Maternal Iron Stores Research Articles

Pregnancy-Associated Anemia and Its Relationship with Gestational Age: A Review

Pregnancy-associated anemia is a prevalent and complex condition affecting a significant proportion of pregnant women worldwide, with higher incidence rates in low-resource settings. Defined as low hemoglobin levels that fail to meet the increased physiological demands of pregnancy, this condition poses serious health risks to both mother and child, including complications such as preterm birth, low birth weight, and increased maternal morbidity. The prevalence and severity of anemia are closely related to gestational age, with higher rates observed in the second and third trimesters due to factors like expanded blood volume and rising fetal demands. Gestational age influences the pathophysiology of anemia in pregnancy, with maternal and fetal demands intensifying as pregnancy progresses. During the first trimester, anemia is less common as blood volume expansion and fetal demands are lower; however, in the second trimester, these demands escalate, leading to increased rates of iron deficiency anemia if adequate supplementation is not provided. By the third trimester, maternal iron stores are often strained by rapid fetal growth and placental development, placing mothers with pre-existing nutritional deficiencies or multiple pregnancies at greater risk. This gestational-age-dependent progression underscores the need for trimester-specific screening and interventions to prevent severe anemia and associated complications.

Importance of Maternal Iron Status on the Improvement of Cognitive Function in Children After Prenatal Iron Supplementation

The effectiveness of prenatal iron supplementation improves maternal hematological outcomes, but little research has focused on child outcomes. The objective of this study was to assess whether prenatal iron supplementation adjusted to maternal needs improves children's cognitive functioning. The analyses included a subsample of nonanemic pregnant women recruited in early pregnancy and their children aged 4 years (n=295). Data were collected between 2013 and 2017 in Tarragona (Spain). On the basis of hemoglobin levels before the 12th gestational week, women receive different iron doses: 80 vs 40 mg/d if hemoglobin is 110-130 g/L and 20 vs 40 mg/d if hemoglobin >130 g/L. Children's cognitive functioning was assessed using the Wechsler Preschool and Primary Scale of Intelligence-IV and Developmental Neuropsychological Assessment-II tests. The analyses were carried out in 2022 after the completion of the study. Multivariate regression models were performed for assessing the association between different doses of prenatal iron supplementation and children's cognitive functioning. Taking 80 mg/d of iron was positively associated with all the scales of the Wechsler Preschool and Primary Scale of Intelligence-IV and Neuropsychological Assessment-II when mothers had initial serum ferritin <15 µg/L, but it was negatively associated with Verbal Comprehension Index, Working Memory Index, Processing Speed Index, and Vocabulary Acquisition Index from Wechsler Preschool and Primary Scale of Intelligence-IV and verbal fluency index from Neuropsychological Assessment-II when mothers showed initial serum ferritin >65 µg/L. In the other group, taking 20 mg/d of iron was positively associated with Working Memory Index, Intelligence Quotient, verbal fluency, and emotion recognition indices when women had initial serum ferritin >65 µg/L. Prenatal iron supplementation adjusted to the maternal hemoglobin levels and baseline iron stores improves cognitive functioning in children aged 4 years.

Oral versus intravenous iron therapy for correction of iron deficiency anaemia in pregnancy

Background: The high prevalence of anaemia in pregnancy has serious adverse consequences in both mother and baby. Management of anaemia in pregnancy should be given great importance in obstetric practice.The study was undertaken to compare the efficacy of oral iron (ferrous sulphate) and intravenous iron sucrose complex in the management of moderate anaemia in pregnancy. Method: A randomized comparative hospital–based longitudinal analysis was conducted in the Department of Obstetrics and Gynaecology of a tertiary care hospital, involving 70 women with haemoglobin between 7- 9.9 g/dl and serum ferritin &lt; 50 mcg/l, attending antenatal clinic. Intravenous iron sucrose complex was given in one group and tablet ferrous sulfate (100 mg elemental iron) to the oral group. Treatment efficacy was assessed by measurement of haemoglobin and reticulocytes on days 8, 15, 21 and 30 and ferritin on day 30. Result: An increase in haemoglobin was observed in both groups, rising from 8.26 ±0.764g/dl to 11.08± 0.71g/dl in the intravenous group and from 8.14±0.767 g/dl to 10.98 ±0.61 g/dl on day 30 in the oral group. S.ferritin on day 30 was significantly higher in the intravenous group. The side effects in both groups were negligible though there were there were 3 dropouts due to adverse effects. Conclusion : Both oral ferrous sulphate and intravenous iron sucrose complex are safe, convenient and effective in treatment of iron deficiency anaemia in pregnant women with negligible side effects, but intravenous iron sucrose complex is better in improving serum iron and in restoring maternal iron stores

Effect of maternal haemoglobin, serum ferritin and gestational age on neonatal iron indices

Background: Iron is the most common micronutrient deficiency in pregnant women and infants throughout the world, mainly in developing countries like India. 30 to 50% of the pregnancies are affected by maternal iron deficiency and in developing countries, more than 80% of the pregnant women are estimated to be anemic. The effects of perinatal iron deficiency are anemia and most importantly neurodevelopmental impairments which are long-lasting and sometimes irreversible. The main goal of this study was to determine the influence of maternal and neonatal factors on the iron stores in neonates and to estimate the appropriate time to supplement iron for neonates in different scenarios. Methods: This is a prospective observational study. Mother-infant pairs were enrolled in the study by following specific inclusion and exclusion criteria. Maternal demographic details, complications during pregnancy, intrapartum details, and neonatal details were recorded. The maternal and cord blood samples were collected for measurement of hemoglobin, serum ferritin, serum iron, total iron-binding capacity, and transferrin saturation. If failed to collect the cord blood sample, the first 24hour sample of the baby was taken into consideration in place of it. The correlation between maternal neonatal iron indices and the influence of the gestational age and IUGR on cord serum ferritin levels was analyzed by using paired t-test and chi-square test for multiple groups. A probability of p&lt;0.05 (two-sided) was used to consider the difference as significant. Results: 125 term and 47 preterm neonates were included in the study. There was correlation between maternal and neonatal iron profiles at birth when there was severe depletion of maternal ferritin (&lt;12µg/dl) with p values less than 0.05 for hemoglobin and serum ferritn levels. Serum ferritin levels at birth were less in preterm as compared to term neonates (mean of 128.9µg/l in the preterm vs. 156.9µg/l in the term, p=0.04). There was a significant correlation between neonatal iron indices at birth with that at 28 days of life (p&lt;0.01). Conclusions: Neonatal iron stores are not affected unless there was severe depletion of maternal iron stores. Preterm neonates have low iron stores compared to term neonates. Gestational age is the major determinant for iron stores at birth as compared to other maternal and neonatal factors. As the most significant adverse effects of iron deficiency are irreversible and long-lasting neurodevelopmental impairments. The term and preterm babies should take prophylactic iron from eight weeks and four weeks of age respectively and continued up to the introduction of iron-fortified cereals as recommended by the American academy of paediatrics.

Iron Profile in Term Small for Gestational Age Infants at 10 Weeks of Age and Correlation With Maternal Iron Profile: A Prospective Cohort Study

Term small for gestational age (SGA) babies are at risk for developing iron deficiency anemia. The association between maternal and infant iron stores is not clear. To assess proportion of term SGA neonates developing iron deficiency anemia by 10 weeks of age, and measure correlation between iron profile and hepcidin of babies at birth and at 10 weeks of age with maternal iron profile. Prospective cohort study conducted from November, 2018 to April, 2020. 120 term SGA babies and their mothers. Hemogram, iron profile and serum hepcidin (every fourth case) estimated in mother, cord blood and baby at 10 weeks. Babies developing anemia at 6 weeks detected by hemogram and ferritin were started on iron supplementation and excluded from the study. Proportion of babies developing iron deficiency anemia at 10 weeks of age. 35 (29.2%) of 120 term SGA babies developed anemia (hemoglobin <9 g/dL) at 6 weeks. Proportion of infants who developed iron deficiency anemia (hemoglobin <9 g/dL and serum ferritin <40 µ/dL) at 6 and 10 weeks of age was 14.2% and 23.3%, respectively. No significant correlation was found bet-ween hemoglobin, iron and hepcidin of the baby in cord blood and at 10 weeks of age with that of mothers. Serum hepcidin in babies at birth (137.5 ng/mL) were higher than maternal values (128 ng/mL). A significant proportion of term SGA infants deve-loped anemia during early infancy, irrespective of maternal iron status.

Associations of maternal iron deficiency with malaria infection in a cohort of pregnant Papua New Guinean women

BackgroundIron deficiency (ID) is common in malaria-endemic settings. Intermittent preventative treatment of malaria in pregnancy (IPTp) and iron supplementation are core components of antenatal care in endemic regions to prevent adverse pregnancy outcomes. ID has been associated with reduced risk of malaria infection, and correspondingly, iron supplementation with increased risk of malaria infection, in some studies.MethodsA secondary analysis was conducted amongst 1888 pregnant women enrolled in a malaria prevention trial in Papua New Guinea. Maternal ID was defined as inflammation-corrected plasma ferritin levels < 15 μg/L at antenatal enrolment. Malaria burden (Plasmodium falciparum, Plasmodium vivax) was determined by light microscopy, polymerase chain reaction, and placental histology. Multiple logistic and linear regression analyses explored the relationship of ID or ferritin levels with indicators of malaria infection. Models were fitted with interaction terms to assess for modification of iron-malaria relationships by gravidity or treatment arm.ResultsTwo-thirds (n = 1226) and 13.7% (n = 258) of women had ID and peripheral parasitaemia, respectively, at antenatal enrolment (median gestational age: 22 weeks), and 18.7% (120/1,356) had evidence of malaria infection on placental histology. Overall, ID was associated with reduced odds of peripheral parasitaemia at enrolment (adjusted odds ratio [aOR] 0.50; 95% confidence interval [95% CI] 0.38, 0.66, P < 0.001); peripheral parasitaemia at delivery (aOR 0.68, 95% CI 0.46, 1.00; P = 0.050); and past placental infection (aOR 0.35, 95% CI 0.24, 0.50; P < 0.001). Corresponding increases in the odds of infection were observed with two-fold increases in ferritin levels. There was effect modification of iron-malaria relationships by gravidity. At delivery, ID was associated with reduced odds of peripheral parasitaemia amongst primigravid (AOR 0.44, 95% CI 0.25, 0.76; P = 0.003), but not multigravid women (AOR 1.12, 95% CI 0.61, 2.05; P = 0.720). A two-fold increase in ferritin associated with increased odds of placental blood infection (1.44, 95% CI 1.06, 1.96; P = 0.019) and active placental infection on histology amongst primigravid women only (1.24, 95% CI 1.00, 1.54; P = 0.052).ConclusionsLow maternal ferritin at first antenatal visit was associated with a lower risk of malaria infection during pregnancy, most notably in primigravid women. The mechanisms by which maternal iron stores influence susceptibility to infection with Plasmodium species require further investigation.Trial registration

Maternal iron stores and its association with newborn iron dynamics and outcomes

Objectives: In pregnant women in developing nations iron deficiency anemia is common. The motherfetus homeostasis may be adversely affected by the demands in pregnancy. This can lead to adverse fetomaternal outcomes like intrauterine growth retardation ,premature delivery, and neonatal and perinatal death. Therefore it is important to understand the relation between maternal and fetal iron handling as this may help in further implementation of measures to prevent iron deficiency in pregnancy and infancy and improve outcomes. Thus, this study was conducted to explore the effect of maternal iron deficiency anemia on newborn iron stores. Methods: The study was conducted in the Department of Obstetrics and Gynecology, Smt. Sucheta Kriplani Hospital, New Delhi, India between November 2014 to March 2016. It was an observational cross sectional study with sample size of 100 antenatal women diagnosed with iron deficiency anemia.We divided the mothers into groups with mild, moderate and severe anemia respectively. The maternal serum ferritin levels were compared with the newborn hemoglobin and serum ferritin levels. Results: Between the three groups the baseline characteristics were comparable. The newborns of mothers with severe anemia had lower Apgar scores and a greater risk of admission. The birth weight did not differ among the groups. The severity of anemia increased with the parity.The cord blood hemoglobin between the groups was comparable, however the cord blood ferritin levels were directly related to maternal hemoglobin values . In those with severe anemia, a positive association was found between maternal ferritin and cord blood hemoglobin and maternal hemoglobin and cord blood serum ferritin. A positive association was also found between maternal hemoglobin and cord blood hemoglobin. Conclusion: The study supports the fact that fetal needs dictate the placental iron demand. With increasing severity of anemia the fetus starts showing decreased serum ferritin and this finally results in iron deficiency at birth. Although the fetal weight and haemoglobin are not compromised with increasing severity of anemia in our study, increased fetal risk manifested by worsening Apgar scores and increased newborn admissions occurred as anemia worsened. This study supports the fact that maternal deficiency of iron affects the newborn iron profile and this reiterates the imperative role of iron supplementation during pregnancy. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 620-625

LITERATURE REVIEW: DAMPAK ANEMIA DEFISIENSI BESI PADA IBU HAMIL

In general, the most common cause of anaemia in pregnancy is iron deficiency, which arises from maternal-fetal iron transfer, which is often exacerbated by a decrease in maternal iron stores. According to the World Health Organization (WHO), pregnancy anaemia is a global health problem that affects almost half of pregnant women. The purpose of this study was to conduct a journal review of explanatory and experimental articles published in the last 5 years starting in 2016 on deficiency anaemia in pregnancy. The research method is carried out by literature study using an electronic reference library through Medline, PubMed, NCBI, Science Direct and Proquest by investigating the impact of anaemia in pregnant women. The results literature from research in various developing and developed countries show that there is an impact that occurs when the mother had anaemia during pregnancy, namely prematurity, low birth weight, postpartum hemorrhage, maternal mortality, cesarean delivery and mental development of children. The conclusion is that there are several effects of anaemia in pregnant women, which are prematurity, low birth weight, postpartum hemorrhage, maternal mortality, cesarean delivery and children's mental development.

Effect of maternal hemoglobin and iron status on fetal hemoglobin, iron status, growth and maturity

Background: Iron deficiency anemia during pregnancy is a major health issue in India. However, the status of iron stores in infants born to iron depleted mothers remains controversial and inadequately investigated. The present study is therefore an attempt to understand whether maternal anemia and iron stores have any significant effect on iron status and growth of fetus.Methods: This is a prospective, cross-sectional, hospital based study conducted at Mata Chanan Devi Hosital, Janakpuri, New Delhi. Hemoglobin and iron profile of 100 newborns and their mothers were taken. Mothers were divided into anemic and non anemic group to see the effect of maternal anemia on fetus.Results: A total of 100 newborns and their mothers were analysed. Cord hemoglobin and iron profile was significantly reduced in anemic compared to non anemic group. Birth weight of newborn was significantly reduced only in moderately anemic group as compared to non anemic group but there was no difference seen in length and head circumference.Conclusions: Maternal serum ferritin levels should be measured for the diagnosis of occult iron deficiency in the fetus so that timely measures can be taken to prevent iron deficiency anemia in the newborn.

Prepregnancy Obesity Does Not Impact Placental Iron Trafficking

BackgroundIron is critical for fetal development. Neonates of obese women may be at risk for poor iron status at birth as a result of maternal inflammation-driven overexpression of hepcidin. ObjectivesThe objective of this study was to determine differences in placental transfer of oral iron (57Fe) and expression of placental transferrin receptor 1 (TFR1) and ferroportin (FPN) mRNA and protein and their association with maternal and neonatal iron-related parameters, including maternal hepcidin, among women with and without prepregnancy (PP) obesity. Methods57Fe ingested during the third trimester of pregnancy was recovered in venous umbilical cord blood among 20 PP obese [BMI (in kg/m2): 30.5–43.9] and 22 nonobese (BMI: 18.5–29.0) women aged 17–39 y. Placental TFR1 and FPN mRNA and protein expression were quantified via qPCR and Western blot. Maternal and neonatal markers of iron status and regulation, as well as inflammation, were measured. Descriptive and inferential statistical tests (e.g., Student t test, Pearson correlation) were used for data analysis. ResultsThere was no difference in cord blood enrichment of 57Fe or placental mRNA or protein expression of TFR1 or FPN among the women with and without PP obesity. Maternal hepcidin was not correlated with cord blood enrichment of 57Fe or placental FPN mRNA or protein expression. Maternal log ferritin (corrected for inflammation) was inversely correlated with log percent enrichment of 57Fe in cord blood (partial r = –0.50; P < 0.01, controlled for marital status) and protein expression of TFR1 (r = –0.43; P = 0.01). ConclusionsPlacental iron trafficking did not differ among women with and without PP obesity. Findings reinforce the importance of maternal iron stores in regulating placental iron trafficking.

Study of efficacy and compliance of iron sucrose in iron deficiency anaemia in pregnancy

A prospective study conducted at Apollo Medical College & Hospital to study the intravenous iron sucrose efficacy in moderate iron deficiency anemia in pregnancy in patients between 14-34 weeks of gestational age.100 patients with moderate iron deficiency anemia with hemoglobin between 7 -10 gm/dl and serum ferritin less than 15mg/ltand peripheral blood picture showing microcytic hypochromic anemia were included in the current study. Majority patients were multiparous with a mean age of 22.9 years and gestational period of 30-34weeks. 60% were vegetarians and 40% non -vegetarians in the present study. Out of100 patients, 70% were from rural area whereas 30% were from urban area. In the present study the mean change of pre-treatment and post- treatment heamoglobin level is found to be 1.6460 which is statistically significant. The median of pre-treatment and post treatment serum ferritin level is found to be 132.2680 which is statistically significant. Largely Iron sucrose can be a treatment of choice with no serious side effects and is indicated for correction of anemia in pregnancy or restoring maternal iron stores. Hence intravenous iron sucrose treatment will certainly help to reduce risk of homologous blood transfusions and correction of anemia.

Association of maternal hemoglobin and iron stores with neonatal hemoglobin and iron stores

BackgroundOne of the commonest causes of anemia in pregnancy is iron deficiency. This study aims at understanding and exploring the association between fetal and maternal iron status. Predelivery maternal hemoglobin (Hb) and iron stores, serum iron, ferritin, and soluble transferrin receptor (sTfR), were assessed and compared to the cord blood Hb and iron stores with an attempt to identify the level of maternal Hb and ferritin at which the fetal iron stores reduce, helping to identify the neonates who will require earlier iron supplementation. MethodFour hundred eight participants were enrolled, and maternal and cord blood was collected at the time of delivery and tested for Hb and iron parameters. The results were statistically analyzed. ResultsOf all mothers, 27.2% mothers were anemic (Hb less than 11 g/dl). Of all newborns, 15.4% newborns had Hb less than 14 g/dl. There was a significant association between the maternal and cord blood iron, ferritin, sTfR and sTfR/log ferritin index. Eighty-five percent of the babies with cord blood Hb <14 g/dl had maternal serum ferritin (SF) <50 μg/L. Maternal SF <10 μg/l was associated with a significant number of babies with cord blood SF <75 μg/l (77.7%). One hundred sixty six neonates had sTfR 2 μg/ml or more. Of these, 80.7% had maternal SF <50 μg/l. Of the 115 newborns with a high sTfR/log ferritin index (>1.5), 56.5% had raised maternal sTfR (>2μg/ml). ConclusionIn view of a significant association between maternal and neonatal Hb and iron stores, newborns of mothers with iron deficiency anemia (IDA) during pregnancy should be monitored and followed up after birth for development of IDA and early iron supplementation.

Functional iron deficiency markers are absent during pregnancy despite evidence of low iron stores.

Introduction Functional iron deficiency parameters predict iron-restricted erythropoiesis more precisely than ferritin. Ferritin and erythropoiesis can be affected by inflammation and hormonal alterations. We hypothesize that the association between low ferritin concentrations and iron-restricted erythropoiesis is not comparable between pregnant and non-pregnant women. Materials and methods Pregnant women ( n = 926) were included at week 12 of gestation. Ferritin concentrations, %hypochromic erythrocytes (%HYPO), %microcytic erythrocytes (%MICRO), reticulocyte haemoglobin content (MCHr), mean cell volume (MCV) and mean cell haemoglobin (MCH) were analysed. Data were compared with non-pregnant women ( n = 1302). Results Functional iron deficiency parameters (%HYPO, %MICRO, MCHr) were present in, respectively, 3.9%, 14.3% and 2.3% off all pregnant women. Univariate analysis of low ferritin (&lt;20 μg/L) showed significant differences between non-pregnant versus pregnant women; %HYPO (10.92% vs. 0.92%), increased %MICRO (4.33% vs. 1.00%) and decreased MCHr (24.9 pg vs. 29.5 pg), respectively. In the logistic regression analysis, MCHr, %MICRO and MCV were independently associated with low ferritin concentrations in pregnant women, while %HYPO and %MICRO were independently associated variables in non-pregnant women with low ferritin concentrations. Discussion Functional iron deficiency is significantly less frequent in pregnant women compared with iron-deficient non-pregnant women. During pregnancy, iron metabolism might be differentially regulated for optimal fetal growth and development despite low maternal iron stores.

Communication of Placental Iron Trafficking Proteins with Maternal and Fetal Iron Regulators

During pregnancy, iron is a primary requisite micronutrient for the developing fetal-placental unit and increased maternal erythrocyte mass expansion. Iron deficiency anemia in pregnancy (IDAP) remains a constant public health problem in our country where all of them receive routine iron supplementation.The mechanism involved in iron regulatory pathway across the placenta is more complex and less understood. Here we examined the hematological and biochemical parameters of mother and fetus, placental mRNA and protein expression of iron trafficking proteins in iron replete and deplete pregnant women.Subjects who presented to the department of community health for child birth were screened and consenting patients (age<35 years and a gestational age≥36weeks) were included in the study. Maternal and cord blood samples were collected and a cut placental tissue (~0.5cm) was obtained at the time of delivery. Hematological and biochemical parameters were analysed according to standard methods. Serum ferritin was measured using chemiluminescent immunoassay. Maternal and cord blood serum hepcidin and GDF15 levels were measured using ELISA (DRG Diagnostics and Ray Biotech, respectively). Placental tissue RNA extracted using PARIS kit (Ambion) and cDNA was synthesised using RT2 first strand Kit (QIAGEN). The relative quantification of twenty two genes involved in iron uptake, export, transport and regulation was done using Custom RT2 PCR Array (SA Biosciences, QIAGEN). Western blot analysis was performed for significantly expressed genes. Statistical analysis was performed using SPSS software.A total of one hundred and thirty eight pregnant women (n=138) were included in the study; 14 subjects were excluded due to unavailability of either maternal or cord blood serum samples. A cut off of ferritin<30ng/mL was taken to define iron deficiency since all of them were on regular iron supplementation during pregnancy. Of the 124 subjects, 28 subjects had iron deficiency anaemia (Hb<10.5g/dL and Ferritin<30ng/mL) and 52 were iron replete (Hb>10.5g/dL and Ferritin>30ng/mL). Forty four women who did not fulfil either of the criteria were not included for analysis. The demographic, hematological and biochemical parameters of the groups are tabulated (Table.1).In the IDAP, even though the maternal serum ferritin levels were reduced, their fetal ferritin levels did not differ significantly from the control fetuses [IDAP fetuses- 139.8ng/mL, 15.4-300.5 vs Control fetuses - 143.4ng/mL, 13.1-461; p= 0.72]. No significant association was observed between ferritin and hepcidin levels either in the maternal or fetal serum. Interestingly, we found a negative correlation between maternal serum GD15 levels and fetal hepcidin: ferritin ratio (r=-0.439; p=0.025). Placental gene expression and protein expression was further analyzed (Table.2). Significantly higher gene expression of placental IREB2 [p=0.011], and ferroportin [p=0.000] were observed in iron deficient cohort. TP53 and LRP1 mRNA expressions were significantly lower in IDAP [p=0.002 & p=0.000]. Maternal serum ferritin had a significant positive correlation with placental expression of IREB2 (r=0.519; p=0.027) and LRP1 (r=0.470; p=0.049). At the protein level, placental GDF15 protein was significantly elevated in IDAP [p=0.04]. Placental GDF15 and ferroportin (FPN) was positively correlated with fetal ferritin (r=0.626; p=0.017 & r=0.552; p=0.041).Even when the maternal iron stores are low, the fetus gets the priority according to the hierarchy of iron usage. In IDAP, we observed a higher expression of placental ferroportin and transferrin receptor which probably leads to the increased efflux of iron towards fetus. Elevated placental GDF15 and ferroportin may imply that they play a major role in accomplishing iron trafficking and has to be further explored. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Relationship between maternal iron and cord blood iron status: A prospective study

Background: Iron sufficiency is of paramount importance in the neonatal period. Controversy exists whether the transfer of iron to the fetus from the mother is determined by fetal demands or by maternal iron stores. Numerous studies correlating maternal and neonatal iron stores revealed conflicting results. Aims: To study the relationship between maternal and neonatal iron indices at birth and to observe the impact of gestational age on iron stores in neonates. Methods and Materials: This prospective study was conducted in neonatal care unit of the tertiary hospital. Total 195 mother and newborn pairs are enrolled in the study. Neonates were divided into groups based on gestational age. The maternal venous samples were collected 1 h ± 15 min before the delivery. Cord blood sample and venous samples were drawn from a peripheral vein in neonates who came for follow-up at 4 weeks. Samples were analyzed for hemoglobin (Hb), serum ferritin, serum iron, and total iron-binding capacity. Results: Significant positive correlation was found between maternal Hb and neonatal ferritin (Pearson’s correlation coefficient =0.26, p=0.002) and maternal iron and neonatal iron (Pearson’s correlation coefficient =0.294, p=0.000). Ferritin concentration of cord blood samples in neonates born to mothers with ferritin levels &lt;12 ?g/L showed significant correlation. Mean ferritin in preterm neonates (128.9±80.7 ?g/dl) was significantly lower than in term neonates (156.9±78.6 ?g/dl) (p=0.040). Mean Hb in preterm neonates (14.5±2.1 g/dl) was significantly lower than in term neonates (15.0±2.1 g/dl) (p=0.028). 4-week samples showed significantly lower serum iron concentrations in preterm when compared to term group. Serum ferritin levels at birth showed positive correlation at 4 weeks. (Pearson’s correlation coefficient =0.211, p=0.028). Conclusions: Neonatal iron stores are affected in case of severe maternal iron deficiency indicated by ferritin levels &lt;12 ?g/L. Gestational age has a significant impact on neonatal iron stores. Neonates with a deficient iron store at birth likely to have low iron stores at 4 weeks.

Iron profiles of preterm infants at two months of chronological age

Background Preterm infants are vulnerable to iron deficiency (ID) due to lack of maternal iron stores, repeated phlebotomy, and the body’s increased demand for iron during growth. The risk of ID increases at 2 months of age, when hemoglobin (Hb) levels start to decrease. Adequacy of body iron level is assessed by ferritin, serum iron (SI), transferrin saturation (Tfsat), total iron-binding capacity (TIBC), and Hb measurements.Objective To describe iron profiles in preterm infants at 2 months of chronological age (CA).Methods This cross-sectional study was conducted in 2-month-old infants, born at 32-36 weeks of gestational age, and who visited the Growth and Development Clinics at Cipto Mangunkusumo, Fatmawati, or Budi Kemuliaan Hospitals. Parental interviews and medical record reviews were done during the clinic visits. Complete blood count, blood smear, SI, TIBC, Tfsat, and ferritin level tests were performed.Results Eighty-three subjects were enrolled in this study. Most subjects were male (51%) and born to mothers &gt;20 years of age (93%). Subjects’ birth weights ranged from 1,180 g to 2,550 g. The prevalence of iron deficiency anemia (IDA) was 6% and that of ID was 10%. The lowest Hb level found in IDA infants was 6.8 g/dL, while the lowest ferritin level was 8.6 ng/mL. Median values for the other tests were as follows: SI 48 µg/dL, TIBC 329µg/dL, and Tfsat 17%. Subjects with IDA were all male (5/5), mostly achieved more than twice their birth weight (4/5), were non-iron supplemented (3/5), born to mothers with low educational background (3/5), and of low socioeconomic status (3/5).Conclusion The prevalence of IDA is 6% and that of ID is 10%. Most subjects with ID and IDA have low SI, high TIBC, low Tfsat, and low ferritin level. Most of the all-male IDA subjects weigh more than twice their birth weight, are non-iron supplemented, and born to mothers with low educational background and low socioeconomic status.

Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam.

ObjectivePreconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum.MethodsWe conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 μg FA (control group), IFA (60 mg Fe and 2800 μg FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 μg FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements ≥ 26 weeks before conception).ResultsAt baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 μg/L) and 3% had iron deficiency (ferritin <12 μg/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (μg/L) [95% CI]: 93.6 [89.3–98.2]) and IFA (91.9 [87.6–96.3]) compared to control (85.3 [81.5–89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3–127.8]), IFA 117.8 [108.7–127.7] vs control 101.5 [94.0–109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1–192.9]), IFA 189.9 [181.6–198.3] vs control 175.1 [167.9–182.6]).ConclusionPreconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia.Trial RegistrationClinicalTrials.Gov NCT01665378

The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy.

Obesity is associated with decreased iron status, possibly due to a rise in hepcidin, an inflammatory protein known to reduce iron absorption. In animals, we have shown that maternal iron deficiency is minimised in the foetus by increased expression of placental transferrin receptor (pTFR1), resulting in increased iron transfer at the expense of maternal iron stores. This study examines the effect of obesity during pregnancy on maternal and neonatal iron status in human cohorts and whether the placenta can compensate for decreased maternal iron stores by increasing pTFR1 expression. A total of 240 women were included in this study. One hundred and fifty-eight placentas (Normal: 90; Overweight: 37; Obese: 31) were collected at delivery. Maternal iron status was measured by determining serum transferrin receptor (sTFR) and ferritin levels at 24 and 34 weeks and at delivery. Hepcidin in maternal and cord blood was measured by ELISA and pTFR1 in placentas by western blotting and real-time RT-PCR. Low iron stores were more common in obese women. Hepcidin levels (ng ml(-1)) at the end of the pregnancy were higher in obese than normal women (26.03±12.95 vs 18.00±10.77, P<0.05). Maternal hepcidin levels were correlated with maternal iron status (sTFR r=0.2 P=0.025), but not with neonatal values. mRNA and protein levels of pTFR1 were both inversely related to maternal iron status. For mRNA and all women, sTFR r=0.2 P=0.044. Ferritin mRNA levels correlated only in overweight women r=-0.5 P=0.039 with hepcidin (r=0.1 P=0.349), irrespective of maternal body mass index (BMI). The data support the hypothesis that obese pregnant women have a greater risk of iron deficiency and that hepcidin may be a regulatory factor. Further, we show that the placenta responds to decreased maternal iron status by increasing pTFR1 expression.

Maternal Anemia and its Correlation with Iron status of Newborn

Aim: To investigate the correlation of maternal blood Hb level and iron stores with neonatal iron status. Methods: A cross sectional analytic study on was conducted on fifty hospitalized pregnant women and their neonates over one year in a teaching hospital in the capital city of Bangladesh. Paired samples (50) of maternal venous and neonatal Women who had no medical complications and had undergone caesarian section were included. Maternal serum and cord hemoglobin concentrations with ferritin values were measured immediately after delivery. Placental weight, birth weight and APGAR scores were recorded. Result: The study involved 50 participants, randomly selected, of whom 10 had normal iron status and others had mild to severe anemia. Our study found no significant correlation of maternal Hb and cord Hb levels. But maternal serum ferritin showed positive correlation with cord ferritin (r=0.94; P&lt;0.001) and with placental weight (r=0.40; p&lt;0.001). Conclusion: Maternal iron deficiency anaemia was strongly associated with lower iron status of newborn DOI: http://dx.doi.org/10.3329/birdem.v4i1.18550 Birdem Med J 2014; 4(1): 27-32

Depleted iron stores without anaemia early in pregnancy carries increased risk of lower birthweight even when supplemented daily with moderate iron

Gestational iron-deficiency anaemia has adverse pregnancy outcomes. Antenatal iron supplementation can be beneficial in anaemic women, but the effects in non-anaemic women are controversial. This observational study assessed the relationship of maternal iron stores (depleted or non-depleted) at gestational Weeks 8-12 with birthweight, in non-anaemic pregnant women following the guidelines of the Ministry of Health of Spain. Healthy, non-anaemic pregnant women (n = 205) were studied. At the first antenatal visit, a general clinical assessment was conducted, and basal blood taken. Women were classified as having non-depleted or depleted iron stores [serum ferritin (SF) < 12 µg/l)]. Daily antenatal iron supplements (48 mg on average) were started at 17 (range: 16-18) weeks. Blood haemoglobin, SF and transferrin saturation (TS) were measured in each trimester. Of the study sample, 20, 54 and 66% had SF < 12 µg/l in the first, second and third trimesters, respectively. The prevalence of iron-depletion (SF < 12 µg/l) and iron-deficiency (SF < 12 µg/l and TS < 16%) was greater during the entire pregnancy in women with initial iron depletion versus no depletion (81.6 and 73.7% versus 61.7 and 55.4%, respectively, in the third trimester, P < 0.05). Women with initial iron-depletion delivered babies weighing on average 192 g less than that with initial iron stores, after adjusting for confounding variables (P = 0.028). Beginning pregnancy with non-depleted iron stores is beneficial for the maternal iron status during pregnancy and infant birthweight. These findings reaffirm the importance of health promotion to ensure that women have adequate iron stores prior to, or early in, pregnancy when supplemented with moderate daily iron doses.