Abstract
BackgroundSeveral biomarkers are used to measure iron deficiency (ID) during pregnancy, but the prevalence of ID and its association with adverse birth outcomes shows inconsistent results. The aim of this study was to examine the prevalence of ID in third trimester using multiple indicators of iron status and the relationship with birth outcomes in Chinese population.MethodsWe conducted a retrospective observational cohort study of 11,581 pregnant women between 2016 and 2017 in Changzhou City, Jiangsu Province, China. We obtained the data (maternal characteristics and birth outcomes) and the concentrations of ID biomarkers from our hospitalization information system and laboratory information system, respectively. Using serum ferritin (SF), serum transferrin (ST) and their ratio as criteria of ID, we investigated associations between birth outcomes and late pregnancy ID.ResultsThe prevalence of ID in our study was 51.82% as defined by low SF (< 12 μg/L), 54.43% as defined by high ST (> 4 g/L) and 53.90% as defined by high ratio of ST/SF (Log 10 transform > 5.52). Maternal ST/SF ratio was associated with higher mean birth weight (97.04 g; 95% CI, 74.28, 119.81 for the highest vs. lowest quartile). Third trimester maternal ID, defined by ST/SF ratio, was associated with lower risks of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) infants, higher risks of macrosomia and large for gestational age (LGA) babies (for PTB: OR = 0.53, 95% CI, 0.36–0.77; for LBW: OR = 0.44, 95% CI, 0.31–0.62; for SGA: OR = 0.69, 95% CI, 0.57–0.83; for macrosomia: OR = 1.39, 95% CI, 1.13–1.70; for LGA: OR = 1.20, 95% CI, 1.04–1.39).ConclusionsID in the third-trimester of pregnancy are frequent in Chinese women. Our findings suggest that the ratio of ST/SF measured in late pregnancy could be useful as a significant predictor of unfavorable birth outcomes.
Highlights
Several biomarkers are used to measure iron deficiency (ID) during pregnancy, but the prevalence of ID and its association with adverse birth outcomes shows inconsistent results
Definitions of the outcomes We considered gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), preeclampsia (PE) and pregnancy-induced hypertension (PIH) as major pregnancy complications; and preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia as unfavorable birth outcomes
The incidence of GDM, ICP, PE and PIH, which were considered as major pregnancy complications, was 8.37% (969), 6.18% (716), 3.44% (398) and 2.12% (246) respectively
Summary
Several biomarkers are used to measure iron deficiency (ID) during pregnancy, but the prevalence of ID and its association with adverse birth outcomes shows inconsistent results. The aim of this study was to examine the prevalence of ID in third trimester using multiple indicators of iron status and the relationship with birth outcomes in Chinese population. Few data have been reported regarding the prevalence of ID using these multiple iron indicators from Chinese large, populationbased study The aims of this observational study were to explore the relationship between maternal iron status in the third trimester and adverse birth outcomes in Chinese pregnant women, while taking into account systemic inflammation as measured by high sensitivity C-reactive protein (hsCRP) and anemia as measured by hemoglobin
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