Refractory anaemia of pregnancy as an expression of zinc deficiency

Thirty-three gravidae with anemia in spite of iron and vitamin supplementation were examined, and 31 were found to have low or very low serum zinc concentrations with regard to the week of gestation. Twenty-three of the 33 showed no bone marrow haemosiderin or only traces. Thirty showed moderate or great increase in intracellular cell debris in the bone marrow macrophages, indicating an increase in intramedullary cell destruction. Two women showed low serum vitamin B-12 or folate concentrations and they also showed lowest zinc concentrations recorded in the series. Twelve of the 33 women gave birth to mature infants by normal delivery; 21 developed complications during labour or gave birth to immature, dysmature, or, in one case, malformed infants and/or were not delivered at normal term. Low serum zinc in pregnant women increases maternal morbidity and involves a higher risk to the fetus. It is suggested that an aetiological relationship exists between low serum zinc concentrations and refractory anaemia of pregnancy resulting in increased intramedullary cell destruction. This effect might be aggravated by iron deficiency.