Maternal Iron Supplementation Research Articles

Risk Factors of Anaemia among Children under Five Years in the Hohoe Municipality, Ghana: A Case Control Study.

Background Anaemia is one of the major causes of death among children under five years in Ghana. We examined the risk factors of anaemia among children under five years in the Hohoe Municipality, Ghana. Methods This facility-based matched case control study recruited 210 children (70 cases and 140 controls) aged 6 to 59 months. Stratified and simple random sampling techniques were used to select mothers attending Child Welfare Clinic (CWC) for the screening of their children. Data were collected using a semistructured questionnaire. Finger prick blood was collected to estimate the haemoglobin (Hb) level and thick film was prepared to determine malaria parasitaemia. Axillary temperature was measured using an +electronic thermometer and anthropometric measurements were done using a weighing scale and inelastic tape measure. Continuous variables were presented as means and standard deviations and categorical variables as frequencies and proportions. Conditional logistic regression was used to determine the strength of association between the dependent and the independent variables. Statistical significance was considered at p value of <0.05. Results The prevalence of anaemia was high (53.8%), while children whose mothers received iron supplementation during pregnancy were 7.64 times more likely to be anaemic compared with those who did not [AOR=7.64 (95% CI:1.41-41.20.93); p=0.018]. Children with poor dietary diversity were 9.15 times more likely to have anaemia [AOR=9.15 (95% CI: 3.13-26.82); p< 0.001]; and children whose mothers were farmers and traders were 83% [AOR = 0.17 (95% CI: 0.05-0.60); p=0.006] and 79% [AOR=0.21 (95% CI: 0.06-0.74); p=0.014], respectively, less likely to have anaemia. Conclusion The biologic, intermediate, and underlying factors that were significantly associated with anaemia comprised maternal iron supplementation, poor dietary diversity, farmers, and traders. Given that iron supplementation during pregnancy did not protect children against anaemia, we recommend the child's nutritional dietary diversity is encouraged.

Maternal Prenatal Psychosocial Stress and BMI Predict Lower Fetal Iron Status in a Mexico City Cohort (FS01-07-19)

ObjectivesInsufficient iron in utero may impair neurocognitive development. Prenatal physiological stress, as in obesity, inhibits fetal iron accumulation. Emerging evidence suggests prenatal psychosocial stress may similarly suppress fetal iron, a novel potential mechanism linking prenatal stress and child neuro-cognition. In a pregnancy cohort in Mexico City, Mexico, we investigated associations between maternal prenatal stress and psychological function, pre-pregnancy BMI and fetal iron at delivery. We hypothesized that maternal prenatal psychosocial stress and psychological dysfunction and pre-pregnancy BMI would be associated with lower cord blood Hb and ferritin. MethodsPsychosocial stress and psychological function were assessed with validated questionnaires in mid-pregnancy: depression symptoms (CES-D), trait anxiety (STI), perceived stress (PSS-4), lifetime exposure to violence (ETV), and negative life events (NLEs, CRISYS). Pre-pregnancy BMI was calculated from self-reported height and weight. Cord blood was collected at delivery and ferritin (ferr.) and hemoglobin (Hb) measured. Regression models were developed for Hb and log-transformed ferr. as functions of dichotomized stress scores (CES-D ≥ 13, STI > median, PSS-4 > 4th quartile, ETV > 0.5, CRISYS > 1st quartile) and pre-pregnancy overweight and obesity in separate models, each adjusted for maternal age, SES, child sex and maternal prenatal iron supplementation (yes/no). ResultsIn 455 dyads with complete data, median (IQR) ferr. and Hb were 186 μg/L (125, 265) and 16 g/dL (14.7, 17), respectively. In adjusted models, lower ferr. was associated with prenatal depression symptoms (11%, 95% CI: –0.26, 0.01), elevated perceived stress (23%, –0.35, –0.09), high lifetime violence (21%, –0.33, –0.06) and high NLEs count (10%, –0.22, 0.02), as well as maternal pre-pregnancy obesity (17%, –0.31, –0.00). Interaction models suggested possible stronger prenatal stressor effects among overweight and obese mothers. No associations with cord blood Hb were observed. ConclusionsIn Mexico City pregnant women, excess pre-pregnancy BMI and multiple prenatal psychosocial stressors were each associated with fetal iron stores at birth. Insufficient fetal iron accrual may explain links between maternal prenatal stress and child neurocognitive development, but more research is needed. Funding SourcesNational Institutes of Health, Office of the Director; National Institute of Environmental Health Sciences.

Maternal Prenatal Psychosocial Stress and BMI Predict Lower Fetal Iron Status in a Mexico City Cohort (FS01-07-19)

ObjectivesInsufficient iron in utero may impair neurocognitive development. Prenatal physiological stress, as in obesity, inhibits fetal iron accumulation. Emerging evidence suggests prenatal psychosocial stress may similarly suppress fetal iron, a novel potential mechanism linking prenatal stress and child neuro-cognition. In a pregnancy cohort in Mexico City, Mexico, we investigated associations between maternal prenatal stress and psychological function, pre-pregnancy BMI and fetal iron at delivery. We hypothesized that maternal prenatal psychosocial stress and psychological dysfunction and pre-pregnancy BMI would be associated with lower cord blood Hb and ferritin. MethodsPsychosocial stress and psychological function were assessed with validated questionnaires in mid-pregnancy: depression symptoms (CES-D), trait anxiety (STI), perceived stress (PSS-4), lifetime exposure to violence (ETV), and negative life events (NLEs, CRISYS). Pre-pregnancy BMI was calculated from self-reported height and weight. Cord blood was collected at delivery and ferritin (ferr.) and hemoglobin (Hb) measured. Regression models were developed for Hb and log-transformed ferr. as functions of dichotomized stress scores (CES-D ≥ 13, STI > median, PSS-4 >4th quartile, ETV >0.5, CRISYS >1st quartile) and pre-pregnancy overweight and obesity in separate models, each adjusted for maternal age, SES, child sex and maternal prenatal iron supplementation (yes/no). ResultsIn 455 dyads with complete data, median (IQR) ferr. and Hb were 186 μg/L (125, 265) and 16 g/dL (14.7, 17), respectively. In adjusted models, lower ferr. was associated with prenatal depression symptoms (11%, 95% CI: -0.26, 0.01), elevated perceived stress (23%, -0.35, -0.09), high lifetime violence (21%, -0.33, -0.06) and high NLEs count (10%, -0.22, 0.02), as well as maternal pre-pregnancy obesity (17%, -0.31, -0.00). Interaction models suggested possible stronger prenatal stressor effects among overweight and obese mothers. No associations with cord blood Hb were observed. ConclusionsIn Mexico City pregnant women, excess pre-pregnancy BMI and multiple prenatal psychosocial stressors were each associated with fetal iron stores at birth. Insufficient fetal iron accrual may explain links between maternal prenatal stress and child neurocognitive development, but more research is needed. Funding SourcesNational Institutes of Health, Office of the Director; National Institute of Environmental Health Sciences.

What explains the fall in child stunting in Sub-Saharan Africa?

There have been steep falls in rates of child stunting in much of Sub-Saharan Africa (SSA). Using Demographic and Health Survey data, we document significant reductions in stunting in seven SSA countries in the period 2005–2014. For each country, we distinguish potential determinants that move in a direction consistent with having contributed to the reduction in stunting from those that do not. We then decompose the change in stunting and in proximal determinants into a part that can be explained by changes in distal determinants and a residual part that captures the impact of unmeasured factors, such as vertical nutrition programs. We show that increases in coverage of child immunization, deworming medication and maternal iron supplementation often coincide with a fall in stunting. The magnitudes and directions of changes in two other proximal determinants -- age-appropriate feeding and diarrhea prevalence -- suggest that these have not been strong contributors to the fall in stunting. Utilization of maternity care emerges from the decomposition analysis as the most important distal determinant associated with reduced stunting, and also with increased coverage of iron supplementation, and, to a lesser extent, with child immunization and deworming medication. This circumstantial evidence is strong enough to warrant more detailed investigation of the extent to which maternity care is an effective channel through which to target further attacks on the blight of undernourished children.

Maternal and Early Life Iron Intake and Risk of Childhood Type 1 Diabetes: A Danish Case-Cohort Study.

Background: Iron overload has been associated with diabetes. Studies on iron exposure during pregnancy and in early life and risk of childhood type 1 diabetes (T1D) are sparse. We investigated whether iron supplementation during pregnancy and early in life were associated with risk of childhood T1D. Methods: In a case-cohort design, we identified up to 257 children with T1D (prevalence 0.37%) from the Danish National Birth Cohort through linkage with the Danish Childhood Diabetes Register. The primary exposure was maternal pure iron supplementation (yes/no) during pregnancy as reported in interview two at 30 weeks of gestation (n = 68,497 with iron supplement data). We estimated hazard ratios (HRs) using weighted Cox regression adjusting for multiple confounders. We also examined if offspring supplementation during the first 18 months of life was associated with later risk of T1D. Results: Maternal iron supplementation was not associated with later risk of T1D in the offspring HR 1.05 (95% CI: 0.76–1.45). Offspring intake of iron droplets during the first 18 months of life was inversely associated with risk of T1D HR 0.74 (95% CI: 0.55–1.00) (ptrend = 0.03). Conclusions: Our large-scale prospective study demonstrated no harmful effects of iron supplementation during pregnancy and in early life in regard to later risk of childhood T1D in the offspring.

Risk Factors of Anaemia Among Pregnant Women in Banyo Health District, Adamawa Region of Cameroon

Background: Anaemia in pregnant women remains a major preoccupation in the fight against maternal and infant mortality. It constitutes a sure materno-infantile morbidity and mortality risk, premature delivery and small weight births. Objective: This study was aimed at determining the risk factors of anaemia among pregnant women in the Banyo Health District in the Adamawa Region, Cameroun. Materials and methods: A cross-sectional study was carried out for six weeks (September 17 to November 3, 2013) in 6 health facilities of the Banyo Health District. Included in this study were all pregnant woman received during prenatal consultation in the health facilities of the Banyo Health District who gave her consent to participate in the study. Data collection was done with the help of a questionnaire. A total of 297 pregnant women received during prenatal consultation in the 6 health facilities of the 5 health areas were chosen by the systematic consecutive sampling method. These women benefited from a haemoglobin test after a capillary blood draw was carried out which permitted a para-clinical evaluation of the anaemia. Data were analysed by Excel and SPSS 22 softwares. Results: The results showed that the mean haemoglobin rate was of 10.8±1.89 g/dl. 52.5% of pregnant women were anaemic amongst which 46% had mild anaemia, 48% had moderate anaemia and 6% had severe anaemia. 63% of the women with anaemia live in polygamous household and 55.7% do not wash their hands with soap after a meal. The prevalence of anaemia among pregnant women in the Banyo Health District was associate with the consumption of kaolin (OR=1.9 [1.1-3.9] p=0.049), irregular iron supplement intake (OR=2.9 [1.4-5.9] p=0.014) and the number of meal consumed per day less than or equal to 2 (OR=2.81 [2.13-5.9] p=0.007). On the other hand, regular fruit consumption (OR=0.28 [0.11-0.74] p=0.011), sound knowledge of the causes (OR=0.36 [0.19-0.68] p=0.002) and the consequences (OR=0.35 [0.19-0.7] p=0.003) of anaemia were significantly associated with lesser risk of anaemia among the pregnant women. Conclusion: The high prevalence of anaemia among pregnant women in the Banyo Health District remains a preoccupying health problem. It demonstrates the need of a global action in resolution of this public health problem. As such, there is a need to mobilize a preventive strategy with emphasis on sensitization, nutritional and health education. In addition, maternal systematic iron supplementation from the second trimester of pregnancy remains an imperative.

Prenatal iron exposure and childhood type 1 diabetes

Iron overload due to environmental or genetic causes have been associated diabetes. We hypothesized that prenatal iron exposure is associated with higher risk of childhood type 1 diabetes. In the Norwegian Mother and Child cohort study (n = 94,209 pregnancies, n = 373 developed type 1 diabetes) the incidence of type 1 diabetes was higher in children exposed to maternal iron supplementation than unexposed (36.8/100,000/year compared to 28.6/100,000/year, adjusted hazard ratio 1.33, 95%CI: 1.06–1.67). Cord plasma biomarkers of high iron status were non-significantly associated with higher risk of type 1 diabetes (ferritin OR = 1.05 [95%CI: 0.99–1.13] per 50 mg/L increase; soluble transferrin receptor: OR = 0.91 [95%CI: 0.81–1.01] per 0.5 mg/L increase). Maternal but not fetal HFE genotypes causing high/intermediate iron stores were associated with offspring diabetes (odds ratio: 1.45, 95%CI: 1.04, 2.02). Maternal anaemia or non-iron dietary supplements did not significantly predict type 1 diabetes. Perinatal iron exposures were not associated with cord blood DNA genome-wide methylation, but fetal HFE genotype was associated with differential fetal methylation near HFE. Maternal cytokines in mid-pregnancy of the pro-inflammatory M1 pathway differed by maternal iron supplements and HFE genotype. Our results suggest that exposure to iron during pregnancy may be a risk factor for type 1 diabetes in the offspring.

The effect of universal maternal antenatal iron supplementation on neurodevelopment in offspring: a systematic review and meta-analysis

BackgroundAlthough antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial. A systematic review and meta-analysis was undertaken to assess whether routine maternal antenatal iron supplementation confers later neurodevelopmental benefit to offspring.MethodsElectronic databases were searched using MESH terms or key words and identified papers were reviewed by two independent reviewers. The study quality was assessed using the Cochrane risk of bias assessment tool. The review was registered in the PROSPERO CRD data base.ResultsSeven publications were identified, based on four randomised trials published between 2006 and 2016. Three of the trials were in the Asian sub-continent. A range of tools were used to evaluate neurodevelopment. Meta-analysis of outcomes from the three RCTs meeting our inclusion criteria showed minimal effect of antenatal iron supplementation on the neurodevelopment of offspring, which was not statistically significant: weighted mean difference of 0.54 (95% CI: -0.67 to 1.75); test for overall effect Z = 0.87; p = 0.38; and heterogeneity 48%. Meta-analysis of outcomes of these RCTs at later stages of development produced similar results.ConclusionsThe benefit of routine antenatal iron supplementation on neurodevelopment in offspring was not statistically significant in this relatively limited set of trials, and some benefit cannot be excluded in areas with a high prevalence of maternal anaemia. A large randomized controlled trial showing significant benefit would be required to modify our conclusions.

Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children.

Iron deficiency is the most common micronutrient deficiency in the world. Women of reproductive age and young children are particularly vulnerable. Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment. This may occur because screening and treatment of iron deficiency in children is currently focused on detection of anemia and not neurodevelopment. Anemia is the end-stage state of iron deficiency. The brain becomes iron deficient before the onset of anemia due to prioritization of the available iron to the red blood cells (RBCs) over other organs. Brain iron deficiency, independent of anemia, is responsible for the adverse neurological effects. Early diagnosis and treatment of impending brain dysfunction in the pre-anemic stage is necessary to prevent neurological deficits. The currently available hematological indices are not sensitive biomarkers of brain iron deficiency and dysfunction. Studies in non-human primate models suggest that serum proteomic and metabolomic analyses may be superior for this purpose. Maternal iron supplementation, delayed clamping or milking of the umbilical cord, and early iron supplementation improve the iron status of at-risk infants. Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined. The potential for oxidant stress, altered gastrointestinal microbiome and other adverse effects associated with iron supplementation cautions against indiscriminate iron supplementation of children in malaria-endemic regions and iron-sufficient populations.

U-shaped curve for risk associated with maternal hemoglobin, iron status, or iron supplementation

Both iron deficiency (ID) and excess can lead to impaired health status. There is substantial evidence of a U-shaped curve between the risk of adverse birth outcomes and maternal hemoglobin concentrations during pregnancy; however, it is unclear whether those relations are attributable to conditions of low and high iron status or to other mechanisms. We summarized current evidence from human studies regarding the association between birth outcomes and maternal hemoglobin concentrations or iron status. We also reviewed effects of iron supplementation on birth outcomes among women at low risk of ID and the potential mechanisms for adverse effects of high iron status during pregnancy. Overall, we confirmed a U-shaped curve for the risk of adverse birth outcomes with maternal hemoglobin concentrations, but the relations differ by trimester. For low hemoglobin concentrations, the link with adverse outcomes is more evident when hemoglobin concentrations are measured in early pregnancy. These relations generally became weaker or nonexistent when hemoglobin concentrations are measured in the second or third trimesters. Associations between high hemoglobin concentration and adverse birth outcomes are evident in all 3 trimesters but evidence is mixed. There is less evidence for the associations between maternal iron status and adverse birth outcomes. Most studies used serum ferritin (SF) concentrations as the indicator of iron status, which makes the interpretation of results challenging because SF concentrations increase in response to inflammation or infection. The effect of iron supplementation during pregnancy may depend on initial iron status. There are several mechanisms through which high iron status during pregnancy may have adverse effects on birth outcomes, including oxidative stress, increased blood viscosity, and impaired systemic response to inflammation and infection. Research is needed to understand the biological processes that underlie the U-shaped curves seen in observational studies. Reevaluation of cutoffs for hemoglobin concentrations and indicators of iron status during pregnancy is also needed.

Magnitude and associated factors of anemia among pregnant women in Dera District: a cross-sectional study in northwest Ethiopia

BackgroundAnemia is associated with adverse health and socio-economic consequences among pregnant women. Particularly, severe anemia increases the risk of maternal mortality by 20%. However, literatures are scarce in the northwest Ethiopia. Therefore, this study aimed to determine the magnitude and associated factors of anemia among pregnant women attending antenatal care in Dera District, South Gondar Zone, northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted in Dera District health centers from June 27 to September 2, 2015. Capillary blood samples were taken from 348 pregnant women. The raw measured values of hemoglobin were obtained using the portable Hb301 instrument and adjusted for altitude. Besides, nutritional status of the women was assessed by the mid upper arm circumference (MUAC) taken on non-dominant upper limb, mostly of the left hand. Socio-demographic factors, obstetric history, environmental related factors and dietary intake were collected by interviewing the pregnant women. A multivariate logistic regression analysis was employed to identify factors associated with anemia. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was computed to show the strength of association. In multivariable analysis, a P value of <0.05 was used to declare statistical significance.ResultsThe overall prevalence of anemia among pregnant women was 30.5% [95% CI 21.0, 40.0]. The result of multivariable analysis revealed that the likelihood of anemia was higher among pregnant women living in rural areas [AOR = 3.03, 95% CI 1.17, 7.82], had no latrine [AOR = 4.75, 95% CI 1.15, 16.60], low monthly income: <Eth. Birr 1200 (US dollar 52.22) [AOR = 2.56, 95% CI 1.17, 5.60], five or above parity [AOR = 4.17; 95% CI 1.62, 10.69], MUAC < 23 cm [AOR = 4.97; 95% CI 2.61, 9.43] and did not prenatal take iron supplementation [AOR = 5.63; 95% 2.21, 14.32].ConclusionSo far in the district, the magnitude of anemia existed as a moderate public health concern. Thus, improved socio-economic status, latrine and maternal iron supplementation coverage are essential to mitigate the high burden of anemia. In addition, nutritional counseling and education on the consumption of extra meals and iron-rich foods should be intensified.

Iron Supplementation in Iron-Replete and Nonanemic Pregnant Women in Tanzania: A Randomized Clinical Trial.

Anemia is common in pregnancy and increases the risk of adverse outcomes. Iron deficiency is a leading cause of anemia in sub-Saharan Africa, and iron supplementation is the standard of care during pregnancy; however, recent trials among children have raised concerns regarding the safety of iron supplementation in malaria-endemic regions. There is limited evidence on the safety of iron supplementation during pregnancy in these areas. To evaluate the safety and efficacy of iron supplementation during pregnancy in a malaria-endemic region. We conducted a randomized, double-blind, placebo-controlled clinical trial among pregnant women presenting for antenatal care in Dar es Salaam, Tanzania, from September 28, 2010, through October 4, 2012. Iron-replete, nonanemic women were eligible if they were uninfected with human immunodeficiency virus, primigravidae or secundigravidae, and at or before 27 weeks of gestation. Screening of 21,316 women continued until the target enrollment of 1500 was reached. Analyses followed the intent-to-treat principle and included all randomized participants. Participants were randomized to receive 60 mg of iron or placebo, returning every 4 weeks for standard prenatal care, including malaria screening, prophylaxis with the combination of sulfadoxine and pyrimethamine, and treatment, as needed. The primary outcomes were placental malaria, maternal hemoglobin level at delivery, and birth weight. Among 1500 study participants (750 randomized for each group), 731 in iron group and 738 in placebo group had known birth outcomes and 493 in iron group and 510 in placebo group had placental samples included in the analysis. Maternal characteristics were similar at baseline in the iron and placebo groups, and 1354 (91.7%) used malaria control measures. The risk of placental malaria was not increased by maternal iron supplementation (relative risk [RR], 1.03; 95% CI, 0.65-1.65), and iron supplementation did not significantly affect birth weight (3155 vs 3137 g, P = .89). Compared with placebo, iron supplementation significantly improved the mean increase from baseline to delivery for hemoglobin (0.1 vs -0.7 g/dL, P < .001) and serum ferritin (41.3 vs 11.3 µg/L, P < .001). Iron supplementation significantly decreased the risk of anemia at delivery by 40% (RR, 0.60; 95% CI, 0.51-0.71) but not severe anemia (RR, 0.68; 95% CI, 0.41-1.14). Iron supplementation significantly reduced the risk of maternal iron deficiency at delivery by 52% (RR, 0.48; 95% CI, 0.32-0.70) and the risk of iron deficiency anemia by 66% (RR, 0.34; 95% CI, 0.19-0.62). Prenatal iron supplementation among iron-replete, nonanemic women was not associated with an increased risk of placental malaria or other adverse events in the context of good malaria control. Participants receiving supplementation had improved hematologic and iron status at delivery compared with the placebo group. These findings provide support for continued administration of iron during pregnancy in malaria-endemic regions. clinicaltrials.gov Identifier: NCT01119612.

Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force

Routine screening and supplementation for iron deficiency anemia (IDA) in asymptomatic, nonanemic pregnant women could improve maternal and infant health outcomes. Update of a 2006 systematic review by the U.S. Preventive Services Task Force on screening and supplementation for IDA in pregnancy. MEDLINE and the Cochrane Library (1996 to August 2014) and reference lists of relevant systematic reviews to identify studies published since 1996. English-language trials and controlled observational studies about effectiveness of screening and routine supplementation for IDA in developed countries. Data extraction and quality assessment confirmed and dual-rated by a second investigator using prespecified criteria. No study directly compared clinical outcomes or harms of screening or not screening pregnant women for IDA. Twelve supplementation trials were included, and no controlled observational studies met inclusion criteria. On the basis of 11 trials, routine maternal iron supplementation had inconsistent effects on rates of cesarean delivery, small size for gestational age, and low birthweight and no effect on maternal quality of life, gestational age, Apgar scores, preterm birth, or infant mortality. Twelve trials reported improvements in maternal hematologic indices, although not all were statistically significant. Pooled analysis of 4 trials resulted in a statistically significant difference in IDA incidence at term, favoring supplementation (risk ratio, 0.29 [95% CI, 0.17 to 0.49]; I2= 0%). Maternal iron supplementation did not affect infant iron status at 6 months. Harms, none of which were serious or had long-term consequences, were inconsistently reported in 10 of the trials, with most finding no difference between groups. Data from trials in countries with limited generalizability to U.S. populations were included. Studies were methodologically heterogeneous, and some were small and underpowered. There is inconclusive evidence that routine prenatal supplementation for IDA improves maternal or infant clinical health outcomes, but supplementation may improve maternal hematologic indices. Agency for Healthcare Research and Quality.

Maternal Iron Deficiency Anemia as a Risk Factor for the Development of Retinopathy of Prematurity

BackgroundRetinopathy of prematurity is a proliferative vascular disease affecting premature newborns and occurs during vessel development and maturation. The aim of this study was to evaluate the maternal iron deficiency anemia as possible risk factors associated with the development of retinopathy of prematurity among premature or very low birth weight infants. MethodsIn this study, mothers of 254 infants with retinopathy of prematurity were analyzed retrospectively, and their laboratory results of medical records during pregnancy were reviewed for possible iron deficiency anemia. ResultsIn a cohort of 254 mothers of premature infants with retinopathy of prematurity, 187 (73.6%) had iron deficiency, while the remaining 67 (26.4%) mothers had no deficiency. Babies born to mothers with iron deficiency anemia with markedly decreased hemoglobin, hematocrit, mean corpuscular volume, serum iron, and ferritin levels were more likely to develop retinopathy of prematurity. ConclusionsOur results are the first to suggest that maternal iron deficiency is a risk factor for the development of retinopathy of prematurity. Our data suggest that maternal iron supplementation therapy during pregnancy might lower the risk of retinopathy of prematurity.

Association Between Maternal Iron Supplementation During Pregnancy and Risk of Celiac Disease in Children

The aim of our study was to determine whether the use of iron supplements during pregnancy affects the risk for celiac disease in children. We assessed data from the prospective Norwegian Mother and Child cohort study, in which individuals with celiac disease were identified by answers on questionnaires and linkage to the Norwegian Patient Register. Complete data were available for 78,846 children (mean age 5.9 years, range 2-12 years); 314 children were identified with celiac disease. Questionnaires were given to pregnant women to collect information on use of iron-containing supplements, diet, anemia, and levels of hemoglobin. Celiac disease was diagnosed in 4.65 of 1000 children whose mothers took iron supplements while they were pregnant, compared with 3.15 of 1000 children whose mothers did not. After adjusting for children's age, sex, and age of gluten introduction, and the presence of celiac disease in mothers, iron supplementation during pregnancy remained significantly associated with celiac disease in children (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.05-1.68; P = .019). However, celiac disease was not associated with the mothers' intake of iron from foods (adjusted OR, 1.00; 95% CI, 0.97-1.03). Anemia before or during the early stages of pregnancy was not significantly associated with the risk of celiac disease in children (adjusted OR, 1.24; 95% CI, 0.84-2.00; P = .24). The use of iron supplements during pregnancy remained significantly associated with celiac disease in children after adjusting for children who were given iron supplements before 18 months of age, which itself was associated with celiac disease. In a prospective Norwegian Mother and Child cohort study, we found an increased risk of celiac disease in children whose mothers used iron supplements during pregnancy; this association does not appear to arise from maternal anemia.

Maternal Iron and Folic Acid Supplementation Is Associated with Lower Risk of Low Birth Weight in India1–3

Improving maternal nutrition is an important step toward reducing low birth weight (LBW) and its sequelae. In India, an estimated 7.5 million babies are born each year with LBW, which accounts for more than one-third of the global burden. In this context, little is known about the population-level association of iron and folic acid supplementation (IFA) during pregnancy and reducing the outcome of LBW. Using pooled data from the nationally representative 1998/1999 and 2005/2006 National Family Health Surveys of India, we examined the association of IFA with LBW and birth weight using multivariable logistic and linear regression models, respectively (n = 22,648). We found that IFA during pregnancy was negatively associated with LBW after adjustment for socioeconomic status [OR = 0.77 (95% CI: 0.68, 0.87); P < 0.001] and further adjustment for antenatal care (ANC) utilization [OR = 0.82 (95% CI: 0.72, 0.94); P < 0.001]. This corresponded to a 41-g [(95% CI: 2 g, 80 g); P < 0.05] increase in birth weight, which attenuated to 28 g [(95% CI: −12 g, 68 g); P = 0.71] after additional adjustment for ANC. At the population level in a context where the burden of anemia is severe (prevalence ≥40%), IFA during pregnancy was significantly associated with decreased LBW. Measures to improve the implementation of this simple intervention should help to address India's burden of LBW.

Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries

Infection is a major cause of neonatal death in developing countries. This review investigates whether host iron status affects the risk of maternal and/or neonatal infection, potentially contributing to neonatal death, and summarizes the iron acquisition mechanisms described for pathogens causing stillbirth, preterm birth, and congenital infection. In vitro evidence shows that iron availability influences the severity and chronicity of infections that cause these negative outcomes of pregnancy. In vivo evidence is lacking, as relevant studies of maternal iron supplementation have not assessed the effect of iron status on the risk of maternal and/or neonatal infection. Reducing iron-deficiency anemia among women is beneficial and should improve the iron stores of babies; moreover, there is evidence that iron status in young children predicts the risk of malaria and, possibly, the risk of invasive bacterial diseases. Caution with maternal iron supplementation is indicated in iron-replete women who may be at high risk of exposure to infection, although distinguishing between iron-replete and iron-deficient women is currently difficult in developing countries, where a point-of-care test is needed. Further research is indicated to investigate the risk of infection relative to iron status in mothers and babies in order to avoid iron intervention strategies that may result in detrimental birth outcomes in some groups of women.

Maternal nutrition and fetal growth: the role of iron status and intake during pregnancy

Correspondence: Clara L RodriguezBernal Centro Superior de Investigacion en Salud Publica, Avenida Cataluna 21, Valencia 46020, Spain Tel +34 961 925 909 Fax +34 961 925 703 Email rodriguez_claber@gva.es Abstract: Fetal growth restriction is an important predictor of infant mortality and morbidity. Maternal iron status and iron supplementation during pregnancy have been related to fetal growth with contrasting results. Therefore, indication of iron supplementation, doses, and timing is still controversial. Current literature was reviewed in PubMed/MEDLINE using the following terms: “iron” or “iron deficiency” or “anemia” or “iron intake” or “iron supplementation” and “pregnancy” or “maternal” and “fetal growth” or “birth weight” or “pregnancy outcomes” or “birth outcomes.” The search was limited to studies in humans since 1991 assessing iron status or supplementation in the periconceptional period or at any time during pregnancy. Evidence suggests that iron deficiency in early pregnancy has an adverse effect on fetal growth. On the other hand, high levels of maternal iron markers have shown a deleterious effect at different stages of pregnancy. The mechanisms underlying such effect are unclear. It is important to acknowledge the need to assess markers of iron status adequately in order to reach reliable conclusions regarding their relationship with fetal growth. In regard to supplementation, it has been shown that low or moderate doses of iron in early pregnancy have a positive effect on fetal growth, regardless of maternal iron status. No such effect has been seen in trials of supplementation later in pregnancy, with low or high doses. Nevertheless, results should be interpreted with caution as some randomized controlled trials lack adequate methodology. Studies assessing the effect of iron supplementation in early pregnancy on fetal growth in iron-deficient and iron-sufficient women are needed in order to establish the most appropriate indications for doses and timing.

Iron Absorption in Peruvian Breast‐fed Infants at Two and Five Months of Age

The effects of maternal prenatal iron (Fe) supplementation on early Fe homeostasis in breast‐fed infants remains largely unexplored. Towards this aim, longitudinal Fe absorption (58Fe) studies were conducted in 41 breast‐fed Peruvian infants at 2 months and 5 months of age. Hodges‐Lehmann 95% CIs were used to express the effect size of Fe supplementation on differences between groups. Predictors of Fe absorption and changes over time were examined using multiple linear regression. Fe absorption from breast milk averaged 7.9% (SD: 9.5) and 12.6% (SD: 11.9) at 2 and 5 months of age. Infants born to Fe supplemented women had greater length at 2 months (p=0.01). Infants born to non‐Fe supplemented women had higher increases in hemoglobin (p&lt;0.05) and Fe absorption (p&lt;0.01), between two and five months of age. Maternal serum zinc and TIBC and infant sTfr levels were associated with significantly increased Fe absorption at 5 months (p&lt;0.05). In analyses of changes in Fe absorption, infant hematocrit (p=0.01) and change in serum Fe (p=0.03) were significant predictors. Fe absorption in early infancy was associated with infant sTfr, hematocrit, and serum iron, and inversely associated with maternal Fe supplementation during pregnancy. Funded by The Nestle Foundation.

Maternal Iron and Zinc Supplementation during Pregnancy Affects Body Weight and Iron Status in Rat Pups at Weaning1–3

Pregnant women worldwide are frequently iron (Fe) and zinc (Zn) deficient. Therefore, cosupplementation with Fe and Zn during pregnancy is common. Although Fe supplementation programs are successful, studies suggest that Zn supplementation negatively affects maternal Fe metabolism. However, little is known about the effects of maternal Fe or Zn supplementation on Fe metabolism in the offspring. We developed a rat model to investigate if Fe and/or Zn supplementation during pregnancy affects regulation of nonheme Fe absorption and Fe status in offspring and if these effects are dependent upon maternal Fe and Zn status at conception. Control (C; fed a Fe- and Zn-adequate diet; 75 and 25 μg/g, respectively) or Fe- and Zn-deficient (D; fed a Fe- and Zn-deficient diet; 12 and 10 μg/g, respectively) rats were supplemented with Fe (27 mg/wk), Zn (4.5 mg/wk), Fe+Zn (27 mg Fe, 4.5 mg Zn/wk), or placebo throughout pregnancy. At postnatal d 21, body weight (BW), hemoglobin (Hb), hematocrit (Hct), liver and intestine Fe concentration, liver hepcidin, and intestine Fe transporter expression were determined in pups. Zn supplementation of C dams decreased pup BW (P < 0.0001), whereas it increased pup BW in D dams (P < 0.0001). Zn supplementation of C dams did not affect Hb and Hct in pups but increased the liver Fe concentration (P = 0.0002). However, Zn supplementation of D dams decreased hepcidin expression in their offspring (P < 0.0001). In C dams, Fe and Fe+Zn supplementation decreased ferroportin levels in pup intestine compared with pups from unsupplemented dams (P < 0.05). In conclusion, Zn supplementation of dams with adequate Fe and Zn status increases offspring liver Fe concentration and postnatally compromises BW. Therefore, potential adverse effects of Zn supplementation should be evaluated.