Additional Iron Supplementation Research Articles

PSIV-14 Assessing sow and suckling pig hemoglobin status in a single lactation following one or two iron supplementations of piglets in a commercial farm

Abstract Newborn piglets are typically anemic at birth [defined as blood hemoglobin concentration (Hb) < 10 g/dL] and sow’s milk contains negligible amounts of iron; common commercial practice is one dose of injectable iron in the first week of life. However, a considerable proportion of piglets have decreased Hb at weaning which may have implications on post-wean performance. Thus, there is interest in additional iron supplementation before weaning. The primary objective of this study was to evaluate the impact of one or two iron supplementations on offspring performance. A total of 172 sows (parity 1 to 8) and litters (n = 2,378 piglets) were assigned in a randomized complete block design to Control [piglets received one injectable iron dose (400 mg)], SUPoral (injectable iron as Control plus oral iron supplement at 1oz/litter per day for 8 d before weaning), or SUPinject (injectable iron as Control plus 100 mg 7 d before weaning). According to barn stand protocol, the first iron dose was provided to all piglets on d 7 after the initiation of farrowing. Sow Hb status was determined at entry to farrowing house and weaning; -Hb status of all born alive piglets was measured within 28 of birth and at weaning. Analysis of variance compared the effect of iron supplementation, parity, and their interaction on piglet Hb status. Sow Hb at entry (9.3, 10.4, and 9.6 g/dL ± 0.15, respectively) was less (P < 0.001) for parity 4-8 sows than parity 1, with parity 2-3 intermediate and no difference between parity groups at weaning (9.5 g/dL ± 0.16). Litter size at birth (total or born alive) and preweaning mortality did not differ between treatments. Piglet Hb at birth was not different between treatments; however, 85% of piglets from parity 4-8 sows were deemed anemic at birth compared with 72 and 76% in parity 1 and 2-3 sows, respectively (P < 0.05). Immediately before additional iron supplementation, Control piglets had lower (P < 0.0001) Hb than SUPoral and SUPinject piglets (7.4 vs 8.0 and 8.1 g/dL ± 0.12, respectively). At weaning, there were no differences in piglet Hb by iron supplementation treatments (11.4 g/dL ± 0.07). However, the percentage of piglets within a litter deemed anemic at weaning was greater (30%; P < 0.011) in parity 4-8 sows compared with parity 1 sows at 13%. There was no difference in piglet body weight at weaning between treatment groups or by parity grouping. In this study, additional iron supplementation before weaning had minimal impact on piglet iron status or growth. The decreased Hb at entry in older sows combined with greater proportion of anemic piglets at birth or weaning suggests greater attention to sow iron intake may be warranted.

Non Breast-Milk-Fed Very Preterm Infants Are at Increased Risk of Iron Deficiency at 4-6-Months Corrected Age: A Retrospective Population-Based Cohort Study.

Iron supplementation is routinely recommended for breast-milk-fed preterm infants. However, the Canadian Pediatric Society recommends no additional iron supplementation for preterm infants fed primarily with iron-rich formula. Other pediatric societies don't provide specific guidance on supplemental iron for formula-fed preterm infants. This study investigated how feeding type influences iron status of very preterm infants at 4-6-months corrected age (CA). A retrospective cohort study was conducted using a population-based database on all very preterm infants (<31 weeks gestational age) born in Nova Scotia, Canada from 2005-2018. Information about feeding type, iron intake from formula, supplemental iron therapy and iron status at 4-6-months CA was extracted. Iron deficiency (ID) was defined as serum ferritin <20 and <12 µg/L at 4-and 6-months CA, respectively. Of 392 infants, 107 were "breast-milk-fed" (exclusively or partially) and 285 were "not breast-milk-fed" (exclusively fed with iron-rich formula) at 4-6-months CA. Total daily iron intake was higher in the non-breast-milk-fed group (2.6 mg/kg/day versus 2.0 mg/kg/day). Despite this, 36.8% of non-breast-milk-fed infants developed ID versus 20.6% of breast-milk-fed infants. ID is significantly more prevalent in non-breast-milk-fed infants than breast-milk-fed infants despite higher iron intake. This suggests the need to revisit recommendations for iron supplementation in non-breast-milk-fed preterm infants.

Effect of vitamin C and iron supplementation in pregnant hyper-prolific sows

Sow nutrition plays a crucial role impact on fetal and neonates’ development, lactation and lifetime production of piglets. In this field study, our aim was to evaluate the impact of two feed supplements, namely vitamin C (VC group) and a combination of vitamin C and ferrous sulfate (VC+Fe group), administered during the last trimester of pregnancy, on sow's blood hemoglobin (Hb) concentration and individual birth weight of piglets. The sows came from hyper-prolific genetic lines (Topigs Norsvin Ninety pregnant sows were randomly divided into three groups: 31, 29 and 30 individuals for the C (control), VC and VC+Fe groups, respectively. We measured individual Hb concentration I (Hb I) on day 76 of pregnancy for all groups, prior to the start of supplementation in the VC and VC+Fe groups. A second measurement (Hb II; antepartum hemoglobin) occurred 2–4 days before the estimated farrowing date for each sow. We recorded the individual birth weight (kg) of 376 piglets in the C group, 403 piglets in the VC group, and 392 piglets in the VC+Fe group. Both the VC and VC+Fe groups showed improvement in Hb II (P = 0.005), improving their hematological status; however, there was no significant advantage of VC+Fe over VC in terms of Hb II. The effect of group on individual birth weight of piglets varied depending on the parity of the mother (P = 0.001). The supplementation with both VC and VC+Fe demonstrated positive effects on the birth weight of piglets, but only in sows with parity 1 and 2 (P < 0.001). These results suggest that additional iron supplementation did not confer significant benefits beyond what was already provided in the pregnancy feed. Therefore, the inclusion of vitamin C supplementation alone appears to be sufficient.

31 Iron Deficiency in Formula-fed Very Preterm Infants: Do We Need to Revise Recommendations for Iron Supplementation?

Abstract Background Preterm infants are at risk for iron deficiency (ID). The Canadian Paediatric Society (CPS) recommends iron supplementation of 2 to 3mg/kg/day for breastfed (BF) preterm infants born &amp;lt;2 kg. Additional iron supplementation is not recommended if these infants are primarily formula-fed (FF) with iron-rich formula, since formula is thought to provide enough iron. However, these recommendations are not universally accepted. Objectives To investigate how feeding type influences the iron status of very preterm infants (VPI) at 4 to 6 months corrected age. Design/Methods A retrospective population-based cohort study was conducted using a provincial database of all VPI (&amp;lt;31 weeks gestational age) born in Nova Scotia from 2005-2018. Information about feeding type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. Two groups were compared using chi-square and unpaired t-tests. Results 392 infants were studied (gestational age: 23-30 weeks). Of these, 285 were exclusively FF with iron-rich formula, and 107 were exclusively or partially BF. Neonatal variables were comparable between the two groups. An elemental iron intake of &amp;gt;2 mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were less likely to receive additional iron supplements. However, total iron intake (from formula and supplements) was higher in FF infants. Despite this, 36.8% of infants in FF group developed ID, versus 20.6% in the BF group (Table 1). Conclusion Most VPI fail to receive elemental iron of &amp;gt;2 mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than in BF infants, despite higher iron intake. Our findings do not support the current CPS guidelines.

Oral iron supplementation exacerbates dextran sulfate sodium (DSS)-induced colitis in mice

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by diarrhea, abdominal pain, and bloody, mucous-laden stools. In one-third of UC patients, severity of blood loss is sufficient to cause iron deficiency anemia, making it the most common extra-intestinal manifestation of UC. Oral iron supplementation is the first line treatment for IDA. However, there is a debate concerning the safety of orally administered iron, as some studies have reported an exacerbation of disease, whereas others report the treatment is well tolerated and effective. Aim: The purpose of this study was to determine the effect of oral iron administration on disease activity in dextran sulfate sodium (DSS)-induced colitis in mice, a model that effectively recapitulates ulcerative colitis. Hypothesis: We hypothesize that iron-supplemented chow will increase disease activity and lead to pathogenic changes in mice with DSS-induced colitis. Methods: Experimental acute colitis (UC) was produced in BALBc/AnNCrl (male and female; 7 weeks old) mice by administration of 3% DSS dissolved in drinking water for 7 days. Control mice received standard water. Normal control (NC) and UC (UC) animals were fed standard chow contained 200 parts per million (ppm) ferrous sulfate (2018 Teklad Global 18% Protein Rodent Diet, Huntingdon, UK), while normal (NCFe) and UC (UCFe) experimental animals were fed an iron-supplemented diet containing 600 ppm ferrous sulfate (2018 Teklad Global 18% Protein Rodent Custom Diet, Huntingdon, UK). Food and water were provided ad libitum. Daily scores for weight loss, stool consistency, and fecal blood content were averaged to produce a disease activity index as previously described by Friedman and co-workers (DAI, 2009). On day-8 post-treatment, mice were euthanized with 5% isoflurane. Length of colon was measured from cecum to rectum, and epithelial cells were isolated from distal colon by EDTA chelation technique. Histopathology, RNA isolation, and qRT-PCR analyses were performed using standard techniques. Results: Food and water consumption were not significantly altered among the 4 groups of mice. Additional iron supplementation significantly: 1) increased DAI; 2) decreased fecal dry weight; and 3) increased blood inflammatory cytokine levels in UCFe as compared to UC group. Colon length was shortened one-third in UC as compared to NC, but was not further significantly altered by iron supplementation. Loss of crypt architecture and increased influx of inflammatory cells identified in UC colon was not significantly altered in colons from the UCFe group. Expression of apical iron importer DMT1 was increased in UC as compared to NC, but not in the UCFe group. In total, there were no differences due to iron supplementation, and no differences were present due to gender. Conclusion: We conclude that iron supplementation increases the severity of colitis by stimulating water secretion. This study was supported by the National Institute of Health NIDDK DK104791 and DK112085 grants This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Benefits and Side Effects of Iron-Folate Tablet Supplementation among the Female Adolescent Garment Workers

Introduction: Among adolescent girls, iron deficiency is not uncommon due to various factors. During this period, iron deficiency anemia can greatly impact various factors of daily life, and additional iron supplementation might be needed. Aim of the Study: The aim of the study was to observe the benefits and side effects of iron folate tablet supplementation in adolescent women garments workers. Methods: This cross-sectional observational and descriptive study was conducted with the female adolescent garment workers of one garment factory located in the Narayangonj district. The data collection for the study was done in a very short period of time, from the 1st week of April to the 2nd week of July 2002, which led to a small sample size of 188 adolescent female workers. Result: Among the participants, 98.40% were Muslim, over half the participants were unmarried, 46.28% had been illiterate, and 51.06% had education up to class 1-3, Among the 81 married cases, 45.68% had husbands who received education from class 1-5, 48.94% had 2- 5 family member, 46.81% had 6-9 family members, and 4.26% had 10-12 family members. The financial characteristics of the participants revealed that 35.11% had 1500-3000 monthly income, 58.51% of the participants had 3-5 earning members, and 40.96% had only 1-2 earning member’s Per capita income was between 286-600 for 34.57% of participants, between 601-1000 for 53.19% participants. It was observed that in 3rd week, 43.62% had good health, 28.72% had increased work performance, and 13.83% had been free from sickness. By 4th week, 38.83% had good health, 25.00% had increased work performance and 10.11% had been free from sickness, which was true for the following weeks as well. In terms of side effects, anorexia, constipation, black stool, and vomiting were observed, with the highest frequency in 4th week of iron supplementation. Conclusion: The study observed that socio-demographic factors had no effect on the acceptance or reluctance ...

Impact of donor ferritin testing on iron deficiency prevention and blood availability in France: A cohort simulation study.

Implementing a ferritin testing policy for whole blood (WB) donors may prevent iron deficiency (ID, ferritin <26 ng/mL) and anaemia, but may induce donation losses. As part of a national prevention plan in France, we aimed to estimate its impact on ID, anaemias and WB donations among donors at high risk of ID. A micro-simulation model was developed to evaluate different scenarios compared to the current situation without ferritin testing as a reference scenario. The following scenarios were simulated: a minimum scenario with a 6-month deferral for donors with absent iron store (AIS, ferritinemia <15 ng/ml), a main scenario with additional delayed invitations for donors with ferritinemia 15-25 ng/ml and a supplementation scenario with additional iron supplementation for 50% of the donors with AIS. In the main scenario, 52,699 WB donations per year were estimated to be lost after 1 year (-8%), falling to 27,687 (-4.7%) after 5 years. IDs and anaemias were reduced by 13.6% and 29.3%, respectively, after 1 year. The supplementation scenario increased the number of prevented IDs and anaemias to 24.1% and 35.4%, respectively, after 1 year, and halved the number of anaemias at 5 years. The latter scenario also had the least impact on the number of donations (-3.2% after 5 years). A ferritin testing policy resulting in delayed donations for ID donors is effective in reducing IDs and anaemias, but significantly impacts the number of donations, thereby posing a self-sufficiency challenge.

Formula Feeding Significantly Increases Risk of Iron Deficiency in Very Preterm Infants during the First 4-6 Months of Life

Introduction: Iron deficiency (ID) early in life is associated with adverse neurodevelopmental and behavioural outcomes later in life. Preterm infants are considered at increased risk of developing ID due to their relative lack of iron stores, accelerated growth during the first few weeks of life and multiple phlebotomies received while in hospital. Breast fed (BF) preterm infants are considered at particularly increased risk of ID due to the lower iron content of breast milk. Therefore, iron supplementation is routinely recommended for these infants. However, the supplemental iron requirements of formula fed (FF) preterm infants are generally deemed to be lower due to the presence of iron in formulas. The Canadian Pediatric Society recommends no additional iron supplementation for preterm infants with a birth weight <2kg if they are primarily FF with iron-rich formula. The American Academy of Pediatrics makes no general recommendation for iron supplementation in infants fed primarily with iron-rich formula. The primary objective of this study was to investigate how feeding type influences the iron status of very preterm infants at 4-6-months corrected age (CA). A secondary objective was to further explore the risk factors associated with ID in the FF group. Methods: A retrospective population-based cohort study was conducted at IWK Health using the Perinatal Follow-Up Program database, a provincial database containing relevant clinical information for all very preterm infants (<31 weeks gestational age) born in the province of Nova Scotia, Canada. All very preterm infants born in Nova Scotia from 2005-2018 were included. Infants with severe congenital malformations, chromosomal anomalies and/or hemolytic anemias were excluded. Information about presence of ID, feeding type, iron intake from formula, and supplemental iron therapy at 4-6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin <20 and <12 mcg/L at 4-and 6-months CA, respectively. Variables were compared between the FF and BF groups using chi square and unpaired t-tests. The FF group was further divided into ID and non-ID groups, which were compared using similar analysis techniques. Results: A total of 392 infants were studied (gestational age: 23-30 weeks; 55.75% male). Of these, 285 were exclusively FF with iron-rich formula and 107 were exclusively or partially BF. Mean birth weight, gestational age and neonatal variables were comparable between the two groups. Mean iron intake from formula in the FF group was 1.66 mg/kg/day. An elemental iron intake of ≥ 2mg/kg/day was obtained from formula alone in only 20.4% of FF infants. FF infants were also less likely to receive additional iron supplements (Table 1). However, mean total daily iron intake (from formula and supplements) was higher in the FF group. Despite this, 36.8% of infants in FF group developed ID versus 20.6% in BF group (p=0.002). Table 2 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were both lower in the ID group. The ID group also had a higher percentage of infants born <1100g (p=0.01). More babies in the ID group received at least one blood transfusion (Odds:1.1-3.0). Other neonatal variables were comparable between the two groups. ID infants had a higher daily formula intake, daily iron intake from formula and total daily iron intake combined from formula and supplements. Conclusion: Most very preterm infants fail to receive elemental iron of 2mg/kg/day from formula alone. ID is significantly more prevalent in FF infants than BF infants despite higher iron intake overall. A possible explanation for this finding could be that the bioavailability of iron from formula is lower than from breast milk. Breast milk contains lactoferrin, which aids iron absorption. Thus, iron from breast milk may be better absorbed than iron from formula. Our observations suggest the need to revisit the international recommendations for iron supplementation in FF very preterm infants. Lower gestational age, lower birth weight and need for blood transfusions were associated with ID in FF infants. Plausibly, blood transfusions may lead clinicians to withhold necessary iron supplementation for fear of iron overload in these infants, leading to unintentional ID. We suggest that optimal iron supplementation in this population should be guided by a risk adapted strategy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Highlights from the International Twins Congress 2021

Highlights from the International Twins Congress 2021

Anemia Prevalence and Iron Supplementation Practices Among Pregnant Women in Vancouver, Canada

ObjectivesHealth Canada recommends supplementation with 16–20 mg iron during pregnancy to maintain adequate iron stores and reduce the prevalence of iron deficiency. Most prenatal vitamins contain 27 mg iron (the recommended dietary allowance). In the case of diagnosed iron deficiency (typically defined as a ferritin concentration < 15–50 μg/L), some pregnant women may be recommended to take additional iron. Iron is an essential nutrient and adequate intake is needed for a healthy pregnancy; however, excess iron can also be harmful. We aimed to evaluate the hematological profile, prevalence of anemia, and iron supplementation practices of healthy pregnant women in Vancouver, Canada. MethodsAs part of an ongoing clinical trial, 40 healthy pregnant women (aged 19–42 years) received prenatal vitamins containing 27 mg iron over 16 weeks of pregnancy, starting at 9–21 weeks gestation. A complete blood count was measured at baseline and endline. Anemia was defined as hemoglobin < 110 g/L in the first/third trimesters and < 105 g/L in the second trimester. Microcytic anemia (most commonly caused by iron deficiency) was defined as having both anemia and a MCV concentration < 80 fL. Participants reported other supplement use throughout the study, including additional iron prescribed for treatment of iron deficiency and/or anemia. ResultsAt baseline and endline, the mean ± SD of hemoglobin was 124 ± 9 g/L and 127 ± 11 g/L; and for MCV was 89 ± 3 fL and 91 ± 3 fL, respectively. Based on hemoglobin (trimester-specific) and MCV thresholds, no participants were classified as having anemia or microcytic anemia at either timepoint, respectively. At endline, a total of n = 8 women (20%) reported that following their baseline visit (during the intervention period) they were informed by their health care provider to increase their supplemental dose of iron up to 300 mg, in addition to the 27 mg in the study prenatal vitamin. ConclusionsWhether recommendation for additional iron was warranted in 20% of women is unclear, as none had microcytic anemia based on hemoglobin and MCV values. Measurement of ferritin is warranted for the definitive diagnosis of iron deficiency, and to elucidate if there is a need for improved clinical practices for recommending additional iron supplementation. Funding SourcesHealthy Starts Catalyst Grant (BC Children’s Hospital Research Institute, Vancouver, Canada).

Reticulocyte hemoglobin content as a function of iron stores at 35–36 weeks post menstrual age in very premature infants

Background Premature infants are born with lower iron stores and are at risk for iron deficiency during early infancy. To prevent iron deficiency, premature infants are routinely supplemented with 2 mg/kg/day oral elemental iron. Reticulocyte hemoglobin content (RET-He), a measure of iron deficiency, has not been well evaluated prior to discharge in premature infants. Objectives Our objectives were to evaluate RET-He and its correlation with serum ferritin (SF), an index of iron stores, at 35–36 weeks postmenstrual age (PMA) in ≤32 weeks gestational age (GA) infants. Methods We performed a prospective nested study involving 24–32 weeks GA infants who were receiving 2 mg/kg/day oral elemental iron with full enteral feedings at 35–36 weeks PMA. Infants with the following conditions were excluded: craniofacial malformation, chromosomal disorders, TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex), culture-proven sepsis, C-reactive protein >5 mg/l within 10 days of iron status assessment, or erythropoietin therapy. SF and RET-He were measured at 35–36 weeks PMA using chemiluminescence immunoassay and Sysmex XN hematology analyzer, respectively. RET-He <27 pg was deemed indicative of iron deficiency. Results Ninety-eight infants were studied, of which 21 infants had RET-He <27 pg. There was a positive correlation between RET-He and SF (coefficient 0.22, p = .03) that remained significant after controlling for GA (coefficient 0.21, p = .03) and frequency of prior erythrocyte transfusions (coefficient 0.21, p = .03). On stratified analysis, there was a positive correlation between SF and RET-He in females (N = 52, coefficient 0.23, p = .02), but not in males (N = 46, coefficient 0.05). Conclusions Most premature infants receiving 2 mg/kg/day oral elemental iron are iron replete for erythropoiesis at 35–36 weeks PMA. RET-He increases with an increase in iron stores, suggesting that additional iron supplementation prior to discharge to very premature infants with borderline low RET-He may help prevent iron deficiency during early infancy.

Iron deficiency and anemia in iron-fortified formula and human milk-fed preterm infants until 6 months post-term

An iron intake of >2 mg/kg/d is recommended for preterm infants. We hypothesized that human milk (HM)-fed preterm infants require iron supplementation after discharge, whereas iron-fortified formulae (IFF; 0.8-1.0 mg iron/100 ml) may provide sufficient dietary iron until 6 months post-term. At term age, 3 and 6 months post-term, ferritin (μg/l) was measured in 92 IFF-fed infants (gestational age (median (interquartile range)) 30.7 (1.4) weeks, birth weight 1,375 (338) gram) and 46 HM-fed infants (gestational age 30.0 (1.7) weeks, birth weight 1,400 (571) gram). Iron intake (mg/kg/d) between term age and 6 months post-term was calculated. Iron was supplemented to 71.7% of HM-fed and 83.7% of IFF-fed infants between term age and 3 months post-term and to 13% of HM-fed and 0% of IFF-fed infants between 3 and 6 months post-term. IFF-fed infants had an iron intake from supplements and formula of 2.66 (1.22) mg/kg/d between term age and 3 months post-term and 1.19 (0.32) mg/kg/d between 3 and 6 months post-term. At 3 and 6 months post-term, the incidence of ferritin <12 μg/l was higher in HM-fed compared to IFF-fed infants (23.8 vs. 7.8% and 26.3 vs. 9.5%, P < 0.02). This observational study demonstrates that ferritin <12 μg/l is more prevalent in HM-fed infants until 6 months post-term. This may be due to early cessation of additional iron supplementation. We speculate that additional iron supplementation is not necessary in preterm infants fed IFF (0.8-1.0 mg iron/100 ml), as they achieve ferritin ≥12 μg/l without additional iron supplements between 3 and 6 months post-term.

Epoetin biosimilars in the management of anemia secondary to chemotherapy in patients with solid tumors, lymphomas, and myelomas: The ORHEO study.

9564 Background: Chemotherapy may induce anemia with potentially severe consequences. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study examined the efficacy and safety of epoetin alfa biosimilars (EABs) for the treatment of chemotherapy-induced anemia (CIA) in the clinical setting. Methods: ORHEO was a multicenter, observational, prospective, post-marketing study conducted in France. Patients with CIA (Hb &lt;110g/L) &gt;18 years old, with solid tumors, lymphomas or myelomas and eligible for epoetin alfa treatment were included in the study; they received EAB as prescribed by their physician. Baseline patient characteristics and anemia-related data including baseline and target Hb level epoetin treatment, adverse events and any other concomitant treatments prescribed were recorded. The primary endpoint was the rate of responders (defined as an increase in Hb levels to 100 g/L or at least 10 g/L since inclusion visit, or reaching target Hb set at start of study, without any blood transfusions in the 3 weeks prior to measurement) at +3 months (M3). Other endpoints included rate of responders at +6 months (M6) and safety endpoints. Results: 2310 patients (51.43 % male, 48.57 % female) from 232 centers were included in this study. At baseline 79.6% had solid tumors, 13.0% lymphomas and 7.4% myelomas. Median age was 68 y (range: 18–93). Mean baseline Hb level was 96 g/L with a target Hb level of &gt;= 120 g/L for 52.7% of patients. Almost all (99.9%) received the biosimilar epoetin zeta (median dose 30,000 IU/week) with 26.6% receiving additional iron supplementation. A total of 2056 and 1664 patients had at least one Hb level value at M3 and M6 respectively. The rate of response was 81.6% and 86.5% at M3 and M6, respectively. In total, 17.0% of treated patients reported clinically relevant adverse events (all grades), the most common being infections (5.0%) and thromboembolic events (3.5%). Transfusion rates were reported as 9.4% and 5.8% at M3 and M6, respectively. No EAB-related deaths were reported. Conclusions: EAB was effective and well-tolerated in the management of CIA. Clinical trial information: NCT01626547.

221: Does antepartum additional iron supplementation to standard prenatal vitamins decrease anemia at delivery?

standard prenatal vitamins decrease anemia at delivery? Samantha Boreland, Clones Lans, Chaur-Dong Hsu, Vinette Greenland, Elsi Santana-Fox, Maggie Tetrokalashvili, Scott Stanislawski, Joshua Fogel Nassau University Medical Center, OBGYN, East Meadow, NY OBJECTIVE: To investigate whether the addition of iron supplementation to the standard prenatal vitamins, improve hemoglobin/hematocrit levels, at delivery. STUDY DESIGN: This is a retrospective review of 300 medical charts of women delivered at our medical health system from January 2009 to December 2009. The patients were divided equally in 2 groups: group 1 consisted of patients who had prenatal care at Hospital Medical Center (HMC) obstetric clinic and received only standard prenatal vitamins, and group 2 consisted of patients followed at the outreach obstetric clinics of Federal Qualified Health Centers (FQHC) affiliated to HMC and received ferrous sulfate in addition to the standard prenatal vitamins. The hemoglobin and hematocrit levels at the first prenatal visit were compared to those at delivery for both groups. ANOVA, Chi-square test, McNemar test and ANCOVA were used for statistical analysis. Data were expressed as mean standard deviation. RESULTS: There were no significant differences for any of the baseline laboratory variables between the two groups. The mean comparisons for the laboratory variables at delivery showed both hemoglobin and hematocrit had significantly lower mean values for the HMC group as compared to FQHC group (Hemoglobin: 11.9 1.26 vs. 12.2 1.26 g/dL, p 0.0001; hematocrit: 34.9% vs. 35.8%, p 0.01). In analyses comparing within each of the two groups, hematocrit significantly decreased (p 0.001) from the first prenatal visit (35.9 3.02%) to delivery (34.9 3.53%) and hemoglobin significantly decreased (p 0.001) from the first prenatal visit (12.3 1.05g/dL) to delivery (11.9 1.26 g/dL). In categorical variable comparisons, there was significant increase of anemia percentage in HMC group from the first prenatal visit to delivery. In the FQHC group, both hematocrit and hemoglobin did not significantly differ from the first prenatal visit to delivery. CONCLUSION: Our data suggests that additional iron supplementation from antepartum at the first prenatal visit to delivery can benefit woman by keeping their hemoglobin/hematocrit levels stable prior to delivery. 222 Birth weight, breast cancer and the potential mediating hormonal environment Radek Bukowski, Rowan Chlebowski, Inger Thune, Anne-Sofie Furberg, Gary Hankins, Fergal Malone, Mary D’Alton University of Texas Medical Branch, Department of Obstetrics and Gynecology, Galveston, TX, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, Oslo University Hospital, Department of Oncology, Oslo, Norway, University of Troms, Faculty of Health Sciences, Department of Community Medicine, Troms, Norway, The University of Texas Medical Branch, Obsterics & Gynecology, Galveston, TX, Royal College of Surgeons in Ireland, Obstetrics and Gynaecology, Dublin, Ireland, Columbia University, Department of Obstetrics and Gynecology, New York, NY OBJECTIVE: A womans breast cancer risk is proportional to her birth weight and the birth weight of her children. The relative contributions of these factors and their mediating mechanisms are not known. STUDY DESIGN: Risk of breast cancer in relation to a mothers birth weight and her first infants birth weight were evaluated in a prospective cohort of 410 women in the Framingham Study. Serum concentrations of estriol (E3), anti-estrogen alpha-fetoprotein (AFP), and pregnancy-associated plasma protein-A (PAPP-A) were measured in 23,824 pregnant women from a separate perspective cohort, the FASTER trial. RESULTS: During follow-up (median, 14 years) 31 women (7.6%) were diagnosed with breast cancer. Women with large birth weight infants (in the top quintile) had a higher breast cancer risk compared to other women (hazard ratio (HR), 2.5; 95% confidence interval (CI), 1.2-5.2; P 0.012). The finding was not affected by adjustment for birth weight of the mother and traditional breast cancer risk factors (adjusted HR, 2.6; 95% CI, 1.2-5.7; P 0.016). An infants birth weight had a strong positive relationship with the mothers serum E3/AFP ratio and PAPP-A concentration during pregnancy. Adjustment for breast cancer risk factors did not have a material effect on these relationships. CONCLUSION: Maternal risk of breast cancer was associated with giving birth to an infant with high birth weight, independent of a mothers own birth weight and traditional breast cancer risk factors. Having an infant with high birth weight was also associated with a hormonal environment during pregnancy favoring breast cancer development and progression.

Comparative Effectiveness of a Prenatal Medical Food to Prenatal Vitamins on Hemoglobin Levels and Adverse Outcomes: A Retrospective Analysis

Background The role of folate in pregnancy is well established, with most prenatal vitamins (PNVs) on the market containing at least 800 μg of folic acid. Folic acid must be converted in the body to L-methylfolate, the natural and biologically active form of folate. The role of vitamin B 12 in pregnancy is less characterized, and most PNV formulations contain only 0 to 12 μg. The present study was undertaken to evaluate whether taking a prenatal medical food containing L-methylfolate and much higher doses of vitamin B 12 results in higher hemoglobin levels and thus, a lower incidence of anemia during pregnancy. Objective The objective of this exploratory study was to evaluate the effects of the prenatal medical food versus standard PNVs on hemoglobin levels and adverse outcomes throughout pregnancy. Methods For this retrospective analysis, we reviewed the charts of female patients taking either a prenatal medical food or standard PNV during pregnancy. Hemoglobin levels measured at initiation of prenatal care, end of second trimester, and delivery were recorded. Patients who had received additional iron supplementation, beyond that contained in the prenatal medical food or PNV they were taking and before anemia screening at the end of the second trimester, were excluded from the study. Fisher exact test, χ 2 test, student t test, and ANOVA were used to evaluate differences between the treatment groups. Results Data were analyzed from 112 charts: 58 patients (51.8%) were taking the prenatal medical food; 54 patients (48.2%) were taking standard PNVs. Mean (SD) age at first prenatal visit was 27 (4.6) years in the medical food group and 28.8 (3.5) years in the PNV group ( P = 0.024). Mean (SD) body mass indices were 29.1 (6.5) and 31.7 (8.9) in the medical food and PNV groups, respectively ( P = NS). In the medical food group, 35 women (60.3%) were white/Caucasian, 17 (29.3%) were African American, and 6 (10.4%) were of other races. In the PNV group, 24 women (44.4%) were white/Caucasian, 25 (46.3%) were African American, and 5 (9.3%) were of other races. However, race was not significantly different between the two groups. At end of second trimester and at delivery, mean (SD) hemoglobin levels were higher in the prenatal medical food group (11.8 [1.1] g/dL and 11.8 [1.3] g/dL, respectively) than in the PNV group (11.3 [1.2] g/dL and 10.7 [1.2] g/dL, respectively) ( P = 0.011 and P = 0.001, respectively). Significantly fewer cases of anemia were reported at end of second trimester in the prenatal medical food group than in the PNV group (39.7% vs 74.1%; P = 0.001). Conclusions In the present study, supplementation with a prenatal medical food containing L-methylfolate and high-dose vitamin B 12 may maintain hemoglobin levels and decrease rates of anemia in pregnancy more effectively than standard prenatal vitamins; however, prospective, controlled studies are warranted. ClinicalTrials.gov identifier: NCT01193192.

Zinc protoporphyrin/heme as an indicator of iron status in NICU patients

Objective Zinc protoporphyrin/heme ratio (ZnPP/H) has been well established as an indicator of functional iron deficiency in subjects 6 months of age to adult. The primary objective of this study was to establish normative values for ZnPP/H in NICU patients and secondarily to explore the utility of this test as an indicator of iron deficiency in neonates. Study design ZnPP/H and complete blood counts were obtained weekly on consecutive NICU patients. Gestational age, growth variables, iron supplementation, erythropoietin treatment, and blood transfusions were documented. Results are reported as mean ± SD. A value of P < .05 was considered significant. Results ZnPP/H ratios (n = 639) were evaluated from 143 infants. During the first week of life, ZnPP/H was inversely correlated with gestational age (n = 78, P < .001, r = −0.72). Maternal diabetes, growth retardation, and exposure to chorioamnionitis were independent risk factors for high ZnPP/H. Both iron supplementation and blood transfusion decreased ZnPP/H (P < .001). Erythropoietin treatment was associated with an increase in reticulocyte count and ZnPP/H (P < .001). Conclusions ZnPP/H is inversely correlated with gestational age, and the range in all newborn infants is higher than in adults. ZnPP/H is elevated in certain infant subpopulations, which suggests that they may require additional iron supplementation. (J Pediatr 2003;142:273-8)

Hepatotoxicity induced by iron overload and alcohol: Studies on the role of chelatable iron, cytochrome P450 2E1 and lipid peroxidation

Background/Aims: Clinical experience and studies with experimental animal models indicate a synergistic hepatotoxic effect of dietary iron overload and chronic alcohol ingestion. In order to elucidate the mechanism underlying this synergism, we examined the hepatic levels of ethanol-inducible cytochrome P450 2E1, glutathione and malondialdehyde, and the effect of iron chelation with desferrioxamine, in livers from rats treated with iron and/or ethanol. Methods: Animals received diets with or without 2.5–3% carbonyl iron for 6–9 weeks, followed by an ethanol-containing diet or a liquid control diet for 5–9 weeks. Desferrioxamine was administered subcutaneously with mini-osmotic pumps. Alanine aminotransferase activity in serum and hepatic contents of glutathione and malondialdehyde were determined. The hepatic level of cytochrome P450 2E1 was determined with Western Blotting using a specific polyclonal antibody. Results: The combination of iron and alcohol led to a marked increase in serum alanine aminotransferase activity as compared with all other treatment groups, and iron chelation with desferrioxamine reversed these increases. Treatment with alcohol alone led to slightly increased aminotransferases compared with controls. The level of cytochrome P450 2E1 was significantly elevated in microsomes isolated from ethanol-treated rats, but neither additional iron supplementation nor desferrioxamine influenced this level significantly. Glutathione contents were increased in the livers of animals treated with iron and/or ethanol. Malondialdehyde values were increased in iron-treated animals, whereas neither ethanol nor desferrioxamine altered malondialdehyde levels significantly. Conclusions: The toxic effects exerted by the combination of iron overload and chronic ethanol feeding on rat liver are dependent on a pool of chelatable iron. The hepatic level of cytochrome P450 2E1 is markedly induced by ethanol but not further altered by iron overload. Neither increased lipid peroxidation nor depletion of hepatic glutathione levels can explain the synergistic hepatotoxic effects of iron and ethanol in this model.

Randomized, Placebo-Controlled Trial of Iron Supplementation in Infants With Low Hemoglobin Levels Fed Iron-Fortified Formula

In spite of the declining prevalence of iron-deficiency anemia, a large proportion of low-income infants have "low-normal" (11-11.5 g/dL) and "low" (less than 11 g/dL) hemoglobin (Hgb) values. Because most of these infants are fed iron-fortified formulas, it was of interest whether additional iron supplementation would enhance Hgb values. A cohort of 334 healthy, inner-city, minority, 6-month-old infants, fed iron-fortified formulas, with Hgb values ranging from 9 to 11.5 g/dL, participated in a double-blind, randomized, placebo-controlled trial of supplemental iron at 0, 3, and 6 mg/kg per day for 3 months. Hemoglobin values increased significantly with age, regardless of assignment to placebo or supplemental iron (means for the entire cohort: 6 months 10.9 g/dL, 8 months 11.2, 10 months 11.3, and 12 months 11.4). The proportion of "responders" (Hgb level increased greater than or equal to 1 g/dL) was 34% and did not differ significantly by placebo or iron dose. There were no significant differences in mean corpuscular volume or levels of erythrocyte porphyrins or serum ferritin between treatment groups. The implications of this clinical trial are twofold: (1) screening healthy infants fed iron-fortified formula at the age of 6 months is not justified, regardless of socioeconomic status; (2) the clinical practice of routinely treating low-income, "low-Hgb" infants with iron supplementation, without regard to dietary considerations, is unwarranted.

Iron supplementation in infancy.

Although dietary practices in the United States have changed in the past decade to include more bioavailable iron in many infant's diets, iron deficiency remains an important problem. Prevalence of iron deficiency is still high, even among economically privileged infants. Not only microcytic anemia but also adverse effects on growth, behavior, intestinal function, energy metabolism, and immune function may result with deficiencies of the many important ironcontaining compounds in the body.Infants are at highest risk for iron deficiency because initial iron endowment is often low, iron needs for growth are high, and foods in infants' diets usually are poor iron sources or impair iron absorption. In addition, the frequent infections typical in infants impair iron absorption when needs remain high.By taking a careful history and using simple laboratory screening procedures, the pediatrician can identify a large proportion of those who will benefit from iron supplementation. Avoiding foods impairing iron absorption, continuing intake of foods with relatively large amounts of bioavailable iron, and giving additional iron supplementation to particularly highrisk infants can further decrease the prevalence of iron deficiency and its potentially serious consequences with minimal risk.

Iron Supplementation in Infancy

Although dietary practices in the United States have changed in the past decade to include more bioavailable iron in many infant's diets, iron deficiency remains an important problem. Prevalence of iron deficiency is still high, even among economically privileged infants. Not only microcytic anemia but also adverse effects on growth, behavior, intestinal function, energy metabolism, and immune function may result with deficiencies of the many important ironcontaining compounds in the body. Infants are at highest risk for iron deficiency because initial iron endowment is often low, iron needs for growth are high, and foods in infants' diets usually are poor iron sources or impair iron absorption. In addition, the frequent infections typical in infants impair iron absorption when needs remain high. By taking a careful history and using simple laboratory screening procedures, the pediatrician can identify a large proportion of those who will benefit from iron supplementation. Avoiding foods impairing iron absorption, continuing intake of foods with relatively large amounts of bioavailable iron, and giving additional iron supplementation to particularly highrisk infants can further decrease the prevalence of iron deficiency and its potentially serious consequences with minimal risk.