{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:31:30Z","timestamp":1760236290370,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T00:00:00Z","timestamp":1636329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Biomedical Research of La Rioja (CIBIR)","award":["PI"],"award-info":[{"award-number":["PI"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: No consensus exists regarding the hemoglobin (Hb) values that define postpartum anemia. Knowledge is currently lacking regarding prescription and consumption practices, which prevents evaluating the rational use of iron supplementation postpartum. Aim: In this study, our objective was to describe this practice and analyze its association with maternal health outcomes. Methods: A prospective observational study was conducted with 1010 women aged between 18 and 50. The hemoglobin value on the first postpartum day; the prescription schedule at hospital discharge; iron consumption; and data on hemoglobin, serum ferritin, maternal fatigue, type of breastfeeding, and perceived health six weeks after delivery were collected. Findings: Oral iron was prescribed to 98.1% of mothers with anemia and 75.8% without anemia. At the same Hb value, the maximum amount of total iron prescribed was between 8 and 10 times greater than the minimum amount. Iron intake was significantly lower than prescribed (p &lt; 0.01). At six weeks, anemic mothers who took iron presented a 3.6-, 3-, and 2.4-times lower probability of iron deficiency, anemia, and abandoning breastfeeding, respectively. Discussion: Postpartum iron intake shows a protective effect on iron deficiency and anemia at six weeks, but not on fatigue or self-perceived health level. Conclusion: We conclude that there is wide variability in the prescription regimen. Oral iron supplementation can benefit mothers with anemia and harm those without. Subsequent studies should further explore the Hb figure that better discriminates the need for postpartum iron.<\/jats:p>","DOI":"10.3390\/jcm10215212","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T22:08:41Z","timestamp":1636409321000},"page":"5212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variability in Oral Iron Prescription and the Effect on Spanish Mothers\u2019 Health: A Prospective Longitudinal Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0345-8028","authenticated-orcid":false,"given":"Regina","family":"Ruiz de Vi\u00f1aspre-Hern\u00e1ndez","sequence":"first","affiliation":[{"name":"Centro de Salud \u201cCascajos\u201d, Servicio Riojano de Salud, Government of La Rioja, 26002 Logro\u00f1o, Spain"},{"name":"GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logro\u00f1o, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Antonio","family":"Garc\u00eda-Erce","sequence":"additional","affiliation":[{"name":"Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain"},{"name":"Hematologist, Bank of Blood and Tissue, Government of Navarra, 31015 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-3839","authenticated-orcid":false,"given":"Francisco Jos\u00e9","family":"Rodr\u00edguez-Velasco","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8607-3195","authenticated-orcid":false,"given":"Vicente","family":"Gea-Caballero","sequence":"additional","affiliation":[{"name":"Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain"},{"name":"Faculty of Health Sciences, International University of Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3756-9914","authenticated-orcid":false,"given":"Teresa","family":"Sufrate-Sorzano","sequence":"additional","affiliation":[{"name":"GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logro\u00f1o, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7504-4070","authenticated-orcid":false,"given":"Mar\u00eda Elena","family":"Garrote-C\u00e1mara","sequence":"additional","affiliation":[{"name":"GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logro\u00f1o, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Urra-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Servicio Riojano de Salud, Hospital San Pedro, Government of La Rioja, 26006 Logro\u00f1o, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3597-2048","authenticated-orcid":false,"given":"Ra\u00fal","family":"Ju\u00e1rez-Vela","sequence":"additional","affiliation":[{"name":"GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logro\u00f1o, Spain"},{"name":"Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4245-5420","authenticated-orcid":false,"given":"Micha\u0142","family":"Czapla","sequence":"additional","affiliation":[{"name":"Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-516 Wroclaw, Poland"},{"name":"Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6705-7122","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Santolalla-Arnedo","sequence":"additional","affiliation":[{"name":"GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logro\u00f1o, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s00277-011-1279-z","article-title":"Postpartum anemia I: Definition, prevalence, causes, and consequences","volume":"90","author":"Milman","year":"2011","journal-title":"Ann. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4139","DOI":"10.1093\/jn\/133.12.4139","article-title":"Low Hemoglobin Level Is a Risk Factor for Postpartum Depression","volume":"133","author":"Corwin","year":"2003","journal-title":"J. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/jn\/135.2.267","article-title":"Maternal Iron Deficiency Anemia Affects Postpartum Emotions and Cognition","volume":"135","author":"Beard","year":"2005","journal-title":"J. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1093\/jn\/135.4.850","article-title":"Mother-infant interactions and infant development are altered by maternal iron deficiency anemia","volume":"135","author":"Perez","year":"2005","journal-title":"J. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"946","DOI":"10.3945\/ajcn.2008.26692D","article-title":"Iron deficiency and child and maternal health 1\u20134","volume":"89","author":"Beard","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_6","unstructured":"Group de travail de la ligne directrice sur l\u2019HPP (2021, May 10). Association of Ontario Midwives. H\u00e9morragie Post-Partum. Available online: http:\/\/www.ontariomidwives.ca."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1111\/bjh.16221","article-title":"UK guidelines on the management of iron deficiency in pregnancy","volume":"188","author":"Pavord","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_8","first-page":"A3711","article-title":"Revised practice guideline \u2019Anaemia in midwifery practice\u2019","volume":"156","author":"Beentjes","year":"2012","journal-title":"Ned Tijdschr Geneeske"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.jgyn.2015.09.024","article-title":"Soins maternels apr\u00e8s accouchement voie basse et prise en charge des complications du post-partum imm\u00e9diat: Recommandations pour la pratique clinique","volume":"44","author":"Simon","year":"2015","journal-title":"J. Gyn\u00e9col. Obstet. Biol. Reprod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/s00404-017-4526-2","article-title":"Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum","volume":"296","author":"Breymann","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"173","DOI":"10.4274\/tjod.01700","article-title":"Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report","volume":"12","author":"Api","year":"2015","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_12","unstructured":"World Health Organisation (WHO) (2016). Guideline: Iron Supplementation in Postpartum Women, World Health Organisation (WHO). Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/249242."},{"key":"ref_13","first-page":"502","article-title":"Rational use of medicines: Cost consideration & way forward","volume":"144","author":"Kshirsagar","year":"2016","journal-title":"Indian J. Med. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ejogrb.2011.07.041","article-title":"Prevalence of maternal anaemia and its predictors: A multi-centre study","volume":"159","author":"Barroso","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.medcli.2016.01.029","article-title":"Anemia en el embarazo y el posparto inmediato. Prevalencia y Factores de Riesgo","volume":"146","author":"Urquizu","year":"2016","journal-title":"Med. Clin."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e3832","DOI":"10.7717\/peerj.3832","article-title":"The Spanish version of the Fatigue Assessment Scale: Reliability and validity assessment in postpartum women","volume":"5","year":"2017","journal-title":"PeerJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4081\/monaldi.2012.121","article-title":"EuroQol-5D (EQ-5D): An instrument for measuring quality of life","volume":"78","author":"Balestroni","year":"2015","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/birt.12282","article-title":"The challenge of defining and treating anemia and iron deficiency in pregnancy: A study of New Zealand midwives\u2019 management of iron status in pregnancy and the postpartum period","volume":"44","author":"Calje","year":"2017","journal-title":"Birth"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1688S","DOI":"10.3945\/ajcn.117.156067","article-title":"The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: A review","volume":"106","author":"Paganini","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tolkien, Z., Stecher, L., Mander, A.P., and Pereira, D.I.A. (2015). Ferrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117383"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Turawa, E.B., Musekiwa, A., and Rohwer, A.C. (2014). Interventions for treating postpartum constipation. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD010273.pub2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1600-0609.2007.00873.x","article-title":"Reference intervals for haematological variables during normal pregnancy and postpartum in 434 healthy Danish women","volume":"79","author":"Milman","year":"2007","journal-title":"Eur. J. Haematol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1002\/ajpa.22907","article-title":"The reproductive ecology of iron in women","volume":"159","author":"Miller","year":"2016","journal-title":"Am. J. Phys. Anthr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s00277-011-1381-2","article-title":"Postpartum anemia II: Prevention and treatment","volume":"91","author":"Milman","year":"2012","journal-title":"Ann. Hematol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/s00277-012-1466-6","article-title":"Increased yet iron-restricted erythropoiesis in postpartum mothers","volume":"91","author":"Torsvik","year":"2012","journal-title":"Ann. Hematol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Markova, V., Norgaard, A., Jorgensen, K., and Langhoff-Roos, J. (2015). Treatment for women with postpartum iron deficiency anaemia (Review). Cochrane Database Syst. Rev., 1\u201338.","DOI":"10.1002\/14651858.CD010861.pub2"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1567S","DOI":"10.3945\/ajcn.117.155812","article-title":"Iron homeostasis during pregnancy","volume":"106","author":"Fisher","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1146\/annurev-nutr-071715-050731","article-title":"Regulation of Hepcidin by Erythropoiesis: The Story So Far","volume":"36","author":"Pasricha","year":"2016","journal-title":"Annu. Rev. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1182\/blood-2015-05-642223","article-title":"Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women","volume":"126","author":"Moretti","year":"2015","journal-title":"Blood"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e524","DOI":"10.1016\/S2352-3026(17)30182-5","article-title":"Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: Two open-label, randomised controlled trials","volume":"4","author":"Stoffel","year":"2017","journal-title":"Lancet Haematol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1080\/00016340701275424","article-title":"New insights into fatigue and health-related quality of life after delivery","volume":"86","author":"Jansen","year":"2007","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00277-016-2817-5","article-title":"The impact of postpartum hemoglobin levels on maternal quality of life after delivery: A prospective exploratory study","volume":"95","author":"Miller","year":"2016","journal-title":"Ann. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1080\/14767058.2018.1498479","article-title":"Association between blood loss at delivery and fatigue in the puerperium: A prospective longitudinal study","volume":"33","author":"Holm","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ejogrb.2014.07.028","article-title":"Health status and fatigue of postpartum anemic women: A prospective cohort study","volume":"181","author":"Pijnenborg","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3148\/67.2.2006.72","article-title":"Is there a link between postpartum anemia and discontinuation of breastfeeding?","volume":"67","author":"Rioux","year":"2006","journal-title":"Can. J. Diet. Pr. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12199-017-0650-7","article-title":"A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan","volume":"22","author":"Horie","year":"2017","journal-title":"Environ. Health Prev. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chessman, J., Patterson, J., Nippita, T., Drayton, B., and Ford, J. (2018). Haemoglobin concentration following postpartum haemorrhage and the association between blood transfusion and breastfeeding: A retrospective cohort study. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3800-0"},{"key":"ref_38","first-page":"CD010647","article-title":"Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby","volume":"2016","author":"Abe","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"566","DOI":"10.7326\/M14-2932","article-title":"Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force","volume":"162","author":"Cantor","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/jebm.12344","article-title":"Oral iron-based interventions for prevention of critical outcomes in pregnancy and postnatal care: An overview and update of systematic reviews","volume":"12","author":"Abraha","year":"2019","journal-title":"J. Evid. Based Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:27:42Z","timestamp":1760167662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,8]]},"references-count":40,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10215212"],"URL":"https:\/\/doi.org\/10.3390\/jcm10215212","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,11,8]]}}}