Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media24804610.18565/aig.2017.12.31-37ArticlesСтатьиReview ArticlePrevention of iron-deficiency states in reproductive-aged womenПрофилактика железодефицитных состояний у женщин репродуктивного возрастаKuznetsovaIrina VsevolodovnaКузнецоваИрина Всеволодовна

MD, professor of the Department of Obstetrics and Gynecology No. 1, Therapeutic Faculty

д.м.н., профессор кафедры акушерства и гинекологии № 1 лечебного факультета

I.M. Sechenov First Moscow State Medical UniversityФГАОУ ВО 1-й МГМУ им. И.М. Сеченова1512201712NO12 (2017)№12 (2017)313718022023Copyright ©; 2017, Bionika MediaCopyright ©; 2017, ООО «Бионика Медиа»2017Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/248046

Objective. To carry out a systematic analysis of the data available in the literature on the prevention of iron-deficiency states in reproductive-aged women. Material and methods. Foreign and Russian articles published in the past 15 years were sought in the international database Pubmed for their analysis. Results. The paper gives the classification of iron-deficiency states, their basic mechanisms and clinical symptoms and highlights the factors influencing the development of iron deficiency in women of reproductive age. It presents the current principles of the diagnosis and treatment of various forms of iron deficiency and ways of its prevention. Particular emphasis is placed on clinical diagnostic methods for iron deficiency and on the possibilities of preventing iron-deficiency anemia with oral iron preparations. Conclusion. Timely recognition of iron-deficiency states and their correction with oral iron preparations are one of the most important components of health preservation in reproductiveaged women.

Цель исследования. Провести систематический анализ литературных данных по проблеме профилактики железодефицитных состояний у женщин репродуктивного возраста. Материал и методы. С целью проведения анализа был осуществлен поиск зарубежных и отечественных публикаций в международной системе цитирования Pubmed, опубликованных за последние 15 лет. Результаты. Приведены классификация, основные механизмы развития и клинические симптомы железодефицитных состояний, освещены факторы, влияющие на формирование дефицита железа у женщин репродуктивного возраста. Представлены современные принципы диагностики и терапии различных форм дефицита железа и способы его профилактики. Особое внимание уделено методам клинической диагностики железодефицита и возможностям предотвращения железодефицитной анемии с помощью оральных препаратов железа. Заключение. Своевременное распознавание железодефицитных состояний и их коррекция с помощью оральных препаратов железа являются одним из важнейших компонентов сохранения здоровья женщин репродуктивного возраста.

anemiaironsideropeniaheavy menstrual bleedingoral iron preparationsvitaminsанемияжелезосидеропениятяжелые менструальные кровотеченияоральные препараты железавитаминыKassebaum N.J., Jasrasaria R., Naghavi M., Wulf S.K., Johns N., Lozano R. et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014; 123(5): 615-24.de Benoist B., McLean E., Egli I., Cogswell M., eds. WHO Global Database on Anaemia. Geneva, Switzerland: WHO; 2008.Павлов А.Д., Морщакова Е.Ф., Румянцев А.Г. Эритропоэз, эритропоэтин, железо. М.: ГЭОТАР-Медиа; 2011. 304с. [Pavlov A.D., Morshchakova E.F., Rumyantsev A.G. Erythropoiesis, erythropoietin, iron. Moscow: GEOTAR-Media; 2011. 304p. (in Russian)]Minutolo R., Locatelli F., Gallieni M., Bonofiglio R., Fuiano G., Oldrizzi L. et al. Anaemia management in non-dialysis chronic kidney disease (CKD) patients: a multicentre prospective study in renal clinics. Nephrol. Dial. Transplant. 2013; 28(12): 3035-45.Baribeault D., Auerbach M. Iron replacement therapy in cancer-related anemia. Am. J. Health Syst. Pharm. 2011; 68(10, Suppl. 1): S4-S14; quiz S15-6.Klip I.T., Comin-Colet J., Voors A.A., Ponikowski P., Enjuanes C., Banasiak W. et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am. Heart J. 2013; 165(4): 575-82. e3.World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. 2011. Available at: http://www. who.int/vmnis/indicators/ferritin/enMiller J.L. Iron deficiency anemia: a common and curable disease. Cold Spring Harb. Perspect. Med. 2013; 3(7): pii: a011866.Andrews N.C. Forging a field: The golden age of iron biology. Blood. 2008; 112(2): 219-30.MacKenzie E.L., Iwasaki K., Tsuji Y. Intracellular iron transport and storage: From molecular mechanisms to health implications. Antioxid. Redox Signal. 2008; 10(6): 997-1030.Collings R., Harvey L.J., Hooper L., Hurst R., Brown T.J., Ansett J. et al. The absorption of iron from whole diets: a systematic review. Am. J. Clin. Nutr. 2013; 98(1): 65-81.Zimmermann M.B., Hurrell R.F. Nutritional iron deficiency. Lancet. 2007; 370(9586): 511-20.Ganz T., Nemeth E. Hepcidin and iron homeostasis. Biochim. Biophys. Acta. 2012; 1823(9): 1434-43.Young M.F., Glahn R.P., Ariza-Nieto M., Inglis J., Olbina G., Westerman M., O’Brien K.O. Serum hepcidin is significantly associated with iron absorption from food and supplemental sources in healthy young women. Am. J. Clin. Nutr. 2009; 89(2): 533-8.Zimmermann M.B., Troesch B., Biebinger R., Egli I., Zeder C., Hurrell R.F. Plasma hepcidin is a modest predictor of dietary iron bioavailability in humans, whereas oral iron loading, measured by stable-isotope appearance curves, increases plasma hepcidin. Am. J. Clin. Nutr. 2009; 90(5): 1280-7.Demeyer D., De Smet S., Ulens M. The near equivalence of haem and non-haem iron bioavailability and the need for reconsidering dietary iron recommendations. Eur. J. Clin. Nutr. 2014; 68(6): 750-1.WHO/NMH/NHD/MNM. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva: WHO; 2011.Тэмл Х., Диам Х., Хаферлах Т. Атлас по гематологии: практическое пособие по морфологической и клинической диагностике. Пер. англ. Камышников В.С., ред. М.: МЕДпресс-информ; 2014; 208с. [Taml H., Diam H., Haferlach T. Atlas on Hematology: A Practical Handbook on Morphological and Clinical Diagnosis. Trans. from Eng. Kamyshnikov VS, ed. Мoscow: MEDpress-inform; 2014; 208p. (in Russian)]WHO/CDC. Assessing the iron status of populations. In: Report of a joint World Health Organization/Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level. 2nd ed. Geneva: World Health Organization and Centers for Disease Control and Prevention; 2007: 1-30.Василевский И.В. Латентный дефицит железа как фактор, лимитирующий возможности спортсменов. В кн.: Образование, физическая культура, спорт и здоровье. Смоленск; 2012: 62-5. [Vasilevsky I.V. Latent iron deficiency as a factor limiting the ability of athletes. In: Education, Physical Culture, Sport and Health. Smolensk; 2012: 62-5. (in Russian)]Avni T., Leibovici L., Gafter-Gvili A. Iron supplementation for the treatment of chronic heart failure and iron deficiency: systematic review and meta-analysis. Eur. J. Heart Fail. 2012; 14(4): 423-9.Steinbicker A.U., Muckenthaler M.U. Out of balance - systemic iron homeostasis in iron-related disorders. Nutrients. 2013; 5(8): 3034-61.Pasricha S.R., Low M., Thompson J., Farrell A., De-Regil L.M. Iron supplementation benefits physical performance in women of reproductive age: A systematic review and meta-analysis. J. Nutr. 2014; 144(6): 906-14.Allen R.P., Auerbach S., Bahrain H., Auerbach M., Earley C.J. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am. J. Hematol. 2013; 88(4): 261-4.Munoz P., Humeres A. Iron deficiency on neuronal function. Biometals. 2012; 25(4): 825-35.Lukowski A.F., Koss M., Burden M.J., Jonides J., Nelson C.A., Kaciroti N. et al. Iron deficiency in infancy and neurocognitive functioning at 19 years: evidence of long-term deficits in executive function and recognition memory. Nutr. Neurosci. 2010; 13(2): 54-70.Murray-Kolb L.E., Beard J.L. Iron treatment normalizes cognitive functioning in young women. Am. J. Clin. Nutr. 2007; 85(3): 778-87.Leonard A.J., Chalmers K.A., Collins C.E., Patterson A.J. A study of the effects of latent iron deficiency on measures of cognition: a pilot randomised controlled trial of iron supplementation in young women. Nutrients. 2014; 6(6): 2419-35.Liu Z., Doan Q.V., Blumenthal P., Dubois R.W. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007; 10(3): 183-94.Frick K.D., Clark M.A., Steinwachs D.M., Langenberg P., Stovall D., Munro M.G. et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Women’s Health Issues. 2009; 19(1): 70-88.Szarewski A. Social and psychological aspects of cervical screening. Expert Rev. Obstet. Gynecol. 2011; 6(1): 37-44.Munro M.G., Critchley H.O., Broder M.S., Fraser I.S. ; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int. J. Gynaecol. Obstet. 2011; 113(1): 3-13.Graziottin A., Skaper S.D., Fusco M. Mast cells in chronic inflammation, pelvic pain and depression in women. Gynecol. Endocrinol. 2014; 30(7): 472-7.Короткова Н.А., Прилепская В.Н. Анемия беременных. Принципы современной терапии. Медицинский совет. 2015; ХХ: 58-62. [Korotkova N.A., Prilepskaya V.N. Anemia of the pregnant. Principles of modern therapy. Medical advice. 2015; XX: 58-62. (in Russian)]British Columbia Medical Association. Iron deficiency - investigation and management. Guidelines & protocols advisory committee. 2010.Бурлев В.А., Коноводова Е.Н., Фёдорова Т.А. и др. Диагностика и лечение железодефицитных состояний у гинекологических больных (клинический протокол). М.: РОАГ, ФГБУ НЦАГиП им. Акад. В.И. Кулакова; 2014. 26с. [Burlev V.A., Kononodova E.N., Fedorova Т.А. Diagnostics and treatment of iron deficiency states in gynecological patients (clinical protocol). M.: RSOG, Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology; 2014. 26p. (in Russian)]Mansvelt E.P.G. Iron deficiency (ID) and iron deficiency anaemia (IDA). PNT. 2009; 13(1): 29-30.Gray J., ed. Therapeutic choices. 5th ed. Toronto: Canadian Pharmacists Association; 2007: 1114-30.Bisbe E., García-Erce J.A., Díez-Lobo A.I., Muñoz M.; Anaemia Working Group Espana. A multicenter comparative study on the efficacy of intravenous ferric carboxymaltose and iron sucrose for correcting preoperative anemia in patients undergoing major elective surgery. Br. J. Anaesth. 2011; 107(3): 477-8.Litton E., Xiao J., Ho K.M. Safety and efficacy of intravenous iron therapy in reducing requirement for allogenic blood transfusion: systematic review and meta-analysis of randomized clinical trials. BMJ. 2013; 347: f4822.Beris P., Muñoz M., García-Erce J.A., Thomas D., Maniatis A., Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br. J. Anaesth. 2008; 100(5): 599-604.Munoz M., Breymann C., García-Erce J.A., Gómez-Ramirez S., Comin J., Bisbe E. Efficacy and safety of intravenous iron therapy as an alternate/ adjunct to allogeneic blood transfusion. Vox Sang. 2008; 94(3): 172-83.Notebaert E., Chauny J.M., Albert M., Fortier S., Leblanc N., Williamson D.R. Short-term benefits and risks of intravenous iron: a systematic review and metaanalysis. Transfusion. 2007; 47(10): 1905-18.Clark S. Iron deficiency anemia. Nutr. Clin. Pract. 2008; 23(2): 128-41.Стуклов Н.И., Семенова Е.Н. Железодефицитная анемия. Современная тактика диагностики и лечения, критерии эффективности терапии. Клиническая медицина. 2013; 91(12): 61-7. [Stuklov N.I., Semenova Ye.N. Iron-deficiency anemia. Modern tactics of diagnosis and treatment, criteria for the effectiveness of therapy. Klinicheskaya meditsina. 2013; 91 (12): 61-7. (in Russian)]Committee on Practice Bulletins-Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet. Gynecol. 2013; 122(1): 176-85.SOGC. Abnormal uterine bleeding in pre-menopausal women. J. Obstet. Gynaecol. Can. 2013; 35(5, Suppl. 1): S1-28.ВОЗ. Интермиттирующий режим приема менструирующими женшинами препаратов железа и фолиевой кислоты. Руководство. Женева: ВОЗ; 2012. [WHO. Intermittent administration of menstruating females with iron and folic acid preparations. Leadership. Geneva: WHO; 2012. (in Russian)]