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Diet quality, nutrient intakes and biochemical status of New Zealand women of childbearing age according to alcohol consumption patterns. Public Health Nutr 2020; 23:2952-2962. [PMID: 32014079 DOI: 10.1017/s1368980019003781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate associations between alcohol consumption patterns and diet quality, nutrient intakes and biochemical profile of women of childbearing age. DESIGN Nutrient intake data from 24 h diet recalls, alcohol consumption data and diet quality from the Dietary Habits Questionnaire, and biochemical analyses from the cross-sectional 2008/09 Adult Nutrition Survey in New Zealand. SETTING New Zealand households. PARTICIPANTS New Zealand women aged 18-45 years (n 1124). RESULTS All analyses were completed using Stata and survey weights were used to allow for the complex survey design to produce population estimates. Multinomial logistic regression models were used to examine the associations between drinking patterns and the variables of interest, with 'infrequent moderate/light' drinkers being the reference category. The findings indicate that alcohol-consuming women of childbearing age tend to replace food energy with alcohol energy (P = 0·022). 'More frequent heavy' and 'more frequent moderate/light' drinkers had higher intakes of total, mono- and polyunsaturated fats with the latter group also consuming higher levels of saturated fats (P < 0·05). Women who were 'infrequent moderate/light' drinkers had relatively better diet quality, nutrient intakes and adequate biochemical status in comparison to other drinkers and abstainers. 'Infrequent heavy' drinkers, who were predominantly younger in age, had lower serum vitamin B12 levels (P = 0·01) with a higher proportion of women in this category having below-recommended levels of serum folate (P < 0·05). CONCLUSIONS Alcohol consumption, especially heavy drinking patterns, may compromise nutritional status of women of childbearing age.
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Nahrisah P, Somrongthong R, Viriyautsahakul N, Viwattanakulvanid P, Plianbangchang S. Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study. J Multidiscip Healthc 2020; 13:43-52. [PMID: 32021233 PMCID: PMC6970256 DOI: 10.2147/jmdh.s213550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake. Patients and Methods The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test–post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits—one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann–Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention. Results The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels. Conclusion Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.
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Affiliation(s)
- Putri Nahrisah
- College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand.,Health Office of Kota Langsa Municipality, Kota Langsa, Province of Aceh, Indonesia
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
| | | | | | - Samlee Plianbangchang
- College of Public Health Sciences, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
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The impact of an income-generating activities programme on children and mothers' undernutrition in extreme poor rural Bangladeshi households. Public Health Nutr 2019; 22:3073-3082. [PMID: 31512574 DOI: 10.1017/s1368980019002015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current study assessed changes in children and mothers' nutritional status before and after raising Bangladeshi households out of extreme poverty through an income-generating activities (IGA) programme. DESIGN Extreme poor households took part in the IGA programme for 2 years and recruitment took place over four waves in annual cycles. Children and mothers were measured with regarding their nutritional status before and after the IGA programme commenced. SETTINGS Rural Bangladesh. SUBJECTS Three-hundred and eighty-two children under 5 years of age at recruitment, and their mothers. RESULTS After 2 years of the IGA programme, the prevalence of stunting significantly declined from 40·3 % to 33·0 % (P = 0·003), anaemia declined from 51·6 % to 44·0 % (P = 0·020) while mothers' CED (Chronic Energy Deficiency) declined from 52·0 % to 42·7 % (P < 0·001), but no significant changes were found in children's wasting, declining from 25·4 % to 21·5 %, underweight which remained the same at 43·2 %, while mothers' anaemia rose from 39·3 % to 42·7 %. There were also highly significant improvements in household socio-economic status. Increases in socio-economic security (especially in relation to cash savings and net income) and improvements in food quantity and quality (indicated by greater food diversity and animal food intake) were associated with normal nutritional status, and cessation of open defecation was associated with reduction in mothers' and child anaemia. CONCLUSION The IGA programme was associated with increased household socio-economic security, such as asset accumulation, food security and sanitation, and with improvements in the nutritional status of children and their mothers in extreme poor households.
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Abioye AI, McDonald EA, Park S, Ripp K, Bennett B, Wu HW, Pond-Tor S, Sagliba MJ, Amoylen AJ, Baltazar PI, Tallo V, Acosta LP, Olveda RM, Kurtis JD, Friedman JF. Maternal anemia type during pregnancy is associated with anemia risk among offspring during infancy. Pediatr Res 2019; 86:396-402. [PMID: 31129681 PMCID: PMC6702090 DOI: 10.1038/s41390-019-0433-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 02/05/2019] [Accepted: 05/06/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND We evaluated the association between etiology of maternal anemia and iron status throughout infancy. METHODS Samples from a study designed to examine Praziquantel treatment during pregnancy were used (n = 359). All women were infected with schistosomiasis and randomized to Praziquantel or placebo at 16 ± 2 weeks' gestation. Hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, C-reactive protein, and interleukin-6 were measured in maternal and infant blood. The relationship between both maternal Praziquantel treatment and etiology of anemia and infant iron status was evaluated. RESULTS Maternal iron-deficiency anemia was associated with increased risk of infant anemia at 6 months of age. Infants of mothers with the lowest levels of circulating hepcidin during gestation, likely a marker for iron deficiency, had higher sTfR:SF levels and lower hemoglobin levels, particularly at 12 months of age. Maternal non-iron-deficiency anemia (NIDA) did not impact infant anemia risk or iron status. Maternal treatment for schistosomiasis had no effect on infant hematologic status. CONCLUSIONS Maternal iron deficiency anemia was associated with an increased risk for anemia or iron deficiency during late infancy. We did not observe an association between maternal NIDA and increased risk for iron deficiency during infancy.
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Affiliation(s)
- Ajibola I Abioye
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily A McDonald
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.
| | - Kelsey Ripp
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brady Bennett
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,School of Public Health, Brown University, Providence, RI,The Health Council of South Florida, Miami, FL
| | - Hannah W Wu
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sunthorn Pond-Tor
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Palmera I Baltazar
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Luz P Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Jonathan D Kurtis
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI,Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
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55
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Bora R, Ramasamy S, Brown B, Wolfson J, Rao R. Effect of iron supplementation from neonatal period on the iron status of6-month-old infants at-risk for early iron deficiency: a randomized interventional trial. J Matern Fetal Neonatal Med 2019; 34:1421-1429. [PMID: 31258019 DOI: 10.1080/14767058.2019.1638358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the effects of iron supplementation from the second day after birth on 6-month hemoglobin (Hb), serum ferritin and motor development in infants at risk of early iron deficiency. STUDY DESIGN Term (37-41 weeks) infants of anemic (Hb ≤ 100 g L-1; N = 100) and non-anemic (Hb > 100 g L-1; N = 100) mothers were randomized to daily iron supplementation at a dose of 2 mg kg-1 from 36 h of age (N = 50, each of anemic and non-anemic mothers) or no iron-supplementation (N = 50 each of anemic and non-anemic mothers). Hb, serum ferritin and motor development at 6 months were compared in the two groups. RESULTS Iron-supplemented infants had higher Hb (103.7 ± 9.3 g L-1 versus 97.0 ± 9.4 g L-1, p < .0001) and serum ferritin (133.93 ± 52.41 ng mL-1 versus 78.09 ± 42.03 ng mL-1, p < .001) concentrations, compared with the no iron-supplementation group. Their motor development was closer to age-appropriate norms than the no iron-supplementation group (5.83 ± 0.69 versus 5.18 ± 1.35, p < .01). CONCLUSION Early Iron supplementation is effective for improving iron status and motor development at 6 months in infants at risk for early iron deficiency.
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Affiliation(s)
- Reeta Bora
- Neonatal Unit, Assam Medical College, Dibrugarh, India
| | | | - Benjamin Brown
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Raghavendra Rao
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, USA
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Effect of routine iron-folic acid supplementation among rural pregnant women living in low- and high-groundwater-iron areas in Bangladesh. Public Health Nutr 2019; 22:2844-2855. [PMID: 31274069 DOI: 10.1017/s1368980019001617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study investigated the risks and benefits of routine Fe-folic acid (IFA) supplementation in pregnant women living in low- and high-groundwater-Fe areas in Bangladesh. DESIGN A case-controlled prospective longitudinal study design was used to compare the effect of daily Fe (60 mg) and folic acid (400 μg) supplementation for 3·5 months. SETTING A rural community in Bangladesh. PARTICIPANTS Pregnant women living in low-groundwater-Fe areas (n 260) and high-groundwater-Fe areas (n 262). RESULTS Mean Hb and serum ferritin concentrations at baseline were significantly higher in pregnant women in the high-groundwater-Fe areas. After supplementation, the mean change in Hb concentration in the women in the low-groundwater-Fe areas (0·10 g/dl) was higher than that in the pregnant women in the high-groundwater-Fe areas (-0·08 g/dl; P = 0·052). No significant changes in the prevalence of anaemia or Fe deficiency (ID) in either group were observed after IFA supplementation; however, the prevalence of Fe-deficiency anaemia (IDA) decreased significantly in the women in the low-groundwater-Fe areas. The risk of anaemia, ID and IDA after supplementation did not differ significantly between the groups. None of the participants had Fe overload. However, a significant proportion of the women in the high- and low-groundwater-Fe areas remained anaemic and Fe-deficient after supplementation. CONCLUSION IFA supplementation significantly increased the Hb concentration in pregnant women living in the low-groundwater-Fe areas. Routine supplementation with 60 mg Fe and 400 μg folic acid does not pose any significant risk of haemoconcentration or Fe overload. Further research to identify other nutritional and non-nutritional contributors to anaemia is warranted to prevent and treat anaemia.
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57
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Leonard D, Buttner P, Thompson F, Makrides M, McDermott R. Anaemia in early childhood among Aboriginal and Torres Strait Islander children of Far North Queensland: a retrospective cohort study. Aust N Z J Public Health 2019; 43:319-327. [PMID: 31180619 DOI: 10.1111/1753-6405.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/01/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Early childhood anaemia affects health and neurodevelopment. This study describes anaemia among Aboriginal and Torres Strait Islander children of Far North Queensland. METHODS This retrospective cohort study used health information for children born between 2006 and 2010 and their mothers. We describe the incidence of early childhood anaemia and compare characteristics of children and mothers where the child had anaemia with characteristics of children and mothers where the child did not have anaemia using bivariate and multivariable analysis, by complete case (CC) and with multiple imputed (MI) data. RESULTS Among these (n=708) Aboriginal and Torres Strait Islander children of Far North Queensland, 61.3% (95%CI 57.7%, 64.9%) became anaemic between the ages of six and 23 months. Multivariable analysis showed a lower incidence of anaemia among girls (CC/MI p<0.001) and among children of Torres Strait Islander mothers or both Aboriginal and Torres Strait Islander mothers (CC/MI p<0.001) compared to children of Aboriginal mothers. A higher incidence of anaemia was seen among children of mothers with parity three or more (CC/MI p<0.001); children born by caesarean section (CC/MI p<0.001); and children with rapid early growth (CC/MI p<0.001). CONCLUSION Early childhood anaemia is common among Aboriginal and Torres Strait Islander children of Far North Queensland. Poor nutrition, particularly iron deficiency, and frequent infections are likely causes. Implications for public health: Prevention of early childhood anaemia in 'Close the Gap' initiatives would benefit the Aboriginal and Torres Strait Islander children of Far North Queensland - and elsewhere in northern Australia.
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Affiliation(s)
- Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Petra Buttner
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute.,Discipline of Paediatrics, School of Medicine, The University of Adelaide, South Australia
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
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Jung J, Rahman MM, Rahman MS, Swe KT, Islam MR, Rahman MO, Akter S. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta‐analysis. Ann N Y Acad Sci 2019; 1450:69-82. [DOI: 10.1111/nyas.14112] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/07/2019] [Accepted: 04/05/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Jenny Jung
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Shafiur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Khin Thet Swe
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
| | - Md. Rashedul Islam
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | | | - Shamima Akter
- Global Public Health Research Foundation Dhaka Bangladesh
- Department of Epidemiology and Prevention, Center for Clinical SciencesNational Center for Global Health and Medicine Tokyo Japan
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The Impact of Maternal Eating Disorders on Dietary Intake and Eating Patterns during Pregnancy: A Systematic Review. Nutrients 2019; 11:nu11040840. [PMID: 31013875 PMCID: PMC6521012 DOI: 10.3390/nu11040840] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
Maternal nutrition in pregnancy has a key influence on optimum fetal health. Eating disorders (EDs) during pregnancy may have detrimental effects on fetal growth and the child’s early development. There is limited knowledge concerning the eating behavior, dietary intake and derived nutritional biomarkers as well as the nutrient supplementation in women with EDs during pregnancy. We performed a systematic review according to the PRISMA statement to synthesize current evidence in this field. Of N = 1203 hits, 13 full-texts were included in the qualitative synthesis. While women with current Binge Eating Disorder (BED) showed higher energy and fat intakes during pregnancy, women with a lifetime Anorexia Nervosa (AN), Bulimia Nervosa (BN) or both (AN + BN) had similar patterns of nutrient intake and dietary supplement use as healthy women. There is evidence, that women with a history of EDs have a sufficient diet quality and are more likely to be vegetarian. Dieting and bingeing improved substantially with pregnancy. The highlighted differences in the consumption of coffee/caffeine and artificially sweetened beverages as well as the elevated prevalence of iron deficiency anemia in women with a past or active ED during pregnancy might have an important impact on fetal development.
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Loy SL, Lim LM, Chan SY, Tan PT, Chee YL, Quah PL, Chan JKY, Tan KH, Yap F, Godfrey KM, Shek LPC, Chong MFF, Kramer MS, Chong YS, Chi C. Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. BMC Public Health 2019; 19:397. [PMID: 30975203 PMCID: PMC6460529 DOI: 10.1186/s12889-019-6736-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/02/2019] [Indexed: 01/06/2023] Open
Abstract
Background Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country. Methods Within a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26–28 weeks’ gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 μg/L (iron sufficiency), 15 to < 30 μg/L (modest iron depletion) and < 15 μg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion. Results The median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9–30.6) μg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15–4.84), Malay (2.05; 1.30–3.24) and Indian (1.98; 1.14–3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13–2.38), multiparity (1.73; 1.23–2.44) and lack of iron-containing supplementation (3.37; 1.25–8.53) were associated with increased odds of modest and severe iron depletion. Conclusions Nearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy. Trial registration NCT01174875. Registered 1 July 2010 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6736-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore
| | - Li Min Lim
- Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Pei Ting Tan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, NUH Medical Centre, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Phaik Ling Quah
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Michael S Kramer
- Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, H3G 2M1, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, H3A 1A2, Canada
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Claudia Chi
- Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. .,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Oaks BM, Jorgensen JM, Baldiviez LM, Adu-Afarwuah S, Maleta K, Okronipa H, Sadalaki J, Lartey A, Ashorn P, Ashorn U, Vosti S, Allen LH, Dewey KG. Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi. J Nutr 2019; 149:513-521. [PMID: 30629202 PMCID: PMC6398386 DOI: 10.1093/jn/nxy278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/29/2018] [Accepted: 10/08/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous literature suggests a U-shaped relation between hemoglobin concentration and adverse birth outcomes. There is less evidence on associations between iron status and birth outcomes. OBJECTIVE Our objective was to determine the associations of maternal hemoglobin concentration and iron status with birth outcomes. METHODS We conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containing nutritional supplements (20-60 mg ferrous sulfate) in Ghana (n = 1137) and Malawi (n = 1243). Hemoglobin concentration and 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at ≤20 weeks and 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth (PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age. RESULTS Prevalence of iron deficiency (sTfR >6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In early pregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33) and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was not associated with LBW in either country; replete iron status (sTfR <10th percentile) was associated with stunting (9% compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated with any birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country and iron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17, 3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associated with birth outcomes in Malawi. CONCLUSIONS The associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. These trials were registered at clinicaltrials.gov as NCT00970866 (Ghana) and NCT01239693 (Malawi).
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Affiliation(s)
- Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI,Address correspondence to BMO (e-mail: )
| | - Josh M Jorgensen
- Program in International and Community Nutrition, Department of Nutrition
| | - Lacey M Baldiviez
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Ken Maleta
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Harriet Okronipa
- Program in International and Community Nutrition, Department of Nutrition,Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - John Sadalaki
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Per Ashorn
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland,Center for Child Health Research, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA
| | - Lindsay H Allen
- USDA, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition
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62
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Good clinical practice advice: Iron deficiency anemia in pregnancy. Int J Gynaecol Obstet 2019; 144:322-324. [PMID: 30710364 DOI: 10.1002/ijgo.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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63
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Juul SE, Derman RJ, Auerbach M. Perinatal Iron Deficiency: Implications for Mothers and Infants. Neonatology 2019; 115:269-274. [PMID: 30759449 DOI: 10.1159/000495978] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022]
Abstract
Iron deficiency, with or without anemia, is common in pregnant women. In fact, nearly 30% of reproductive-age women are anemic worldwide, and anemia in pregnancy has an estimated global prevalence of 38%. Severe anemia can substantially increase the risk of maternal mortality, and can adversely affect fetal development. In this review, we examine the available data regarding epidemiology and consequences of iron deficiency in mothers and infants, current treatment strategies, and make recommendations for screening and treatment of iron deficiency anemia in gravidas and neonates.
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Affiliation(s)
- Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Richard J Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Auerbach
- Georgetown University School of Medicine, Washington, District of Columbia, USA,
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64
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Adu-Afarwuah S, Young RT, Lartey A, Okronipa H, Ashorn P, Ashorn U, Oaks BM, Arimond M, Dewey KG. Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants' Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial. J Nutr 2019; 149:149-158. [PMID: 30624674 PMCID: PMC6351141 DOI: 10.1093/jn/nxy225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Interventions are needed to address iron deficiency in low-income settings. Objective This secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana. Methods Women ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 µg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants' Hb (g/L) and ZPP (µmol/mol heme) at 6 and 18 mo of age. Results At 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation. Conclusions In this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants' Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants' iron status at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT00970866.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana,Address correspondence to SA-A (e-mail: )
| | - Rebecca T Young
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Harriet Okronipa
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana,Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA
| | - Per Ashorn
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Mary Arimond
- Intake—Center for Dietary Assessment, FHI 360, Washington, DC
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA
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Abstract
The prevalence of age-associated disease is increasing at a striking rate globally and there is evidence to suggest that the ageing process may actually begin before birth. It has been well-established that the status of both the maternal and early postnatal environments into which an individual is exposed can have huge implications for the risk of developing age-associated disease, including cardiovascular disease (CVD), type-2 diabetes (T2D) and obesity in later life. Therefore, the dissection of underlying molecular mechanisms to explain this phenomenon, known as 'developmental programming' is a highly investigated area of research. This book chapter will examine the epidemiological evidence and the animal models of suboptimal maternal and early postnatal environments and will discuss the progress being made in the development of safe and effective intervention strategies which ultimately could target those 'programmed' individuals who are known to be at-risk of age-associated disease.
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Affiliation(s)
- Jane L Tarry-Adkins
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Cambridge, UK.
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Cambridge, UK
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66
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Blanco-Rojo R, Vaquero MP. Iron bioavailability from food fortification to precision nutrition. A review. INNOV FOOD SCI EMERG 2019. [DOI: 10.1016/j.ifset.2018.04.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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67
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Srour MA, Aqel SS, Srour KM, Younis KR, Samarah F. Prevalence of Anemia and Iron Deficiency among Palestinian Pregnant Women and Its Association with Pregnancy Outcome. Anemia 2018; 2018:9135625. [PMID: 30675398 PMCID: PMC6323536 DOI: 10.1155/2018/9135625] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Anemia is a public health problem especially among pregnant women. This study aimed to investigate the prevalence of anemia and iron deficiency among pregnant women and its association with pregnancy outcome in Hebron Governorate in southern Palestine. METHODS This is a cross-sectional study that included 300 pregnant women in their first trimester and 163 babies. Maternal anthropometric and socioeconomic and newborns' data were collected. Complete blood count for study subjects and maternal serum ferritin were measured. RESULTS The prevalence of iron deficiency anemia among pregnant women was 25.7% and 52% of them had depleted iron stores. When pregnant women were grouped into three hemoglobin (Hb) tertile groups, a significant difference was observed between maternal Hb and newborns' birth weight (P= 0.009), height (P= 0.022), head circumference (P= 0.017), and gestational age (P= 0.012). There was a significant association between maternal serum ferritin and frequency of low birth weight (P= 0.001) and frequency of preterm delivery (P= 0.003). No significant association was observed between maternal anthropometric measures or the socioeconomic status and pregnancy outcomes. CONCLUSION Iron deficiency is a moderate public health problem among the study subjects. Maternal Hb and serum ferritin significantly affect pregnancy outcomes.
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Affiliation(s)
- Mahmoud A. Srour
- Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, East Jerusalem, State of Palestine
- Department of Biology & Biochemistry, Birzeit University, Birzeit, State of Palestine
| | - Samah S. Aqel
- Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, East Jerusalem, State of Palestine
| | - Khaled M. Srour
- Anatomy and Physiology Department, Faculty of Medicine, Al-Quds University, East Jerusalem, State of Palestine
| | - Khalid R. Younis
- Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, East Jerusalem, State of Palestine
| | - Fekri Samarah
- Department of Medical Laboratory Sciences, Arab-American University, Jenin, State of Palestine
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68
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Rabindrakumar MSK, Pujitha Wickramasinghe V, Gooneratne L, Arambepola C, Senanayake H, Thoradeniya T. The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka. BMC HEMATOLOGY 2018; 18:37. [PMID: 30607249 PMCID: PMC6303966 DOI: 10.1186/s12878-018-0131-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/02/2018] [Indexed: 11/28/2022]
Abstract
Background Early detection and treatment of iron deficiency during pregnancy is crucial for optimum pregnancy outcomes. Anaemia is a late indictor of iron deficiency measured as Hb < 11 g/dL, and is widely used as a proxy for iron deficiency. We aimed to evaluate the role of red cell indices as a screening tool for early detection of iron deficiency among pregnant women in an urban area of Sri Lanka. Method A cross-sectional study was conducted among 110 apparently healthy pregnant women ≤12 weeks of gestation attending antenatal clinics in Colombo, Sri Lanka. Women already on nutritional supplements were excluded. Full blood count, serum ferritin (SF) and high sensitive C-reactive protein (hs-CRP) assessments were performed. The women with evidence of inflammation as indicated by hs-CRP > 10 mg/L were excluded (N = 20) from data analysis. Anaemia (Hb < 11 g/dL) and iron deficiency (SF < 30 μg/L) were defined according to WHO guidelines. Receiver operating characteristics curves were used to derive red blood cell indices that showed the optimal cut-offs in detecting early iron deficiency. Results Of the 90 women, 63 (70.0%) were iron deficient (SF < 30 μg/L), out of whom 10 (15.9%) were identified as having iron deficiency anaemia (Hb < 11 g/dL). A high sensitivity (> 70%) in the prediction of iron deficiency was obtained for the optimal cut-off values of Hb < 12.2 g/dL, MCV < 83.2 fl, MCH < 26.9 pg and MCHC 33.2 g/dL while maintaining a specificity > 40%. Conclusion Iron deficiency can be predicted in early stages using Hb and red cell indices, which is much less expensive. This could be a useful method in areas with limited resources and a high prevalence of iron deficiency.
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Affiliation(s)
| | | | - Lallindra Gooneratne
- 3Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- 4Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Hemantha Senanayake
- 5Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Tharanga Thoradeniya
- 1Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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69
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Kusneniwar GN, Whelan RM, Betha K, Robertson JM, Ramidi PR, Balasubramanian K, Kamasamudram V, Haggerty CL, Bunker CH, Reddy PS. Cohort Profile: The Longitudinal Indian Family hEalth (LIFE) Pilot Study, Telangana State, India. Int J Epidemiol 2018; 46:788-789j. [PMID: 27649805 DOI: 10.1093/ije/dyw174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- G N Kusneniwar
- SHARE INDIA, MediCiti Institute of Medical Sciences, Ghanpur, Telangana State-501401, India
| | - R Margaret Whelan
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Kalpana Betha
- SHARE INDIA, MediCiti Institute of Medical Sciences, Ghanpur, Telangana State-501401, India
| | - Jamie M Robertson
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | | | - K Balasubramanian
- SHARE INDIA, MediCiti Institute of Medical Sciences, Ghanpur, Telangana State-501401, India
| | | | | | - Clareann H Bunker
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
| | - P S Reddy
- SHARE INDIA, MediCiti Institute of Medical Sciences, Ghanpur, Telangana State-501401, India
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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70
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Petkus DL, Murray-Kolb LE, De Souza MJ. The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Med 2018; 47:1721-1737. [PMID: 28290159 DOI: 10.1007/s40279-017-0706-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.
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Affiliation(s)
- Dylan L Petkus
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Mary Jane De Souza
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA.
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71
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Milnerowicz H, Wrześniak M, Królik M, Kowalska K. Influence of tobacco smoke on zinc, cadmium, iron, iron-binding proteins, and low-weight anti-oxidant status in pregnancy. Inhal Toxicol 2018; 30:534-541. [PMID: 30794012 DOI: 10.1080/08958378.2019.1576805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/30/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
Pregnancy and tobacco smoking (TS) each can cause increases in reactive oxygen species (ROS) production; this, in turn, can lead to disorders in iron management and disruption of the pro- and anti-oxidant balance. The aim of the study was to analyze the influence of TS and Cd on Fe, Zn, and anti-oxidant levels (i.e. glutathione [GSH], metallothionein [MT]) in the blood of pregnant women. The study reported here evaluated 110 blood samples from pregnant women in their 1st, 2nd and 3rd trimester. Concentrations of ferritin and transferrin were measured in the serum; Zn, Fe and cotinine in the plasma, that of Cd in whole blood, that for glutathione in red blood cell lysates, and levels of metallothionein both in the plasma and in lysates prepared from isolated erythrocytes. The results indicated there was a decrease in Zn and increase in Cd and metallothionein levels in pregnant women smokers as compared to in nonsmoking counterparts. Differences in intracellular MT concentration were noted both in smoking and nonsmoking women during pregnancy while there were no changes in extracellular MT level. A decline in circulating ferritin and a rise in transferrin during pregnancy was observed in all groups. Based on the results, it was concluded that exposure to TS-associated xenobiotics like Cd could result in higher MT levels in erythrocytes and in pregnant smokers, the major anti-oxidant mechanism that is in place is one being mediated by MT and not by reduced GSH.
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Affiliation(s)
- Halina Milnerowicz
- a Department of Biomedical and Environmental Analysis, Faculty of Pharmacy , Wroclaw Medical University , Wrocław , Poland
| | - Marta Wrześniak
- a Department of Biomedical and Environmental Analysis, Faculty of Pharmacy , Wroclaw Medical University , Wrocław , Poland
- b Department and Clinic of Internal Medicine and Allergology, Faculty of Medicine , Wroclaw Medical University , Wrocław , Poland
| | - Małgorzata Królik
- c Early Pregnancy Pathology Clinic , Centre of Gynecology, Obstetrics and Neonatology , Opole , Poland
| | - Katarzyna Kowalska
- a Department of Biomedical and Environmental Analysis, Faculty of Pharmacy , Wroclaw Medical University , Wrocław , Poland
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72
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Abstract
Iron deficiency anemia of pregnancy is common, especially in South Asia, and is associated with adverse maternal and fetal outcomes including increased incidences of maternal mortality, preterm labor and low birth weight. Screening for anemia alone is not sufficient to diagnose iron deficiency. Iron deficiency in neonates is associated with a statistically significant increment in cognitive and behavioral abnormalities which persist after iron repletion. Oral iron is the frontline standard but is associated with an unacceptably high incidence of gastrointestinal adverse events leading to poor adherence. Prospective evidence reports an incidence of neonatal iron deficiency up to 45% even with oral iron supplementation. New evidence reports oral iron ingestion increases serum hepcidin leading to decreased absorption suggesting further decreasing efficacy. Published evidence reports that intravenous iron is safe and effective in the second and third trimesters of pregnancy. Intravenous iron is the preferred route when there is oral iron intolerance or in those situations where oral iron is ineffective or harmful. Intravenous iron is also preferred if the anemia is severe (< 8 g/dL) in the second trimester or at any time in the third trimester when there is little expectation that adequate quantities of iron will be delivered to the fetus as iron requirements increase in each trimester. Guidelines for maternal and neonatal screening and treatment lack consistency and differ between the United States and Europe. New formulations of intravenous iron with complex carbohydrate cores that bind elemental iron more tightly mitigating the release of large quantities of labile free iron allow the administration of complete replacement doses in 15-60 min. The preponderance of published evidence suggests that intravenous iron is underutilized in pregnancy and guidelines suggesting there is insufficient evidence to recommend the routine screening and treatment of iron deficiency in gravidas should be revisited. The major recommendation from this commentary is that in low-income countries, a trial or demonstration project to test the efficacy, safety, cost and feasibility of the administration of intravenous iron to anemic and/or iron-deficient women be undertaken.
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Affiliation(s)
- Michael Auerbach
- Auerbach Hematology and Oncology, Baltimore, MD, USA.
- Georgetown University, Washington DC, USA.
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73
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Naidoo P, Naidoo RN, Ramkaran P, Muttoo S, Asharam K, Chuturgoon AA. Maternal miRNA-146a G/C rs2910164 variation, HIV/AIDS and nitrogen oxide pollution exposure collectively affects foetal growth. Hum Exp Toxicol 2018; 38:82-94. [PMID: 29896975 DOI: 10.1177/0960327118781902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE: Nitrogen oxide (NOx) pollution and human immunodeficiency virus (HIV)/AIDS intensify inflammation during pregnancy and linked with adverse birth outcomes (ABOs). MicroRNA (miRNA)-146a plays a crucial role in regulating inflammation in the NF-κB pathway. The G/C rs2910164 dampens miRNA-146a activity and linked with inflammatory diseases. The present study investigated whether HIV/AIDS and NOx exposure throughout pregnancy further intensifies ABO in Black South African women genotyped for the rs2910164. METHODS: Pregnant women ( n = 300) were subdivided into low, medium and high NOx exposure groups, genotyped for the miRNA-146a G/C rs2910164 using polymerase chain reaction-restriction fragment length polymorphism, and further stratified based on HIV status. RESULTS: Unstratified data (HIV+ and HIV- mothers combined): Mothers from the high NOx group with the variant C-allele had low blood iron levels ( p = 0.0238), and had babies with reduced birthweights ( p = 0.0283). As NOx increased, the prevalence of preterm birth and low birth weight also increased in mothers with the variant C-allele versus wildtype G-allele. HIV-infected mothers: In all NOx exposure groups, mothers with the variant C-allele had higher systolic blood pressure (low: p = 0.0386, medium: p = 0.0367 and high: p = 0.0109) and had babies with lower Appearance, Pulse, Grimace, Activity and Respiration scores at 1 min (low: p = 0.0190, medium: p = 0.0301 and high: p = 0.0361). CONCLUSION: Maternal rs2910164 variant C-allele, NOx pollution and HIV/AIDS might collectively play a role in intensifying gestational hypertension and ABO.
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Affiliation(s)
- P Naidoo
- 1 Discipline of Medical Biochemistry and Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa
| | - R N Naidoo
- 2 Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - P Ramkaran
- 1 Discipline of Medical Biochemistry and Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa
| | - S Muttoo
- 2 Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Asharam
- 2 Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - A A Chuturgoon
- 1 Discipline of Medical Biochemistry and Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa
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74
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Ahmed F, Khan MR, Shaheen N, Ahmed KMU, Hasan A, Chowdhury IA, Chowdhury R. Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater. Nutrition 2018; 51-52:46-52. [PMID: 29604479 DOI: 10.1016/j.nut.2018.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/06/2018] [Accepted: 01/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies found a low rate of iron deficiency in Bangladeshi non-pregnant and non-lactating women. This was attributed to high iron concentrations in drinking water. However, there are limited data on iron deficiency among pregnant women in Bangladesh. OBJECTIVES Our aim was to investigate the prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) among rural pregnant women and explore the association of groundwater iron concentration with anemia and iron deficiency in this group. METHODS This study used data from a baseline assessment of an intervention study on rural pregnant women (n = 522), gestational age ≤20 wk, living in areas of low and high iron in groundwater. RESULTS Overall, 34.7% of the pregnant women had anemia, 27% had iron deficiency, and 13.4% had IDA. Prevalence of anemia, iron deficiency, and IDA among the pregnant women living in low-groundwater-iron areas was significantly higher than among the pregnant women from high-groundwater-iron areas. The odds of iron deficiency were significantly lower among pregnant women in the higher quartiles of daily iron intake from drinking water. CONCLUSIONS This study found a differential prevalence of anemia and iron deficiency among pregnant women living in areas of high and low groundwater iron. Iron status was independently associated with daily iron intake from drinking water. However, a significant proportion of the anemia could not be attributed to iron deficiency. Further research to identify other nutritional and non-nutritional contributors to anemia in Bangladesh is needed to formulate effective prevention and control programs for anemia.
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Affiliation(s)
- Faruk Ahmed
- Public Health, School of Medicine, Griffith University, Gold Coast, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | | | - Najma Shaheen
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | | | - Aziz Hasan
- Department of Geology, University of Dhaka, Dhaka, Bangladesh
| | | | - Rafiqul Chowdhury
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
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Vricella LK. Emerging understanding and measurement of plasma volume expansion in pregnancy. Am J Clin Nutr 2017; 106:1620S-1625S. [PMID: 29070547 PMCID: PMC5701717 DOI: 10.3945/ajcn.117.155903] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Plasma volume expansion is an important component of a successful pregnancy. The failure of maternal plasma volume expansion has been implicated in adverse obstetric outcomes such as pre-eclampsia, fetal growth restriction, and preterm birth. Altered iron homeostasis and elevated maternal hemoglobin concentrations have also been associated with adverse pregnancy outcomes; limited data have suggested that these effects may be mediated by inadequate plasma volume expansion. In addition, it has been noted that pregnant, obese women, compared with lean subjects, have decreased plasma volume expansion along with impaired iron homeostasis and increased inflammation. Current estimates of plasma volume expansion are outdated and do not necessarily reflect contemporary obstetric populations. Moreover, the validation of clinically applicable methods of plasma volume determination as well as enhanced methodologies should be a priority. Further study is needed to characterize diminished plasma volume expansion during pregnancy and to understand the potential role of impaired iron homeostasis and inflammation in adverse obstetric outcomes, especially in obese women.
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Affiliation(s)
- Laura K Vricella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, St. Louis, MO
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76
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Friedrisch JR, Friedrisch BK. Prophylactic Iron Supplementation in Pregnancy: A Controversial Issue. BIOCHEMISTRY INSIGHTS 2017; 10:1178626417737738. [PMID: 29123406 PMCID: PMC5661664 DOI: 10.1177/1178626417737738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 09/25/2017] [Indexed: 12/12/2022]
Abstract
In our world today, iron deficiency (ID) is the most frequent nutritional deficiency and it is being considered as an epidemic public health crisis. Women of reproductive age and infants are at particular risk of ID, especially in underdeveloped countries. During pregnancy, iron deficiency anemia is a specific risk factor associated with negative maternal and perinatal outcomes. Many countries have iron supplementation (IS) programs-as recommended by the World Health Organization-during pregnancy; however, IS clinical benefits and risks are unclear. This review aims to discuss the threats and benefits of routine IS on maternal and infant outcomes.
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Affiliation(s)
- João Ricardo Friedrisch
- Hematology and Bone Marrow Transplantation Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Kras Friedrisch
- Departamento de Biologia e Farmácia, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
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Hanieh S, Ha TT, Simpson JA, Braat S, Thuy TT, Tran TD, King J, Tuan T, Fisher J, Biggs BA. Effect of low-dose versus higher-dose antenatal iron supplementation on child health outcomes at 36 months of age in Viet Nam: longitudinal follow-up of a cluster randomised controlled trial. BMJ Glob Health 2017; 2:e000368. [PMID: 29018582 PMCID: PMC5623322 DOI: 10.1136/bmjgh-2017-000368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Intermittent iron-folic acid supplementation (IFA) is currently recommended for pregnant women in populations where anaemia prevalence among pregnant women is <20% or if daily iron is not acceptable. The effect of providing lower doses of antenatal elemental iron through intermittent regimes on longer-term health outcomes in childhood is unclear. Methods A prospective cohort study conducted between May 2012 and May 2014 in Viet Nam among children of 36 months of age, born to women previously enrolled in a cluster randomised controlled trial of antenatal micronutrient supplementation (daily IFA (60 mg elemental iron) vs twice-weekly IFA (60 mg elemental iron) vs twice-weekly multiple micronutrient (MMN) supplementation (60 mg elemental iron)). Primary outcomes were height-for-age z-scores (HAZ), according to WHO growth standards and cognitive composite scores (Bayley Scales of Infant and Toddler Development, third edition) at 36 months of age. Results A total of 1017 children born to mothers enrolled in the cluster randomised trial were assessed at 36 months of age. Adjusted mean differences (MDs) in HAZ were –0.14 (95% CI –0.28 to –0.01) and –0.15 (95% CI –0.29 to –0.01) in children born to mothers who received twice-weekly IFA or MMN compared with those who received daily IFA. Children born to mothers who received twice-weekly MMN had lower composite motor scores compared with those who received daily IFA (MD –2.07, 95% CI –4.11 to –0.03). There were no differences in composite cognitive scores in the twice-weekly compared with daily regimens. Conclusions Low-dose antenatal IFA supplementation (120 mg elemental iron per week) resulted in lower HAZ and motor composite scores in children compared with higher-dose antenatal IFA supplementation (420 mg elemental iron per week). This highlights the importance of adequate iron stores during pregnancy and the need for careful monitoring when lower-dose antenatal iron regimens are used. Trial registration number Australia New Zealand Clinical Trials Registry: 12610000944033.
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Affiliation(s)
- Sarah Hanieh
- Department of Medicine, University of Melbourne, Peter Doherty Institute for Immunity and Infection, Parkville, Victoria, Australia
| | - Tran T Ha
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tran T Thuy
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Thach D Tran
- Research and Training Centre for Community Development, Hanoi, Viet Nam
- The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Janet King
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - Tran Tuan
- Research and Training Centre for Community Development, Hanoi, Viet Nam
| | - Jane Fisher
- The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, University of Melbourne, Peter Doherty Institute for Immunity and Infection, Parkville, Victoria, Australia
- The Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Qassim A, Mol BW, Grivell RM, Grzeskowiak LE. Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review. Aust N Z J Obstet Gynaecol 2017; 58:22-39. [PMID: 28921558 DOI: 10.1111/ajo.12695] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. AIMS To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). MATERIALS AND METHODS We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality. RESULTS A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635; 41 studies), FCM (n = 276; four studies) and IPM (n = 164; three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3-4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L; range: 20-39.6 g/L) compared with low dose (20 g/L; range: 6.2-50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2%; range: 0-4.5%) was lower than FCM (5.0%; range: 0-20%) and IS (6.7%; range: 0-19.5%). CONCLUSION While IV iron in pregnancy improves haematological parameters, there is an absence of evidence for improvements in important maternal or perinatal outcomes. No single preparation of IV iron appeared to be superior, with the current IV iron preparation of choice largely determined by cost and convenience around administration.
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Affiliation(s)
- Alaa Qassim
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ben W Mol
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Rosalie M Grivell
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Obstetrics and Gynaecology, School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- The Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,SA Pharmacy, SA Health, Flinders Medical Centre, Bedford Park, SA, Australia
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Wibowo N, Bardosono S, Irwinda R, Syafitri I, Putri AS, Prameswari N. Assessment of the nutrient intake and micronutrient status in the first trimester of pregnant women in Jakarta. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i2.1617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Maternal nutrition before and during pregnancy is important for a healthy pregnancy outcome. According to National Basic Health Research (Riskesdas) 2013, 24.2% of pregnant women are at risk of chronic malnutrition and 37.1% of them suffer from anemia. The aim of this study was to obtain information about the nutrient intake and serum micronutrient status in the first trimester of pregnant women in Jakarta.Methods: A descriptive study was conducted towards 234 pregnant women with gestational age no more than 14 weeks. The nutrient intake data was obtained from the conversion of frequency food questionnaire (FFQ) which was semi quantitative data using a Nutrisurvey application. The maternal serum was examined to obtain data about nutrient level.Results: The mean of daily maternal energy intake was 1,256.1 kcal. Most subjects had nutrient intake below the recommendations of Institute of Medicine (IOM) and recommended dietary allowances (RDA), i.e. energy (88.9%), protein (80.8%), iron (85%), folic acid (74.8%), calcium (90.6%), and zinc (94.9%). However, they showed a high intake level of vitamin A (70.5%). Most subjects had deficiency in vitamin A (69.7%), vitamin D (99.6%), and zinc (81.2). No correlation was found between the maternal nutrient intake and nutritional status.Conclusion: Most of the first-trimester-pregnant-women in Jakarta had low maternal energy and nutrient intake, except for vitamin A, as well as low serum vitamin A, vitamin D, and zinc level.
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Naidoo P, Naidoo RN, Ramkaran P, Asharam K, Chuturgoon AA. The Tyr113His T/C rs1051740 and 'very slow' phenotype of the EPHX1 gene alters miR-26b-5p and miR-1207-5p expression in pregnancy. Gene 2017; 633:71-81. [PMID: 28789952 DOI: 10.1016/j.gene.2017.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/29/2017] [Accepted: 07/31/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Environmental insults and microsomal epoxide hydrolase 1 (EPHX1) single nucleotide polymorphisms (SNPs), Tyr113His T/C rs1051740 and His139Arg A/G rs2234922, aberrantly alters microRNA (miR) expression and are linked to low birthweights (LBW). OBJECTIVES To investigate the interplay between pollution, EPHX1 SNPs and miRs during pregnancy and associated LBW outcomes. METHODS South African pregnant women (n=241) were recruited in the MACE birth cohort study in Durban, a city with high levels of industry and traffic related pollutants. EPHX1 SNPs were genotyped using PCR-RFLP and grouped into their respective phenotypes, i.e. normal (N), slow (S), very slow (VS) and fast (F). EPHX1, miR-26b-5p, miR-193b-3p and miR-1207-5p expression were determined using quantitative PCR. RESULTS Mothers with the Tyr113His SNP had low iron levels [TT vs. TC+CC: mean difference (MD)=0.67g/dl; p=0.0167], LBW [TT vs. TC+CC: MD=189.30g; p=0.0067], and low EPHX1 expression; p<0.0001. miR-26b-5p and miR-1207-5p expression were significantly higher in the CC genotypes compared to TT+TC groups; p<0.0001. The opposite trend occurred for miR-193b-3p; p=0.0045. Mothers with the VS phenotype had low iron levels [N vs. VS and VS vs. F: MD=2.03 and -1.96g/dl; p=0.0021, respectively], decreased gestational age [VS vs. F: MD=-2.14weeks; p=0.0051, respectively], and LBW [N vs. VS, VS vs. F and S vs. VS: MD=1000, -940.30 and 968.80g; p<0.0001, respectively]; F phenotype had the highest EPHX1 expression [N vs. F, VS vs. F and S vs. F: MD=-1.067, -1.854 and -1.379; p=0.0002, respectively]; and N phenotype had low miR-26b-5p [N vs. VS: MD=-0.6100; p=0.0159] and miR-1207-5p [N vs. VS and VS vs. F: MD=-0.834 and 1.103; p=0.0007, respectively] expression. miR-193b-3p expression between phenotypes remained unchanged. CONCLUSION The Tyr113His T/C variant of rs1051740 and VS phenotype alters EPHX1, miR-26b-5p and miR-1207-5p expression, and contributes towards low blood iron levels and LBW.
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Affiliation(s)
- Pragalathan Naidoo
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - Prithiksha Ramkaran
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - Anil A Chuturgoon
- Discipline of Medical Biochemistry and Chemical Pathology, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
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Review of the Plausibility of Iron Deficiency Hypothesis of Autism. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0108-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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82
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Daru J, Allotey J, Peña-Rosas JP, Khan KS. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus Med 2017; 27:167-174. [PMID: 28425182 PMCID: PMC5763396 DOI: 10.1111/tme.12408] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
Abstract
The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL−1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.
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Affiliation(s)
- J Daru
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - J Allotey
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - J P Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - K S Khan
- Women's Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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83
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Vohr BR, Poggi Davis E, Wanke CA, Krebs NF. Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings. Pediatrics 2017; 139:S38-S49. [PMID: 28562247 DOI: 10.1542/peds.2016-2828f] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/24/2022] Open
Abstract
The rapid pace of fetal development by far exceeds any other stage of the life span, and thus, environmental influences can profoundly alter the developmental course. Stress during the prenatal period, including malnutrition and inflammation, impact maternal and fetal neurodevelopment with long-term consequences for physical and mental health of both the mother and her child. One primary consequence of maternal malnutrition, inflammation, and other sources of prenatal stress is a poor birth outcome, such as prematurity or growth restriction. These phenotypes are often used as indications of prenatal adversity. In fact, the original evidence supporting the fetal programming hypothesis came from studies documenting an association between birth phenotype and the development of subsequent physical and mental health problems. Fetal growth restriction in both term and preterm infants is associated with neonatal morbidities and a wide variety of behavioral and psychological diagnoses in childhood and adolescence, including attention-deficit/hyperactivity disorder, anxiety, depression, internalizing and thought problems, poor social skills, and autism spectrum disorder. Improving maternal-child health requires interventions that begin before pregnancy and continue throughout gestation and into the postpartum period. Such interventions might include supporting pregnancy intention, maternal nutrition, health/medical care, mental health, and providing social support. This article discusses the impact of maternal nutrition and inflammation during preconception and pregnancy among women living in low-resource settings, with an emphasis on key knowledge gaps that need to be addressed to guide program and policy decisions at local, regional and global levels.
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Affiliation(s)
- Betty R Vohr
- Neonatal Follow-up Program, Women & Infants Hospital, Providence, Rhode Island; .,Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, Colorado.,Department of Psychiatry, University of California Irvine, Irvine, California
| | - Christine A Wanke
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts; and
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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84
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How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood 2017; 129:940-949. [DOI: 10.1182/blood-2016-08-672246] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 01/28/2023] Open
Abstract
AbstractAnemia of pregnancy, an important risk factor for fetal and maternal morbidity, is considered a global health problem, affecting almost 50% of pregnant women. In this article, diagnosis and management of iron, cobalamin, and folate deficiencies, the most frequent causes of anemia in pregnancy, are discussed. Three clinical cases are considered. Iron deficiency is the most common cause. Laboratory tests defining iron deficiency, the recognition of developmental delays and cognitive abnormalities in iron-deficient neonates, and literature addressing the efficacy and safety of IV iron in pregnancy are reviewed. An algorithm is proposed to help clinicians diagnose and treat iron deficiency, recommending oral iron in the first trimester and IV iron later. Association of folate deficiency with neural tube defects and impact of fortification programs are discussed. With increased obesity and bariatric surgery rates, prevalence of cobalamin deficiency in pregnancy is rising. Low maternal cobalamin may be associated with fetal growth retardation, fetal insulin resistance, and excess adiposity. The importance of treating cobalamin deficiency in pregnancy is considered. A case of malarial anemia emphasizes the complex relationship between iron deficiency, iron treatment, and malaria infection in endemic areas; the heightened impact of combined etiologies on anemia severity is highlighted.
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85
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Wilunda C, Tanaka S, Esamai F, Kawakami K. Prenatal anemia control and anemia in children aged 6-23 months in sub-Saharan Africa. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27714958 DOI: 10.1111/mcn.12375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/28/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Abstract
It is unclear whether routine prenatal anemia control interventions can reduce anemia risk in young children. This study examines the associations between prenatal iron supplementation and/or deworming and anemia in children aged 6-23 months in sub-Saharan Africa (SSA). We analyzed data from Demographic and Health Surveys conducted between 2003 and 2014 in 25 SSA countries. The surveys collected data on prenatal iron supplementation and deworming and determined children's hemoglobin levels through blood testing. We assessed the associations between prenatal iron supplementation and/or deworming and anemia using multinomial logistic regression. The study included 31,815 mother-child pairs: 25.0%, 41.4%, and 4.8% of children had mild, moderate, and severe anemia, respectively. Compared with children whose mothers did not take iron and deworming drugs prenatally, the risk of moderate/severe anemia was reduced among children whose mothers took only iron supplements for ≥6 months (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.45-0.76); only deworming drugs (OR: 0.73; 95% CI: 0.56-0.93); deworming drugs plus iron for <6 months (OR: 0.79; 95% CI: 0.67-0.93); and deworming drugs plus iron for ≥6 months (OR: 0.77; 95% CI: 0.59-0.99). Prenatal use of only iron for <6 months was not associated with moderate/severe anemia. Prenatal iron and/or deworming drugs had no effect on mild anemia. Prenatal anemia control interventions are associated with reduced risk of moderate/severe anemia but not with mild anemia in young children in SSA. Iron supplements should be taken for ≥6 months or with deworming drugs prenatally to reduce moderate/severe anemia risk in children.
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Affiliation(s)
- Calistus Wilunda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Fabian Esamai
- Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Ru Y, Pressman EK, Cooper EM, Guillet R, Katzman PJ, Kent TR, Bacak SJ, O'Brien KO. Iron deficiency and anemia are prevalent in women with multiple gestations. Am J Clin Nutr 2016; 104:1052-1060. [PMID: 27581469 DOI: 10.3945/ajcn.115.126284] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little attention has been placed on the unique iron demands that may exist in women with multiple gestations. This merits attention because iron deficiency (ID) during pregnancy is associated with adverse pregnancy outcomes that are known to be more prevalent in multiple births. OBJECTIVE We characterized longitudinal changes in iron status across pregnancy in a cohort of healthy women with multiple gestations and identified determinants of maternal ID and anemia. DESIGN A group of 83 women carrying twins, triplets, or quadruplets (aged 20-46 y) was recruited from 2011 to 2014. Blood samples obtained during pregnancy (∼24 wk; n = 73) and at delivery (∼35 wk; n = 61) were used to assess hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, serum iron, erythropoietin, serum folate, vitamin B-12, C-reactive protein, and interleukin-6. RESULTS The prevalence of tissue ID (sTfR >8.5 mg/L) increased significantly from pregnancy to delivery (9.6% compared with 23%, P = 0.03). Women with depleted iron stores (SF <12 μg/L, n = 20) during pregnancy had a 2-fold greater risk of anemia at delivery, and 25% (n = 5) developed iron deficiency anemia (IDA). Overall, 44.6% of women studied (n = 37/83) were anemic at delivery, and 18% of women (n = 11/61) had IDA. Erythropoietin during pregnancy was significantly negatively associated with hemoglobin at delivery. Women with erythropoietin >75th percentile during pregnancy exhibited a 3-fold greater risk of anemia, suggesting that erythropoietin is a sensitive predictor of anemia at delivery. Inflammation was present at delivery, which limited the utility of ferritin or hepcidin as iron-status indicators at delivery. CONCLUSIONS ID and anemia are highly prevalent in women with multiple gestations. Additional screening and iron supplementation may be warranted in this high-risk population given the known associations between ID anemia and adverse maternal and neonatal outcomes. This trial was registered at clinicaltrials.gov as NCT01582802.
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Affiliation(s)
- Yuan Ru
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Eva K Pressman
- School of Medicine, University of Rochester, Rochester, NY
| | | | - Ronnie Guillet
- School of Medicine, University of Rochester, Rochester, NY
| | | | - Tera R Kent
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
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Wrześniak M, Królik M, Kepinska M, Milnerowicz H. The influence of maternal smoking on transferrin sialylation and fetal biometric parameters. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 47:100-107. [PMID: 27664951 DOI: 10.1016/j.etap.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Transferrin is a glycosylated protein responsible for transporting iron, an essential metal responsible for proper fetal development. Tobacco is a heavily used xenobiotic having a negative impact on the human body and pregnancy outcomes. Aims of this study was to examine the influence of tobacco smoking on transferrin sialic acid residues and their connection with fetal biometric parameters in women with iron-deficiency. METHODS The study involved 173 samples from pregnant women, smokers and non-smokers, iron deficient and not. Transferrin sialylation was determined by capillary electrophoresis. The cadmium (Cd) level was measured by atomic absorption and the sialic acid concentration by the resorcinol method. RESULTS Women with iron deficiencies who smoked gave birth earlier than non-smoking, non-iron-deficient women. The Cd level, but not the cotinine level, was positively correlated with transferrin sialylation in the blood of iron-deficient women who smoked; 3-, 4-, 5- and 6-sialoTf correlated negatively with fetal biometric parameters in the same group. CONCLUSION It has been shown the relationship between Cd from tobacco smoking and fetal biometric parameters observed only in the iron deficient group suggests an additive effect of these two factors, and indicate that mothers with anemia may be more susceptible to Cd toxicity and disturbed fetal development.
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Affiliation(s)
- Marta Wrześniak
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland.
| | - Małgorzata Królik
- Early Pregnancy Pathology Clinic, Centre of Gynecology, Obstetrics and Neonatology, Reymonta 8, 45-066 Opole, Poland
| | - Marta Kepinska
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Halina Milnerowicz
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland.
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88
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Basu S, Kumar N, Srivastava R, Kumar A. Maternal and Cord Blood Hepcidin Concentrations in Severe Iron Deficiency Anemia. Pediatr Neonatol 2016; 57:413-419. [PMID: 26922566 DOI: 10.1016/j.pedneo.2015.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/07/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The present study was conducted to assess the maternal and cord blood hepcidin concentrations in severe iron deficiency anemia (IDA) and to find out its correlation with other iron status parameters. METHODS This prospective observational study was carried out in 30 mothers with severe IDA (hemoglobin < 70 g/L and serum ferritin < 12 μg/L), and 15 healthy nonanemic (hemoglobin ≥ 110 g/L) mothers, who delivered live singleton neonates at term gestation. Mothers and neonates with infection/inflammatory conditions were excluded. Quantitative estimation of complete blood count, serum iron, ferritin, total iron binding capacity (TIBC), and transferrin saturation (Tfsat) was done in maternal and cord blood immediately after delivery by an auto analyzer. Serum hepcidin concentrations were measured by double-antibody sandwich enzyme-linked immunosorbent assay using a Human Hepcidin-25 kit. Data were analyzed by statistical software SPSS 16.0. RESULTS The serum iron and ferritin concentrations in severe IDA were 6.7 ± 1.8 μmol/L and 4.1 ± 1.4 μg/L in maternal blood, and 9.5 ± 2.6 μmol/L and 55.4 ± 19.7 μg/L in cord blood, respectively, significantly lower than nonanemic controls (p < 0.001). The corresponding serum hepcidin concentrations were 76.6 ± 22.7 μg/L and 110.5 ± 11.8 μg/L, respectively (p < 0.05). The proportion of cord blood/maternal blood hepcidin concentration was similar in both anemic (1.4:1) and nonanemic (1.3:1) mothers. Significant correlation was observed among maternal and cord blood hepcidin concentrations and other iron status parameters. CONCLUSION Even in the presence of low serum iron and ferritin, maternal and cord blood hepcidin concentrations remained high in severe anemia. Failure of this proportional suppression of hepcidin indicates poor systemic bioavailability of iron to the mother and poor placental transport.
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Affiliation(s)
- Sriparna Basu
- Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Naveen Kumar
- Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ragini Srivastava
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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89
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Banjari I, Kenjerić D, Mandić ML. What Is the Real Public Health Significance of Iron Deficiency and Iron Deficiency Anaemia in Croatia? A Population-Based Observational Study on Pregnant Women at Early Pregnancy from Eastern Croatia. Cent Eur J Public Health 2016; 23:122-7. [PMID: 26851422 DOI: 10.21101/cejph.a3962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/04/2015] [Indexed: 11/15/2022]
Abstract
AIM Studies imply that significance of iron deficiency (ID) and iron deficiency anaemia (IDA) for pregnancy outcomes is especially highlighted in the early pregnancy. Prevalence around the world varies widely, however, no data is available up to date for Croatia or neighbouring countries. Therefore, the objective was to determine the prevalence of ID and IDA among pregnant women from Croatia at the first trimester. Also, the aim was to compare two criterions; the World Health Organization (WHO) one and the clinical one. METHODS Randomised observational population based study was set up and 265 pregnant women at the first trimester were enrolled. RESULTS Based on the WHO criteria, 17.7% on haemoglobin basis and 18.5% on haematocrit basis had either ID or IDA. Clinical criteria showed that even 32.8% had either ID or IDA (transferrin saturation <20.0%). The WHO criterion shows less sensitivity, especially in detecting less severe stages of IDA. CONCLUSIONS Regardless of the criteria used, ID and IDA present a mild to moderate public health problem in pregnant women population. This high share of pregnant women who are starting their pregnancy as iron deficient, presents a potentially high risk for the pregnancy outcomes, especially in terms of a newborn, and it is fully justified to treat them as diseases of public health significance.
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Affiliation(s)
- Ines Banjari
- Department of Food and Nutrition Research, Faculty of Food Technology, University of Osijek, Osijek, Croatia
| | - Daniela Kenjerić
- Department of Food and Nutrition Research, Faculty of Food Technology, University of Osijek, Osijek, Croatia
| | - Milena L Mandić
- Department of Food and Nutrition Research, Faculty of Food Technology, University of Osijek, Osijek, Croatia
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90
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Wrześniak M, Kepinska M, Królik M, Milnerowicz H. Influence of tobacco smoking on transferrin sialylation during pregnancy in smoking and non-smoking women with iron deficiency. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 46:95-102. [PMID: 27448041 DOI: 10.1016/j.etap.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Tobacco smoking influence on proteins is leading to despaired foetal nourishment. Transferrin, is an essential metal-binding protein responsible for iron transport and proper foetal development. This study examines influence of tobacco smoking on transferrin sialic acid residues and its connection to foetal nourishment at women with iron deficiency. METHODS The study involved 190 samples from pregnant women in 1st, 2nd and 3rd trimester. Women were divided in terms of tobacco smoking and iron deficiency. RESULTS During pregnancy, the levels of 2-, 5- and 6-sialo transferrin were increasing while 3- and 4-sialo transferrin were decreasing in all groups. Transferrin isoforms showed positive correlation with lowered iron stores in the blood of non-smoking women. CONCLUSION Tobacco smoking has an influence on number of sialic acids residues in the transferrin and seems to change conversion of Tf isoforms, and this may disturb iron transport and in consequence influence on foetal development and nourishment.
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Affiliation(s)
- Marta Wrześniak
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland.
| | - Marta Kepinska
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland
| | - Małgorzata Królik
- Early Pregnancy Pathology Clinic, Centre of Gynecology, Obstetrics and Neonatology, Reymonta 8, 45-066 Opole, Poland
| | - Halina Milnerowicz
- Department of Biomedical and Environmental Analyses, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland.
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91
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Pinho-Pompeu M, Surita FG, Pastore DA, Paulino DSM, Pinto E Silva JL. Anemia in pregnant adolescents: impact of treatment on perinatal outcomes. J Matern Fetal Neonatal Med 2016; 30:1158-1162. [PMID: 27354114 DOI: 10.1080/14767058.2016.1205032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study sought to evaluate the anemia prevalence and effect of anemia treatment in pregnant adolescents. METHODS A cross-sectional study. Data from perinatal outcomes, serum hemoglobin level and iron supplementation were collected. Samples were divided into three groups: pregnant adolescents without anemia, with treated anemia and with untreated anemia. Frequencies, means, standard deviations and Chi-squared values were calculated. The significance level was 5%, and the software used was Epi-info 7. RESULTS The study included 458 pregnant adolescents. The mean age was 16 years old, and the prevalence of anemia was 41.27% (189). Mild, moderate or severe anemia were presented in 65.60%, 33.86% and 0.52%, respectively, of study participants. Among pregnant adolescents with anemia, 87.24% received treatment with iron supplementation. Preterm labor (p = 0.003), gestational age at birth <37 weeks (p = 0.036) and stillbirth (p = 0.004) showed an association with nontreated anemia. Positive HIV was more prevalent in adolescents with nontreated anemia (p = 0.018). The cesarean rate was 36.90%, with no difference between groups. CONCLUSION Anemia is a public health problem among pregnant adolescents, and iron supplementation reduces negative neonatal outcomes. Treatment adherence by a multidisciplinary and qualified prenatal care team can be key in reducing adverse neonatal outcomes associated with pregnancy during adolescence.
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Affiliation(s)
- Maira Pinho-Pompeu
- a School of Medical Science, University of Campinas, Campinas , Sao Paulo , Brazil
| | | | - Danilo Abib Pastore
- a School of Medical Science, University of Campinas, Campinas , Sao Paulo , Brazil
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92
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Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, Ma RC, McAuliffe FM, Maleta K, Purandare CN, Yajnik CS, Rushwan H, Morris JL. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: "Think Nutrition First". Int J Gynaecol Obstet 2016; 131 Suppl 4:S213-53. [PMID: 26433230 DOI: 10.1016/s0020-7292(15)30034-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mark A Hanson
- Institute of Developmental Sciences, University of Southampton; and NIHR Nutrition Biomedical Research Centre, University Hospital Southampton; Southampton, UK
| | - Anne Bardsley
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and Department of Nutrition, Harvard TH Chan School of Public Health; Boston, MA, USA
| | | | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong; and the Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ken Maleta
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | - Hamid Rushwan
- International Federation of Gynecology and Obstetrics, London, UK
| | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK.
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93
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Impact of Growth Restriction and Other Prenatal Risk Factors on Cord Blood Iron Status in Prematurity. J Pediatr Hematol Oncol 2016; 38:210-5. [PMID: 26907656 DOI: 10.1097/mph.0000000000000536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether prenatal risk factors (RFs) that predict cord blood iron status in term newborns also predict iron status of premature newborns. STUDY DESIGN Cord blood iron indices from 80 preterm newborns were compared with historical and demographic RFs for developing iron deficiency if born at term. RESULT The presence of multiple RFs did not incrementally interfere with cord iron status in preterm newborns. Poorer iron status accompanied being small for gestational age in prematurity, but other RFs, including diabetes, had relatively little impact. CONCLUSION Growth-restricted preterm newborns are at risk for poor iron endowment, likely due to uteroplacental insufficiency. Other RFs were less impactful on iron status of premature newborns than in term newborns, likely reflecting that disruptive effects of RFs are more impactful in the third trimester. Understanding RFs for poor iron endowment is important for clinical recognition and treatment of premature babies.
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94
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Moghaddam Tabrizi F, Barjasteh S. Maternal Hemoglobin Levels during Pregnancy and their Association with Birth Weight of Neonates. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2015; 5:211-7. [PMID: 26985354 PMCID: PMC4779156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
BACK GROUND Anemia in pregnancy is associated with increased rates of maternal and perinatal mortality, premature delivery, low birth weight, and other adverse outcomes. MATERIALS AND METHODS A prospective study was conducted on 1405 Iranian pregnant women who delivered during 2015. Blood was collected from all the subjects to measure the hemoglobin (Hb) during 16-19 weeks, 22-24 weeks, and 34-36 weeks of gestation. According to the level of hemoglobin, it is divided into 4 groups. Group 1; Hb > 10.1 gm/100ml (control group), Group 2; Hb= 8.1-10 gm/100ml (mild anemia) Group 3; Hb= 6.5-8 gm/100ml (moderate anemia) Group 4; Hb <6.5 gm/100ml (severe anemia). After delivery, the neonates were weighted within 24 hours after birth. Maternal hemoglobin and birth weights were compared. RESULTS The anemia prevalence was 20.2% (Hb<10g/dl). Out of them, 16.2 % hadmoderate anemia (Hb=6.5-8 g/dl) and 83.8% had mild anemia (Hb=8.1-10 g/dl). Severe anemia did not detect in pregnant women. The hemoglobin levels in non anemic group showed a drop in the second trimester. Pregnant women with hemoglobin less than 10 g/dl, considered as anemic gave birth to neonates with birth weight of 2.6kg, while pregnant women with higher hemoglobin level (>10 g/dl), considered as normal gave birth to heavier and normal babies (3.3 kg). The severity of anemia during three trimesters was closely associated with birth weight of newborns. CONCLUSION The low hemoglobin values during three trimesters of pregnancy were associated with low birth weight in Iran. The anemia can lead to intra uterine growth retardation.
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Affiliation(s)
- F Moghaddam Tabrizi
- Assistant Professor in Nursing and Midwifery Department, Reproductive Health Research Center , Urmia University of Medical Sciences, Urmia, Iran
| | - S Barjasteh
- Midwifery Masters Degree Student, Student Research Center, Urmia University of Medical Sciences, Urmia, Iran
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95
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Wibowo N, Irwinda R. The effect of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women. MEDICAL JOURNAL OF INDONESIA 2015. [DOI: 10.13181/mji.v24i3.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Potential benefits of multiple micronutrient supplements has become an increasing interest seeing as the high rate of pregnant women with suboptimal nutritional status, but low compliance often reduces effectiveness of large-scale iron and folic acid supplementation program. The aim of this study was to investigate the efficacy of multi-micronutrient and protein supplementation on iron and micronutrients status in pregnant women. Methods: An exploratory study was conducted to 100 pregnant women ≤ 12 weeks, who underwent antenatal care in Budi Kemuliaan Hospital, Jakarta. The subjects received formulated powder milk containing multi-micronutrient and protein supplement monthly until delivery. Anthropometric measurement, maternal and cord blood exam, ultrasound and dietary recall were done. The data was analyzed by correlation test. Correlation between variables was tested using Pearson or Spearman correlation test.Results: The mean maternal hemoglobin level significantly decreased during study (p < 0.001), being the lowest in second trimester. The levels on the first, second, and third trimester respectively was 12.16 ± 1.03 g/d; 12 anemic subjects and 17 had low ferritin level, 10.85 ± 0.95 g/dL; 58 anemic subjects and 69 had low ferritin level, and 11.02 ± 0.35 g/dL; 50 anemic subjects and 51 had low level of ferritin). Ferritin and serum iron levels were decreased at trimester one and two (p < 0.001), also the zinc and vitamin D level declined. Anemia did not correlate with pregnancy outcomes such as preterm delivery, preeclampsia, or low birth weight.Conclusion: The levels of maternal hemoglobin, ferritin, iron, zinc, and vitamin D during pregnancy could not be maintained or increased by multi-micronutrient and protein supplementation.
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96
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8. References. Int J Gynaecol Obstet 2015. [DOI: 10.1016/s0020-7292(15)30032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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97
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Menon KC, Ferguson EL, Thomson CD, Gray AR, Zodpey S, Saraf A, Das PK, Skeaff SA. Effects of anemia at different stages of gestation on infant outcomes. Nutrition 2015; 32:61-5. [PMID: 26643748 DOI: 10.1016/j.nut.2015.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Maternal anemia is a public health challenge worldwide. The present study aims to explore the effects of maternal anemia at different stages of gestation on postnatal growth and neurobehavioral development in infants. METHODS A cohort of pregnant Indian women were followed from 13 to 22 wk gestation (i.e., second trimester; n = 211), 29 to 42 wk gestation (i.e., third trimester; n = 178); their infants were followed to ∼3 wk (n = 147) postpartum. Data collected included information on sociodemographic and health-related factors, including anemia (i.e., low hemoglobin status), maternal and infant anthropometric data, and infant neurobehavioral data. A mixed logistic regression model was used to examine the impact of anemia during pregnancy on maternal and infant outcomes (i.e., anthropometric growth parameters and infant neurobehavioral development). RESULTS The prevalence of maternal anemia was 41% and 55% (P < 0.001), and iron deficiency anemia was 3.6% and 5.6%, respectively, in the second trimester and third trimester. Infants of pregnant women who were not anemic in the second trimester were 0.26 standard deviations (SD) heavier (P = 0.029), 0.50 SD taller (P = 0.001), and had 0.26 SD larger head circumference (P = 0.029) compared with infants of anemic pregnant women. Infants of pregnant women who were not anemic in the third trimester had orientation scores 3.88 higher (P = 0.004) than infants of women who were anemic. CONCLUSIONS Our findings indicate that maternal anemia in the second trimester of gestation influences postnatal infant growth and underscores the necessity of alleviating anemia in young women in the early stages of gestation.
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Affiliation(s)
- Kavitha C Menon
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
| | - Elaine L Ferguson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andrew R Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Abhay Saraf
- Symbiosis School of Biomedical Sciences, Symbiosis International University, Pune, India
| | | | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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98
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Magnussen K, Ladelund S. Handling low hemoglobin and iron deficiency in a blood donor population: 2 years' experience. Transfusion 2015; 55:2473-8. [DOI: 10.1111/trf.13152] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/29/2015] [Accepted: 04/01/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Karin Magnussen
- Department of Clinical Immunology and Blood Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Steen Ladelund
- Clinical Research Centre; Copenhagen University Hospital; Hvidovre Denmark
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99
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Gunaratna NS, Masanja H, Mrema S, Levira F, Spiegelman D, Hertzmark E, Saronga N, Irema K, Shuma M, Elisaria E, Fawzi W. Multivitamin and iron supplementation to prevent periconceptional anemia in rural tanzanian women: a randomized, controlled trial. PLoS One 2015; 10:e0121552. [PMID: 25905863 PMCID: PMC4408096 DOI: 10.1371/journal.pone.0121552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 02/12/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Women's nutritional status during conception and early pregnancy can influence maternal and infant outcomes. This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce the prevalence of anemia during the periconceptional period among rural Tanzanian women and adolescent girls. DESIGN A double-blind, randomized controlled trial was conducted in which participants were individually randomized to receive daily oral supplements of folic acid alone, folic acid and iron, or folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance (RDA) doses for six months. SETTING Rural Rufiji District, Tanzania. SUBJECTS Non-pregnant women and adolescent girls aged 15-29 years (n = 802). RESULTS The study arms were comparable in demographic and socioeconomic characteristics, food security, nutritional status, pregnancy history, and compliance with the regimen (p>0.05). In total, 561 participants (70%) completed the study and were included in the intention-to-treat analysis. Hemoglobin levels were not different across treatments (median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p = 0.65). However, compared with the folic acid arm (28%), there was a significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm (17%, RR: 0.61, 95% CI: 0.42-0.90, p = 0.01) and the folic acid, iron, and multivitamin arm (19%, RR: 0.66, 95% CI: 0.45-0.96, p = 0.03). Inverse probability of treatment weighting (IPTW) to adjust for potential selection bias due to loss to follow-up did not materially change these results. The effect of the regimens was not modified by frequency of household meat consumption, baseline underweight status, parity, breastfeeding status, or level of compliance (in all cases, p for interaction>0.2). CONCLUSIONS Daily oral supplementation with iron and folic acid among women and adolescents prior to pregnancy reduces risk of anemia. The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies. TRIAL REGISTRATION ClinicalTrials.gov NCT01183572.
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Affiliation(s)
- Nilupa S. Gunaratna
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | - Donna Spiegelman
- Departments of Epidemiology, Biostatistics, and Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ellen Hertzmark
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Naomi Saronga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kahema Irema
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mary Shuma
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Wafaie Fawzi
- Departments of Global Health and Population, Epidemiology, and Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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100
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Bottalico DM, Johnson GD, Chazotte C, Karkowsky CE. Maternal anemia associated with walkable distance to healthy food sources in Bronx, New York. Spat Spatiotemporal Epidemiol 2015; 12:19-25. [PMID: 25779906 DOI: 10.1016/j.sste.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 11/07/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
Abstract
The relationship between walkable access to healthy food sources and risk of anemia in pregnancy was evaluated for a cohort of 4678 women who initiated prenatal care in the year 2010 at an academic medical center in Bronx, New York. After geocoding patient residences, street network distances were obtained for the closest healthy food sources, which were identified from multiple databases. For lower-income patients, as indicated by Medicaid or lack of health insurance, those who lived less than 0.25miles from a healthy food source were less likely to be anemic when compared to those who lived farther (adjusted OR=0.65, 95% CI 0.48, 0.88). Patients with commercial insurance showed no effect. These results help to understand how a nutritionally-mediated condition such as anemia during pregnancy can be affected by one's built environment, while also highlighting the importance of conditioning on socioeconomic status for these types of studies.
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Affiliation(s)
| | - Glen D Johnson
- City University of New York, Lehman College, Department of Health Sciences, Bronx, NY, USA
| | - Cynthia Chazotte
- Albert Einstein College of Medicine, Bronx, NY, USA; Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, NY, USA
| | - Chavi Eve Karkowsky
- Albert Einstein College of Medicine, Bronx, NY, USA; Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, NY, USA.
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