{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T16:32:05Z","timestamp":1786379525862,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science Centre in Poland","award":["2019\/33\/N\/NZ5\/02303"],"award-info":[{"award-number":["2019\/33\/N\/NZ5\/02303"]}]},{"name":"National Science Centre in Poland","award":["Scho 849\/6-2"],"award-info":[{"award-number":["Scho 849\/6-2"]}]},{"name":"PRELUDIUM-17 grant","award":["2019\/33\/N\/NZ5\/02303"],"award-info":[{"award-number":["2019\/33\/N\/NZ5\/02303"]}]},{"name":"PRELUDIUM-17 grant","award":["Scho 849\/6-2"],"award-info":[{"award-number":["Scho 849\/6-2"]}]},{"name":"Deutsche Forschungsgemeinschaft (DFG) research unit FOR-2558 \u201cTraceAge\u201d","award":["2019\/33\/N\/NZ5\/02303"],"award-info":[{"award-number":["2019\/33\/N\/NZ5\/02303"]}]},{"name":"Deutsche Forschungsgemeinschaft (DFG) research unit FOR-2558 \u201cTraceAge\u201d","award":["Scho 849\/6-2"],"award-info":[{"award-number":["Scho 849\/6-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The aim of this study was to compare the iron and calcium status in singleton and twin pregnancies and to assess whether there is an increased risk for iron and calcium deficiency in twin gestation. The study included 105 singleton and 9 twin pregnancies at or above 35 weeks of gestation. Information on prenatal supplementation with iron or calcium was acquired, and adverse perinatal outcomes were recorded. Biosamples from all 114 mothers and 73 newborns (61 singleton and 12 twin newborns) were finally analyzed. Total iron and calcium concentrations in serum were measured through total reflection X-ray fluorescence analysis. The results indicated no significant differences in maternal serum iron and calcium concentrations between singleton and twin pregnancies. Similarly, iron and calcium concentrations in newborn umbilical cord serum samples were not different between singleton and twin pregnancies. The comparison of total iron and calcium between mothers and umbilical cord serum indicated significantly lower concentrations in the mothers, with the differences being not homogenous but rather pair-specific. A significant positive correlation between maternal serum and umbilical cord serum calcium concentration was noticed. Prenatal iron supplementation was associated with higher iron concentrations in both mothers and newborns, supporting the efficiency of supplementation and the quality of the study methods. Collectively, the data indicate no significant differences in serum iron and calcium concentrations with regard to singleton or twin pregnancies and the efficiency of iron supplementation during pregnancy for increasing iron status.<\/jats:p>","DOI":"10.3390\/nu15184047","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T02:47:52Z","timestamp":1695091672000},"page":"4047","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Are Twin Pregnancies at Higher Risk for Iron and Calcium Deficiency than Singleton Pregnancies?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5984-5532","authenticated-orcid":false,"given":"Anna","family":"Dera-Szymanowska","sequence":"first","affiliation":[{"name":"Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2205-4558","authenticated-orcid":false,"given":"Dorota","family":"Filipowicz","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3185-5020","authenticated-orcid":false,"given":"Natalia","family":"Misan","sequence":"additional","affiliation":[{"name":"Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Szymanowski","sequence":"additional","affiliation":[{"name":"Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7706-7906","authenticated-orcid":false,"given":"Thilo Samson","family":"Chillon","sequence":"additional","affiliation":[{"name":"Institute for Experimental Endocrinology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, D-10115 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Asaad","sequence":"additional","affiliation":[{"name":"Institute for Experimental Endocrinology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, D-10115 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4458-6555","authenticated-orcid":false,"given":"Qian","family":"Sun","sequence":"additional","affiliation":[{"name":"Institute for Experimental Endocrinology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, D-10115 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewelina","family":"Szczepanek-Parulska","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9445-1555","authenticated-orcid":false,"given":"Lutz","family":"Schomburg","sequence":"additional","affiliation":[{"name":"Institute for Experimental Endocrinology, Charit\u00e9-Universit\u00e4tsmedizin Berlin, D-10115 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-7220","authenticated-orcid":false,"given":"Marek","family":"Rucha\u0142a","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.3945\/ajcn.110.007195","article-title":"Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999","volume":"93","author":"Mei","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mikulska, A.A., Kara\u017aniewicz-\u0141ada, M., Filipowicz, D., Rucha\u0142a, M., and G\u0142\u00f3wka, F.K. (2022). Metabolic Characteristics of Hashimoto\u2019s Thyroiditis Patients and the Role of Microelements and Diet in the Disease Management\u2014An Overview. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23126580"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"590S","DOI":"10.1093\/jn\/131.2.590S","article-title":"Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?","volume":"131","author":"Rasmussen","year":"2001","journal-title":"J. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1093\/ajcn\/55.5.985","article-title":"Anemia vs iron deficiency\u2014Increased risk of preterm delivery in a prospective study","volume":"55","author":"Scholl","year":"1992","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1542\/peds.114.1.86","article-title":"Daily multivitamins with iron to prevent anemia in highrisk infants: A randomized clinical trial","volume":"114","author":"Geltman","year":"2004","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1301\/nr.2006.may.S34-S43","article-title":"Long-lasting neural and behavioral effects of iron deficiency in infancy","volume":"64","author":"Lozoff","year":"2006","journal-title":"Nutr. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1203\/01.PDR.0000047657.23156.55","article-title":"Iron deficiency anemia in infancy: Long-lasting effects on auditory and visual system functioning","volume":"53","author":"Peirano","year":"2003","journal-title":"Pediatr. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1093\/jn\/138.12.2534","article-title":"Why iron deficiency is important in infant development","volume":"138","author":"Beard","year":"2008","journal-title":"J. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(07)60076-2","article-title":"Child development: Risk factors for adverse outcomes in developing countries","volume":"369","author":"Walker","year":"2007","journal-title":"Lancet"},{"key":"ref_10","first-page":"365","article-title":"Changes in cognitive functions in a girl with severe acquired hypothyroidism in comparison to the healthy twin sister","volume":"71","author":"Majewska","year":"2020","journal-title":"Endokrynol. Pol."},{"key":"ref_11","first-page":"47","article-title":"Hemoglobin levels during twin vs. singleton pregnancies. Parity makes the difference","volume":"40","author":"Blickstein","year":"1995","journal-title":"J. Reprod. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.3109\/14767058.2015.1084616","article-title":"The effect of maternal anemia on maternal and neonatal outcomes in twin prengnacies","volume":"29","author":"Kosto","year":"2016","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/humrep\/16.3.567","article-title":"Iron metabolism in monochorionic twin pregnancies in relation to twin-twin transfusion syndrome","volume":"16","author":"Bajoria","year":"2001","journal-title":"Hum. Reprod."},{"key":"ref_14","first-page":"357","article-title":"Determination of serum ferritin in the evaluation of iron depletion and iron overload in chronic twin-to-twin transfusion syndrome","volume":"17","author":"Caglar","year":"1989","journal-title":"J. Perinat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.3945\/ajcn.115.126284","article-title":"Iron deficiency and anemia are prevalent in women with multiple gestations","volume":"104","author":"Ru","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/AOG.0b013e3181bb14c8","article-title":"Optimal nutrition for improved twin pregnancy outcome","volume":"114","author":"Goodnight","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_17","unstructured":"World Health Organization (WHO) (2016). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2008). ACOG Practice Bulletin No. 95, Anemia in pregnancy. Obstet. Gynecol., 112, 201\u2013207.","DOI":"10.1097\/AOG.0b013e3181809c0d"},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00277-006-0145-x","article-title":"Iron prophylaxis in pregnancy--general or individual and in which dose?","volume":"85","author":"Milman","year":"2006","journal-title":"Ann. Hematol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine (2019). Good Clinical Practice Advice: Iron Deficiency Anemia in Pregnancy. Int. J. Gynaecol. Obstet., 144, 322\u2013324.","DOI":"10.1002\/ijgo.12740"},{"key":"ref_22","unstructured":"National Institute for Health and Care Excellence (NICE) (2019). Clinical Guidelines, National Institute for Health and Care Excellence (NICE)."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.4236\/ojog.2020.10120161","article-title":"Single vs. Double Dose Iron Supplementation for Prevention of Iron Deficiency Anemia in Twin Pregnancy: A Randomized Controlled Clinical Trial","volume":"10","author":"Abbas","year":"2020","journal-title":"Open J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"795","DOI":"10.3126\/nje.v9i4.23150","article-title":"Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India","volume":"9","author":"Kant","year":"2019","journal-title":"Nepal J. Epidemiol."},{"key":"ref_25","unstructured":"CMR (Indian Council of Medical Research) (2011). National Institute of Nutrition\/Indian Council of Medical Research. Dietary Guidelines for Indians, National Institute of Nutrition."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/0002-9378(77)90256-3","article-title":"Serum calcium concentrations in human pregnancy","volume":"127","author":"Pitkin","year":"1977","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1080\/09513590601005409","article-title":"Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: A cross-sectional study","volume":"22","author":"Sabour","year":"2006","journal-title":"Gynecol. Endocrinol."},{"key":"ref_28","first-page":"CD001059","article-title":"Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems","volume":"10","author":"Hofmeyr","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/0002-9378(85)90434-X","article-title":"Calcium metabolism in pregnancy and the perinatal period: A review","volume":"151","author":"Pitkin","year":"1985","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s13224-017-1007-2","article-title":"Calcium: A Nutrient in Pregnancy","volume":"67","author":"Kumar","year":"2017","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1148\/radiology.181.1.1887021","article-title":"In utero analysis of fetal growth: A sonographic weight standard","volume":"181","author":"Hadlock","year":"1991","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1148\/radiology.152.2.6739822","article-title":"Estimating fetal age: Computer-assisted analysis of multiple fetal growth parameters","volume":"152","author":"Hadlock","year":"1984","journal-title":"Radiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1017\/S0007114510002618","article-title":"The choice of biomarkers determines the selenium status in young German vegans and vegetarians","volume":"104","author":"Hoeflich","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1002\/ijc.29071","article-title":"Selenium status is associated with colorectal cancer risk in the European prospective investigation of cancer and nutrition cohort","volume":"136","author":"Hughes","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ajcnut.2022.10.004","article-title":"Prediagnostic serum calcium concentrations and risk of colorectal cancer development in 2 large European prospective cohorts","volume":"117","author":"Karavasiloglou","year":"2023","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"450","DOI":"10.19127\/mbsjohs.1138244","article-title":"In Twin Pregnancies, Zinc and Iron Decreased, While Copper Increased Minimally","volume":"8","author":"Cikim","year":"2022","journal-title":"Middle Black Sea J. Health Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Campbell, R.K., Buhimschi, C.S., Zhao, G., Dela Rosa, C., Stetson, B.T., Backes, C.H., and Buhimschi, I.A. (2022). Prevalence of and Risk Factors for Iron Deficiency in Twin and Singleton Newborns. Nutrients, 14.","DOI":"10.3390\/nu14183854"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1017\/thg.2017.43","article-title":"Iron Supplementation in Twin Pregnancy\u2014The Benefit of Doubling the Iron Dose in Iron Deficient Pregnant Women: A Randomized Controlled Trial","volume":"20","author":"Shinar","year":"2017","journal-title":"Twin Res. Hum. Genet."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1038\/jp.2017.43","article-title":"Iron supplementation in singleton pregnancy: Is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? a randomized controlled trial","volume":"37","author":"Shinar","year":"2017","journal-title":"J. Perinatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.4103\/njcp.njcp_211_18","article-title":"Daily versus twice daily dose of ferrous sulphate supplementation in pregnant women: A randomized clinical trial","volume":"22","author":"Adaji","year":"2019","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1038\/s41390-018-0044-6","article-title":"Predictors of anemia and iron status at birth in neonates born to women carrying multiple fetuses","volume":"84","author":"Ru","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1080\/14767058.2016.1266478","article-title":"A randomized clinical trial of the efficacy of single versus double-daily dose of oral iron for prevention of iron deficiency anemia in women with twin gestations","volume":"30","author":"Ali","year":"2017","journal-title":"J. Matern. Fetal. Neonatal Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s00404-004-0672-4","article-title":"Serum calcium and serum magnesium in normal and preeclamptic pregnancy","volume":"273","author":"Sukonpan","year":"2005","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.nutres.2012.09.007","article-title":"Serum levels of zinc, calcium, and iron are associated with the risk of preeclampsia in pregnant women","volume":"32","author":"Kim","year":"2012","journal-title":"Nutr. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s12011-009-8423-9","article-title":"The role of calcium, magnesium, and zinc in pre-eclampsia","volume":"133","author":"Jain","year":"2010","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/ijn.12171","article-title":"Calcium supplementation reducing the risk of hypertensive disorders of pregnancy and related problems: A meta-analysis of multicentre randomized controlled trials","volume":"21","author":"An","year":"2015","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Grzeszczak, K., Kapczuk, P., Kupnicka, P., Cecerska-Hery\u0107, E., Kwiatkowski, S., Chlubek, D., and Kosik-Bogacka, D. (2023). Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies. Life, 13.","DOI":"10.3390\/life13010153"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.bone.2011.05.016","article-title":"Differences in bone metabolism between singleton pregnancy and twin pregnancy","volume":"49","author":"Nakayama","year":"2011","journal-title":"Bone"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1111\/jog.13060","article-title":"Maternal and neonatal vitamin-D status in twin versus singleton pregnancies","volume":"42","author":"Goswami","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejogrb.2011.04.002","article-title":"Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: Should routine vitamin D supplementation be increased in pregnant women?","volume":"158","author":"Haliloglu","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. 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