Abstract
ABSTRACT Background: Iron supplementation in pregnancy is recommended by the WHO to prevent a major public health problem, namely, maternal iron deficiency and its consequences. There are gaps in the existing evidence regarding maternal and neonatal benefits and harms of universal iron supplementation. Objective: To evaluate the association between maternal iron status during pregnancy and infant size at birth (birth weight and length). Method: This present prospective cohort study was nested in a food and micronutrient supplementation trial conducted in Matlab (MINIMat study), rural Bangladesh. We randomly selected 573 women recruited into the MINIMat study from January – December 2002 who delivered singletons with available birth anthropometric information. The plasma ferritin of each mother was measured at gestational week 14 (GW14; before the start of micronutrient supplementation) and at week 30 (GW30). Results: Multivariable linear regression revealed no association between plasma ferritin at GW14 and birth weight. However, newborns of women in the highest tertile of plasma ferritin at GW30 (median = 29 µg/L) had on average a 93-gm lower birth weight (95% CI: −172, – 14; p = 0.021) than the newborns of women in the lowest tertile (median = 8 µg/L). Logistic regression showed that odds of low birth weight were approximately two times higher [odds ratio (OR) = 2.27; 95% CI: 1.40, 3.67] among those with mothers in the highest ferritin tertile than in the lowest tertile at GW30. No association was found between maternal plasma ferritin and birth length. Conclusion: We observed an inverse association between high plasma ferritin in the last trimester (GW30) and birth weight but not birth length. The results suggested that elevated plasma ferritin in pregnancy could have an untoward effect on birth weight.
Highlights
Iron supplementation in pregnancy is recommended by the WHO to prevent a major public health problem, namely, maternal iron deficiency and its consequences
If the body iron store is deficient at conception, it is unlikely that dietary iron would be able to match the pregnancy-induced increase in demand [3]
1000 women were randomly selected for assessment of micronutrient status during pregnancy
Summary
Iron supplementation in pregnancy is recommended by the WHO to prevent a major public health problem, namely, maternal iron deficiency and its consequences. Iron deficiency results from depletion of stored iron. Increased iron demand dur ing pregnancy can worsen this, resulting in irondeficient erythropoiesis and, eventually, iron defi ciency anemia [2]. If the body iron store is deficient at conception, it is unlikely that dietary iron would be able to match the pregnancy-induced increase in demand [3]. While ferritin is the most commonly used indicator [4], providers often rely on Hb levels to assess iron deficiency at the population level. This use of Hb levels is problematic for two reasons. Physiological expansion of plasma volume during pregnancy leads to a lowering of hemoglobin (Hb) concentration, irrespective of the iron status
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