Discussion
anaemia, multiparity
ANAEMIA, SAID, EARLY PREGNANCY
This study contributes to the identification of some maternal sociodemographic and lifestyle factors associated with the risk of developing ID in early pregnancy in a sample of non-anaemic pregnant women from northeastern Spain, with the aim of preventing this deficiency, which is so common during pregnancy, and to avoid its negative consequences.From all the analysed maternal biological, sociodemographic, and lifestyle conditions, the most relevant predictor of iron status in early pregnancy identified in this work was multiparity, showing almost 7 times higher odds of ID than primiparous women. That has already been repeatedly reported from around the world [This study also assessed dietary intake and its relationship with iron levels. Thus, it was expected that a higher daily intake of total, red and processed meat, as well as protein and iron, would increase both Hb and SF concentrations in early pregnancy, protecting against ID. However, a concern arising from our results is the low iron intake that women reported (median: 8 mg/day), with only 8 participants (1%) meeting the DRI (16 mg/day), and 35.5% not even reaching the EAR (7 mg/day) that EFSA indicates for pregnant women [A high percentage of women with ID in early pregnancy show no signs of anaemia and their low iron stores go undetected and untreated since Hb is often the only biomarker measured for assessing iron status in routine practice [It must be said that deciphering which factors are associated with ID in early pregnancy does not mean that iron stores should not continue to be monitored throughout pregnancy. However, it has been observed that early iron status is highly correlated with iron status during and at the end of gestation. Therefore, it is in the early stages of pregnancy, and even periconceptionally, that effective preventive actions can be considered, such as increased promotion of healthier lifestyles from pregnancy planning services and increased monitoring of non-modifiable characteristics where appropriate. Thus, knowing which maternal conditions or characteristics may affect maternal iron stores would allow obstetricians and midwives to focus public health actions on the target population for early prevention of ID, helping women to achieve the best possible iron status.The strengths of the present work include (1) the extensive data collection carried out, which covered many sociodemographic and lifestyle characteristics of the participants, including diet and toxic habits; (2) SF levels were adjusted for CRP concentrations in multivariate analyses allowing control for acute inflammatory processes at the time of measurements that could bias the results. However, some limitations must be considered when interpreting these findings. First, the observational design of the study may influence the external validity of the results. On the assumption that the sample includes only non-anaemic women in early pregnancy, the current findings cannot be extrapolated to other populations. Second, information on recent blood donations, which would reduce iron reserves, was not available. Third, dietary assessment using questionnaires is susceptible to misreporting bias; however, given that women with low BMI in our study did not over-report food intake, as is often the case, we believe that potential misreporting bias would not greatly influence our results. Finally, information about interpregnancy interval was not available, which could have allowed further interpretation of parity as a predictor of iron status.