early pregnancy through 3 months postpartum. These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation.

Main Outcome Measures Children’s intellectual functioning, assessed using the Universal Nonverbal Intelligence Test (UNIT); tests of executive function, including go/no-go, the Stroop test, and backward digit span; and motor function, assessed using the Movement Assessment Battery for Children (MABC) and finger-tapping test.

Results The difference across outcomes was significant (Bonferroni-adjusted P < .001) for iron/folic acid vs control but not for other supplement groups. The mean UNIT T score in the iron/folic acid group was 51.7 (SD, 8.5) and in the control group was 48.2 (SD, 10.2), with an adjusted mean difference of 2.38 (95% confidence interval [CI], 0.06-4.70; P = .04). Differences were not significant between the control group and either the iron/folic acid/zinc (0.73; 95% CI, −0.95 to 2.42) or multiple micronutrient (1.00; 95% CI, −0.55 to 2.56) groups. In tests of executive function, scores were better in the iron/folic acid group relative to the control group for the Stroop test (adjusted mean difference in proportion who failed, −0.14; 95% CI, −0.23 to −0.04) and backward digit span (adjusted mean difference, 0.36; 95% CI, 0.01-0.71) but not for the go/no-go test. The MABC score was lower (better) in the iron/folic acid group compared with the control group but not after adjustment for confounders (mean difference, −1.47; 95% CI, −3.06 to 0.12; P = .07). Finger-tapping test scores were higher (mean difference, 2.05; 95% CI, 0.87-3.24; P = .001) in the iron/folic acid group.

Conclusion Aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent.

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3 Responses to “Prenatal Iron and Folate Vital”

  1. Amanda says:

    I’m prone to low iron levels and am planning on ttc later this year. I take celebrate iron but was told that I’m slightly anemic. What are your thoughts on Integra F? I took it last year when I was having PCOS related bleeding issues. Is this something we can absorb?

  2. Andrea says:

    Not really. We don’t absorb ferrous fumarate very well.

  3. Amanda says:

    Thanks! I went and picked up some feosol(carbonyl) after reading another post of yours about carbonyl and heme being absorbed better. Thanks!

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