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 International Journal of Medical Sciences and Pharma Research 

Open Access to Medical Science and Pharma Research

Copyright  © 2025 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

 

The Role of Copper Deficiency in Anemia during Pregnancy

Emmanuel Ifeanyi Obeagu ¹*, S K Prajapati ², Sheo Datta Maurya ³

¹ Department of Biomedical and Laboratory Science, Africa University, Zimbabwe

² Professor & Head, Institute of Pharmacy, Bundelkhand University, Jhansi (U.P.), India

³ Pharmacist, Health Unit, Sitarampur, Eastern Railway, Asansol, West Bengal, India-713359

 

 

Introduction

Anemia during pregnancy is a widespread health concern, affecting millions of women worldwide. It is associated with a range of complications, including fatigue, reduced immune function, preterm birth, and low birth weight. Traditionally, iron deficiency has been considered the leading cause of pregnancy-related anemia. However, emerging evidence suggests that other micronutrient deficiencies, particularly copper deficiency, may also contribute significantly to this condition. Copper plays a vital role in numerous biological processes essential for maternal and fetal health, including hematopoiesis, iron metabolism, and antioxidant defense. Despite its importance, copper deficiency remains an underrecognized and frequently overlooked cause of anemia in pregnancy.^1-2 Copper is a trace element that is essential for the proper functioning of various enzymes involved in red blood cell production and iron metabolism. One of copper's primary roles in hematopoiesis is its involvement in the synthesis of ceruloplasmin, a copper-dependent enzyme responsible for oxidizing ferrous iron to ferric iron, the form required for incorporation into hemoglobin. Without sufficient copper, iron utilization becomes inefficient, impairing the production of healthy red blood cells. Copper also acts as a cofactor for enzymes that support the production of hemoglobin and protect red blood cells from oxidative damage, further linking copper deficiency to anemia. This review aims to examine the role of copper deficiency in maternal anemia, its mechanisms, and the associated clinical outcomes during pregnancy.^3-4 Pregnancy increases the demand for many nutrients, including copper, due to the needs of the developing fetus and the placenta. During pregnancy, copper is required for fetal development, including the formation of the fetal brain and cardiovascular system, as well as for placental vascularization. As copper is absorbed in the gastrointestinal tract, it is transported to the placenta, where it is essential for the proper function of the growing fetus. However, if maternal copper stores are insufficient, the fetus may not receive adequate amounts of this essential nutrient, leading to developmental issues and other health risks. As a result, copper deficiency can compromise both maternal and fetal health, yet it is often overshadowed by the more commonly diagnosed iron deficiency.⁵

In addition to increased physiological demands, the causes of copper deficiency in pregnancy are multifactorial. Women with poor dietary habits or those with limited access to copper-rich foods, such as shellfish, nuts, and seeds, are particularly at risk. Copper absorption can also be affected by gastrointestinal disorders, such as celiac disease or Crohn’s disease, which interfere with nutrient absorption. Furthermore, certain medications, including high-dose zinc supplements, can inhibit copper absorption, potentially leading to deficiency. Zinc supplementation, commonly recommended during pregnancy, may particularly contribute to copper deficiency by competing for absorption sites in the intestines, highlighting the need for careful micronutrient balance during pregnancy.^6-7 Another factor contributing to copper deficiency is the increasing prevalence of micronutrient deficiencies worldwide, often related to poor maternal nutrition, especially in low-resource settings. These deficiencies may not only result from inadequate dietary intake but also from underlying health conditions such as chronic illnesses or malabsorption syndromes. Iron and zinc deficiencies are more commonly addressed in clinical settings, while copper deficiency remains less frequently investigated or diagnosed. The lack of awareness about copper's role in maternal and fetal health may contribute to its underdiagnosis, leading to untreated deficiency and its associated health risks.⁸

Causes of Copper Deficiency in Pregnancy

Copper deficiency in pregnancy can arise from several factors, including inadequate dietary intake, increased physiological demands, impaired absorption, and interactions with other nutrients. Each of these causes can contribute to insufficient copper levels in the body, leading to a variety of health complications for both the mother and the fetus.

1. Inadequate Dietary Intake: The most straightforward cause of copper deficiency is a diet that does not provide sufficient amounts of copper-rich foods. Copper is found in a variety of foods, including shellfish, organ meats, nuts, seeds, and legumes. Pregnant women who consume a diet low in these foods, often due to dietary restrictions or preferences, may be at risk of copper deficiency. This is particularly common in populations where access to diverse and nutrient-dense foods is limited, or in those following vegetarian or vegan diets that may lack adequate sources of bioavailable copper.^9-10
2. Increased Physiological Demand: Pregnancy places increased demands on the body’s nutritional requirements, including copper. Copper is necessary for the formation of hemoglobin, the development of the fetal brain and nervous system, placental vascularization, and antioxidant defense mechanisms. As a result, copper levels can become depleted in pregnant women who do not have sufficient copper stores or dietary intake to meet the increased demands. This increased requirement for copper is especially pronounced during the second and third trimesters when fetal growth accelerates, and copper is transported across the placenta for fetal development.^11-12
3. Impaired Absorption: Copper absorption occurs primarily in the small intestine, and several factors can interfere with this process. Conditions that impair the gastrointestinal system, such as celiac disease, Crohn's disease, or gastric bypass surgery, can reduce the efficiency of copper absorption. These conditions often cause malabsorption of various nutrients, including copper, leading to deficiency over time. Moreover, certain medications, such as proton pump inhibitors (PPIs) or antacids, may alter the stomach’s acidity and affect copper absorption, exacerbating the risk of deficiency during pregnancy.^13-14
4. Micronutrient Interactions: Copper absorption and utilization can be influenced by the presence of other nutrients in the body. High levels of zinc, commonly taken as a supplement during pregnancy for immune function and fetal development, can interfere with copper absorption. Zinc and copper compete for the same absorption sites in the intestines, and excessive zinc intake can reduce the body’s ability to absorb copper effectively. This competition is particularly relevant in women taking high doses of zinc supplements, which may be used to prevent or treat zinc deficiency, without careful monitoring of copper levels.¹⁵
5. Chronic Illnesses and Medications: Chronic conditions such as chronic kidney disease or diabetes may also contribute to copper deficiency by disrupting normal copper metabolism or increasing urinary excretion of copper. In addition, certain medications, such as antibiotics, diuretics, or chelation therapy used to treat metal toxicity, can also lead to copper depletion. Pregnant women on such medications should be closely monitored for signs of copper deficiency, especially if they are also at risk due to dietary or health factors.¹⁶
6. Genetic and Hereditary Factors: In rare cases, genetic mutations that affect copper metabolism may contribute to deficiency. Disorders such as Menkes disease, a rare genetic disorder that impairs copper transport, can lead to significant copper deficiency. Although these conditions are uncommon, they can result in severe copper deficiencies in affected individuals, potentially complicating pregnancy if left undiagnosed or untreated.¹⁷

Mechanisms of Copper Deficiency in Anemia

Copper plays a crucial role in various physiological processes, and its deficiency can contribute to the development of anemia, particularly in pregnancy. The mechanisms through which copper deficiency induces anemia are complex and involve multiple pathways that disrupt iron metabolism, hematopoiesis, and red blood cell function. Below are the key mechanisms by which copper deficiency leads to anemia:

1. Impaired Iron Utilization: One of the primary mechanisms by which copper deficiency causes anemia is through its disruption of iron metabolism. Copper is an essential cofactor for the enzyme ceruloplasmin, which is responsible for oxidizing ferrous iron (Fe2+) to ferric iron (Fe3+). Ferric iron is the form that can be incorporated into transferrin, the protein responsible for transporting iron in the bloodstream. Without adequate copper, the activity of ceruloplasmin is reduced, impairing the oxidation of iron. As a result, iron cannot be efficiently utilized for hemoglobin synthesis in red blood cells, leading to iron retention in an unusable form and contributing to anemia. Despite having adequate iron stores, the body cannot properly utilize it in the absence of sufficient copper.¹⁸
2. Reduced Hemoglobin Synthesis: Copper is involved in the activity of several enzymes critical for hemoglobin synthesis. One such enzyme is cytochrome c oxidase, which plays a role in mitochondrial function and energy production, both of which are essential for hemoglobin production in erythroblasts (immature red blood cells). When copper is deficient, the synthesis of hemoglobin is impaired, and red blood cell production is compromised. This leads to a reduced number of red blood cells (erythrocytes) and decreased oxygen-carrying capacity of the blood, contributing to the development of anemia. This mechanism is particularly important in pregnancy, when there is an increased demand for hemoglobin and red blood cells to meet the needs of the growing fetus.¹⁹
3. Impaired Red Blood Cell Maturation: Copper is involved in the proper maturation of red blood cells, which occurs in the bone marrow. Copper deficiency can lead to defective erythropoiesis (red blood cell production), characterized by the production of immature and dysfunctional red blood cells. These immature cells may exhibit structural and functional abnormalities, such as decreased hemoglobin content and impaired oxygen transport capacity. Copper deficiency may also interfere with the enzymatic activity required for normal red blood cell development, leading to microcytic anemia, where the red blood cells are smaller than normal and unable to effectively transport oxygen.²⁰
4. Oxidative Stress and Membrane Integrity: Copper also plays a role in protecting cells, including red blood cells, from oxidative damage. Copper-dependent enzymes, such as superoxide dismutase, are responsible for neutralizing reactive oxygen species (ROS) that can cause oxidative damage to cell membranes, proteins, and DNA. In the absence of sufficient copper, the body’s ability to defend against oxidative stress is diminished, leading to the destruction of red blood cells. This may contribute to a phenomenon known as hemolysis, where red blood cells break down prematurely, further exacerbating anemia. Additionally, the accumulation of oxidative damage can impair the function and lifespan of red blood cells, leading to anemia due to shortened red blood cell survival.²¹
5. Impaired Immune Function and Inflammation: Copper deficiency can also contribute to anemia through its effects on the immune system and inflammation. Copper is critical for the proper functioning of the immune system, and a deficiency may result in impaired immune responses. Chronic inflammation, which is common in copper-deficient individuals, can suppress the production of red blood cells in the bone marrow, a condition known as anemia of inflammation or anemia of chronic disease. Inflammation can also disrupt the balance of iron metabolism by increasing the production of hepcidin, a hormone that inhibits iron absorption and restricts iron release from stores. This creates a situation where iron is sequestered in storage sites but is unavailable for use in red blood cell production, compounding the anemia.²²
6. Disrupted Copper-Dependent Enzyme Activity: Copper is a cofactor for several enzymes that are critical for proper cell function and overall health. Among these enzymes is tyrosinase, which is involved in melanin synthesis and plays a role in the formation of red blood cells. Copper deficiency leads to a reduction in the activity of these enzymes, further disrupting erythropoiesis and contributing to anemia. Furthermore, the lack of copper-dependent enzymes can affect overall metabolic processes, impairing the body's ability to maintain homeostasis and exacerbating the effects of anemia.²³

Clinical Implications of Copper Deficiency in Pregnancy

Copper deficiency during pregnancy can have significant and potentially serious clinical implications for both the mother and the developing fetus. The role of copper in various biological processes is critical, especially during pregnancy, when both maternal and fetal copper requirements are elevated. The clinical consequences of copper deficiency extend beyond the development of anemia and can include compromised immune function, poor fetal growth, and developmental abnormalities, highlighting the importance of early detection and appropriate management.²³

1. Anemia and Hematologic Complications: One of the most direct and clinically evident consequences of copper deficiency during pregnancy is the development of anemia. Copper deficiency impairs iron metabolism, reduces hemoglobin synthesis, and disrupts red blood cell maturation, leading to hypochromic, microcytic anemia. This condition, characterized by small, pale red blood cells, can significantly reduce oxygen delivery to tissues, which is particularly harmful during pregnancy. Maternal anemia increases the risk of fatigue, weakness, and decreased exercise tolerance, all of which can reduce the quality of life for pregnant women. Furthermore, if left untreated, anemia can exacerbate the risk of preterm labor, postpartum hemorrhage, and maternal mortality, particularly in cases where other nutritional deficiencies or underlying health conditions are present.²⁴
2. Fetal Development and Growth: Copper is essential for fetal growth and development, particularly in the formation of the brain, nervous system, and cardiovascular system. Copper deficiency during pregnancy can lead to intrauterine growth restriction (IUGR), a condition where the fetus does not grow to its expected size due to insufficient nutrients and oxygen. Copper is involved in the synthesis of collagen, a structural protein required for proper placental development and function. Deficient copper levels can lead to abnormal placental vascularization, reduced blood flow to the fetus, and compromised nutrient transfer, all of which can impair fetal growth and increase the risk of low birth weight. Studies suggest that copper deficiency may also be associated with an increased risk of preterm birth and neonatal complications, including developmental delays, due to its impact on fetal brain development.²⁵
3. Immunological Implications and Infection Susceptibility: Copper plays a crucial role in maintaining a healthy immune system, as it is involved in the activity of superoxide dismutase, an enzyme that protects cells from oxidative damage. During pregnancy, a copper-deficient state can weaken the immune response, making pregnant women more vulnerable to infections. Increased susceptibility to bacterial and viral infections can have adverse outcomes for both the mother and fetus, including prolonged labor, maternal sepsis, and fetal distress. Furthermore, copper deficiency can exacerbate the inflammatory response during infections, leading to a higher risk of anemia of inflammation or anemia of chronic disease, where iron is sequestered in storage sites and is not available for red blood cell production. This can worsen the anemia and complicate the management of copper deficiency.²⁶
4. Neurological and Developmental Deficits in the Fetus: Copper is essential for the development of the fetal brain and nervous system. Its role in the synthesis of myelin, the fatty substance that insulates nerve fibers, is vital for proper neural transmission and brain function. Copper deficiency during pregnancy can result in neurological abnormalities, including cognitive impairments and motor dysfunction in the fetus. In severe cases, copper deficiency may contribute to developmental delays or congenital defects. Additionally, inadequate copper during pregnancy may influence the expression of genes involved in brain development, leading to long-term neurodevelopmental issues for the child.²⁷
5. Maternal Health and Postpartum Recovery: Maternal copper deficiency can also affect postpartum recovery. Copper is involved in the synthesis of collagen and elastin, which are necessary for wound healing and tissue repair. Copper deficiency can impair postpartum tissue repair, increasing the risk of complications such as poor wound healing, infection, and excessive scarring after cesarean section or vaginal delivery. Moreover, copper deficiency has been linked to the development of cardiovascular issues in the mother, including an increased risk of hypertension and preeclampsia, as copper plays a role in maintaining normal blood vessel function and vascular health.²⁸
6. Potential Long-Term Effects: Long-term consequences of copper deficiency during pregnancy may extend beyond immediate maternal and fetal health. Studies have suggested that copper deficiency during pregnancy could have lasting effects on childhood health, potentially contributing to developmental and behavioral problems in later life. Deficient copper levels may influence the development of the immune system, leading to an increased risk of autoimmune diseases, allergies, or infections later in life. Additionally, copper deficiency may have implications for bone health, as copper is involved in the metabolism of collagen and bone formation, raising concerns about the long-term skeletal development of the offspring.²⁹

Diagnostic Approaches for Copper Deficiency in Pregnancy

Accurate diagnosis of copper deficiency during pregnancy is essential for preventing its adverse effects on both maternal and fetal health. However, diagnosing copper deficiency is challenging, as the symptoms can overlap with other common pregnancy-related conditions, such as anemia or fatigue. There is no single, definitive test for copper deficiency, and clinicians must rely on a combination of clinical signs, laboratory tests, and patient history to make a proper diagnosis.

1. Clinical Assessment: The initial step in diagnosing copper deficiency during pregnancy involves a comprehensive clinical evaluation. Symptoms of copper deficiency, such as fatigue, weakness, pallor, hair loss, and neurological disturbances, can be subtle and often attributed to other pregnancy-related conditions. Anemia is one of the most common signs of copper deficiency, and it may present as microcytic, hypochromic anemia, similar to iron deficiency anemia. Additionally, neurological symptoms, such as numbness, tingling, and difficulty walking, may suggest impaired nerve function due to insufficient copper levels. However, because these symptoms are non-specific, a clinical assessment alone may not provide conclusive evidence of copper deficiency.³⁰
2. Serum Copper and Ceruloplasmin Levels: Laboratory tests measuring serum copper and ceruloplasmin levels are commonly used to assess copper status. Serum copper levels reflect the total copper present in the bloodstream, while ceruloplasmin, a copper-dependent enzyme, serves as a more specific marker of copper status. Ceruloplasmin is synthesized in the liver and is the primary copper-carrying protein in the blood. A decrease in ceruloplasmin levels can indicate copper deficiency. However, these markers can be influenced by other factors, such as inflammation, infection, and liver disease, which may lead to false interpretations. In pregnancy, ceruloplasmin levels tend to increase due to hormonal changes, which can complicate the diagnosis of copper deficiency.³¹
3. Urinary Copper Excretion: Urinary copper excretion is another diagnostic tool that can be useful in detecting copper deficiency. Copper is excreted through the urine, and a low level of urinary copper can suggest insufficient copper intake or absorption. However, urinary copper levels may be affected by various factors, including hydration status and renal function, which can make interpretation more challenging. As such, urinary copper is often used in conjunction with other tests to provide a more comprehensive picture of copper status.³²
4. Red Blood Cell (RBC) Copper Levels: Since copper is involved in several enzymatic reactions within red blood cells, measuring copper levels within these cells can offer valuable insights into copper deficiency. RBC copper levels are typically assessed using atomic absorption spectrometry or inductively coupled plasma mass spectrometry. This test provides a more direct measure of copper in erythrocytes, which is useful for diagnosing copper deficiency when other markers are inconclusive. However, this test is not commonly available in routine clinical practice due to its complexity and cost.³³
5. Hematological Tests: Hematological tests that assess red blood cell morphology, hemoglobin content, and overall blood cell counts can support the diagnosis of copper deficiency-induced anemia. In copper deficiency, blood tests typically reveal microcytic and hypochromic anemia with small and pale red blood cells. A complete blood count (CBC) is often the first step in assessing anemia, followed by iron studies to rule out iron deficiency. When copper deficiency is suspected, additional tests like serum ferritin and transferrin saturation may be performed to differentiate between copper deficiency and iron deficiency anemia, which share similar hematologic features.³⁴
6. Genetic Testing: In some cases, copper deficiency may result from genetic mutations affecting copper transport or metabolism. Menkes disease, a rare genetic disorder caused by mutations in the ATP7A gene, leads to defective copper transport, resulting in copper deficiency. While genetic testing is not routinely performed for copper deficiency in pregnancy, it may be considered in cases of severe deficiency or if other underlying genetic conditions are suspected. Genetic testing can help confirm the diagnosis of disorders related to copper metabolism, providing additional insight into the cause of copper deficiency.³⁵
7. Imaging and Other Advanced Tests: Although not commonly used in routine clinical practice, magnetic resonance imaging (MRI) and other advanced imaging techniques may be employed in cases where neurological deficits are suspected as a result of copper deficiency. Copper is vital for brain development, and its deficiency can lead to neurological abnormalities, including cognitive impairment and motor dysfunction. MRI scans may reveal changes in brain structure or function associated with copper deficiency, although these findings are not always definitive.

Management Strategies for Copper Deficiency in Pregnancy

The management of copper deficiency during pregnancy is critical to ensure both maternal and fetal health. Copper plays an essential role in various biological processes, including iron metabolism, immune function, and fetal development. Addressing copper deficiency early can help prevent the serious consequences that may arise, such as anemia, poor fetal growth, and neurological complications. The management strategies focus on improving copper intake through diet, supplementation, and addressing any underlying conditions that may contribute to the deficiency.

1. Dietary Modifications: One of the first steps in managing copper deficiency is through dietary changes. Copper-rich foods, such as shellfish (oysters, lobster), organ meats (liver), nuts (cashews, almonds), seeds (sunflower seeds), legumes (lentils, chickpeas), and whole grains (oats, quinoa), should be encouraged. Dark chocolate, mushrooms, and avocados are also excellent sources of copper. Pregnant women should be advised to include these copper-rich foods in their daily diet to help meet the increased copper demands during pregnancy. However, dietary intake alone may not always be sufficient to correct a deficiency, particularly in cases where absorption is impaired or dietary intake is insufficient.³⁶
2. Copper Supplementation: When dietary intake is not enough or when copper deficiency is diagnosed, copper supplementation becomes essential. Copper supplements are typically available in the form of copper sulfate or copper gluconate. These supplements can be taken orally, with the recommended dose generally ranging from 1 to 3 mg per day, depending on the severity of the deficiency and the individual needs of the pregnant woman. Copper supplementation should always be done under medical supervision, as excessive copper intake can lead to toxicity, which may result in gastrointestinal disturbances and liver damage. In cases of severe deficiency, intravenous copper supplementation may be considered, particularly if oral supplementation is ineffective or if the patient has gastrointestinal malabsorption.³³
3. Addressing Underlying Conditions: Copper deficiency during pregnancy can be exacerbated by certain underlying conditions, such as malabsorption syndromes (e.g., celiac disease, Crohn’s disease) or gastrointestinal surgeries that impair nutrient absorption. In these cases, it is crucial to manage the underlying condition in parallel with copper supplementation. For example, individuals with celiac disease may require a gluten-free diet to improve nutrient absorption, while those with inflammatory bowel disease may benefit from medications that help reduce inflammation and improve nutrient absorption. In addition, the management of iron deficiency anemia should be considered, as the two conditions often coexist and may have overlapping symptoms. However, supplementation with iron should be done cautiously to avoid exacerbating copper deficiency, as high iron levels can interfere with copper absorption.³⁴
4. Monitoring and Regular Follow-ups: Ongoing monitoring of copper levels, along with hemoglobin and hematocrit tests, is essential to assess the effectiveness of treatment. Regular follow-up appointments should include laboratory tests, such as serum copper and ceruloplasmin levels, to track improvement. Complete blood counts (CBC) and iron studies should also be performed to monitor for any signs of anemia or other nutrient deficiencies. Additionally, the pregnant woman should be monitored for any side effects of copper supplementation, including gastrointestinal discomfort or potential signs of copper toxicity. Adjustments to the supplementation regimen may be necessary based on the patient's response to treatment.³⁵
5. Preventive Strategies: Preventing copper deficiency during pregnancy is an important aspect of managing maternal health. Pregnant women, particularly those at higher risk of deficiency (e.g., those with multiple pregnancies, poor nutritional intake, or gastrointestinal disorders), should receive appropriate counseling on maintaining a balanced diet rich in copper. In some cases, prenatal vitamins containing copper may be recommended to provide a steady supply of essential nutrients. Additionally, healthcare providers should be aware of the early signs of copper deficiency, such as fatigue, pallor, and neurological symptoms, to allow for prompt intervention before more serious complications develop.³⁶
6. Integrated Nutritional Care: An integrated approach to nutritional care is essential for managing copper deficiency in pregnancy. This includes not only copper supplementation but also ensuring that other important micronutrients, such as iron, vitamin B12, folate, and vitamin A, are adequately addressed. Many of these nutrients interact with copper in metabolic pathways, and deficiencies in one can exacerbate deficiencies in others. For example, both copper and iron are involved in the formation of red blood cells, and an imbalance can result in worsened anemia. Therefore, a comprehensive, multi-nutrient approach to pregnancy nutrition should be emphasized, with appropriate supplementation tailored to the needs of the pregnant woman.
7. Patient Education: Educating pregnant women about the importance of copper during pregnancy and the potential risks of deficiency is a crucial part of management. Patients should be informed about the symptoms of copper deficiency, such as fatigue, anemia, and neurological issues, and be encouraged to seek medical advice if they experience these symptoms. They should also be educated on how to incorporate copper-rich foods into their diets and the potential role of supplements if dietary intake is inadequate. Additionally, women should be informed about the potential risks of copper toxicity, especially when taking supplements, and advised on the importance of following recommended dosages.³⁶

Conclusion

Copper deficiency during pregnancy, though less commonly recognized than iron deficiency, plays a critical role in maternal and fetal health. The increased demand for copper during pregnancy, coupled with potential factors that impair its absorption, places some women at risk of deficiency. Copper is essential for various physiological processes, including red blood cell formation, immune function, and fetal development. When left unaddressed, copper deficiency can lead to adverse outcomes such as anemia, poor fetal growth, and neurological impairments. Effective management of copper deficiency involves a combination of dietary modifications, copper supplementation, and the management of underlying conditions that may contribute to the deficiency. Regular monitoring and follow-up care are crucial for ensuring that copper levels return to normal and that any associated complications, such as anemia, are managed appropriately. Preventive strategies, including dietary counseling and the use of prenatal vitamins, can help mitigate the risk of deficiency, particularly in at-risk populations. 

Conflict of Interest: Author declares no potential conflict of interest with respect to the contents, authorship, and/or publication of this article.

Source of Support: Nil

Funding: The authors declared that this study has received no financial support.

Informed Consent Statement: Not applicable. 

Data Availability Statement: The data supporting in this paper are available in the cited references. 

Ethics approval: Not applicable.

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30. Obeagu EI, Obeagu GU. Enhancing Maternal and Fetal Well-being: The Role of Antioxidants in Pregnancy. Elite Journal of Medical Sciences. 2024;2(4):76-87.

31. Obeagu EI, Obeagu GU. Antioxidant Supplementation and Prevention of Early Pregnancy Loss: A Narrative Review. Int. J. Curr. Res. Chem. Pharm. Sci. 2024;11(9):28-37. https://doi.org/10.22270/ijmspr.v10i4.120

32. Obeagu EI, Obeagu GU. Molar Pregnancy: Update of prevalence and risk factors. Int. J. Curr. Res. Med. Sci. 2023;9(7):25-8. https://doi.org/10.19080/JGWH.2023.25.556169

33. Obeagu EI, Obeagu GU. Hypoxia-induced Metabolic Changes in Pregnancy: Clinical Perspectives. Elite Journal of Medicine. 2024;2(8):50-9.

34. Obeagu EI, Obeagu GU. Hemolysis Challenges for Pregnant Women with Sickle Cell Anemia: A Review. Elite Journal of Haematology. 2024;2(3):67-80.

35. Obeagu EI, Obeagu GU, Ezeonwumelu JO. Safety and Efficacy of Blood Transfusions in Pregnant Women. Elite Journal of Haematology, 2024; 2 (3).:96-106.

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