Maternal iron homeostasis, disorders and pregnancy outcomes

Iron is essential for a healthy pregnancy, and multiple iron-regulatory mechanisms-maternal, placental and fetal-are involved in maintaining iron homeostasis during pregnancy. Iron disorders, particularly iron deficiency anaemia, are prevalent in women of reproductive age and represent the leading cause of years lived with disability in women worldwide. During pregnancy, the prevalence of iron deficiency anaemia increases further (ranging from 12% to 80% depending on the region) and is associated with maternal morbidity and mortality, as well as adverse fetal and long-term outcomes in offspring. Despite this burden, routine screening for iron deficiency is uncommon, and early treatment prior to the development of anaemia is lacking. Although far less prevalent, iron overload is also associated with adverse outcomes. Further studies are needed to elucidate the effects of maternal iron overload on the placenta and fetus, its consequences for child development, and to inform improved management strategies for this underrecognized condition. The goal of this review is to summarize physiological iron requirements and regulatory mechanisms during pregnancy, evaluate the benefits and limitations of available biomarkers and therapies, and underscore the importance of early and repeated screening for iron deficiency throughout gestation.