By Ana Espino | Published on February 19, 2026 | 3 min read
Iron-deficiency anemia is one of the most common nutritional disorders
during pregnancy, resulting from insufficient iron to support maternal
erythropoiesis and fetal development. To prevent it, routine iron
supplementation is widely implemented in obstetric protocols. However, this
uniform approach has limitations. It
overlooks individual variability in iron
stores and fails to account for the potentially harmful effects of iron excess,
particularly in non-deficient women.
Elevated ferritin levels—reflecting both iron stores and inflammatory
status—may be
associated with metabolic and vascular complications of
pregnancy, such as gestational diabetes, hypertension, and intrauterine growth
restriction. These associations remain underexplored in current clinical
practice, where ferritin is rarely used as a predictive tool.
One of the
key challenges is to better
individualize iron intake during
pregnancy by identifying women at risk of iron overload. In this context, the
present study was initiated to
test the hypothesis that
elevated maternal
ferritin levels are
associated with an increased risk of obstetric
complications and to evaluate ferritin as a potential
risk-stratification
biomarker in obstetrics.
High ferritin, high-risk pregnancy ?
A total of 1,561 pregnant women were selected and divided into two
groups according to ferritin levels: <40 ng/mL and ≥40 ng/mL, based on
previously established data. The researchers compared the frequency of major
obstetric complications between the two groups, including gestational diabetes
mellitus (GDM), gestational hypertension (GH), preeclampsia, intrauterine
growth restriction (IUGR), preterm birth, and amniotic fluid abnormalities.
The results showed a significant increase in several complications among
women with ferritin levels ≥40 ng/mL. In particular, significant associations
were observed with gestational diabetes, hypertensive disorders, and fetal
growth restriction. No notable differences were found regarding amniotic fluid
abnormalities or preterm birth. These findings support the hypothesis that
elevated maternal ferritin may serve as a marker of metabolic or inflammatory
risk rather than simply reflecting adequate iron stores.
Toward smarter supplementation ?
Iron-deficiency anemia is common during pregnancy, yet its standardized
treatment does not account for interindividual differences in iron status. A
major challenge lies in identifying women with iron excess or underlying
inflammation who may be at increased risk of obstetric complications.
This study aimed to evaluate the association between maternal ferritin
levels and adverse pregnancy outcomes. The findings suggest that elevated
ferritin may be linked to a higher risk of complications, particularly
gestational diabetes, preeclampsia, and impaired fetal growth, supporting a
more individualized approach to iron supplementation.
However, important limitations remain and warrant further investigation.
Future research should include larger-scale cohort studies, improved control
for inflammatory confounders, and randomized controlled trials assessing
personalized supplementation strategies based on baseline ferritin levels. A
better understanding of the interactions among iron metabolism, inflammation,
and oxidative stress will also be essential to develop more targeted
interventions and improve maternal and neonatal outcomes.
Read next: Vaginal microbiome: a cause of miscarriage ?
About the author – Ana EspinoPhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
