Hemochromatosis and prenatal vitamins
I just found out I am pregnant and have an appointment with my doctor in two weeks. In the meantime, I've been told to take prenatal supplements; however, I have a common genetic condition called hemochromatosis. Isn't it dangerous for doctors to prescribe supplements without establishing the patient's iron status first?
Question:Peg Plumbo CNM
Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more
Yes, your concern is very justified. Hemochromatosis is one of the most common genetic diseases. In Caucasians, the estimated prevalence is 1 in 300.
Many physicians and obstetric care providers lack sufficient knowledge of this condition because older studies indicated that it had predominantly been found in men. It is not discovered as often in women because hemochromatosis in women was thought to be mitigated by the beneficial effects of menstruation and pregnancy on the degree of iron overload and subsequent tissue damage. Newer studies have not confirmed this. So the diagnosis of hemochromatosis may be missed, even in women who have symptoms.
Iron overload is the possible result of this condition and could lead to the development of organ damage and increased mortality. Excess iron can accumulate through the placental route during fetal life or through the use of medications containing iron. In hemochromatosis, deregulation of intestinal iron absorption results in the iron overload. Diagnosis of iron overload can be suspected on the basis of clinical data, high transferrin saturation and/or serum ferritin values.
You are right to be concerned about our lack of knowledge and experience. I'm afraid that you may have to educate your providers on this topic and hopefully they will be motivated to do some literature reviews on this topic.
You may consider seeking the opinion of a perinatologist and then deciding to continue care with that specialist or with someone they recommend. If you have any indication that the care provider you use is not open to your concern, I would not commit my care to them.
Although prenatal vitamins do not have much iron in them, most do have some. It would be wise, in your case, to check ferritin levels.
There is really no reason to use prenatal vitamins if the woman has a good diet containing adequate amounts of the four food groups. However, a folic acid supplement should be recommended for all women prior to and during the first three months of pregnancy.
I'm sorry that you had this unfortunate encounter with your care provider. If you would like to find a nurse-midwife in your area, you could access this web site at http://www.acnm.org or call 1-888-MIDWIFE. I think a nurse-midwife might be more open to investigating how to individualize your care.
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