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Zhang F, Xie Z, Peng S, Jiang N, Li B, Chen B, Deng S, Yuan Y, Wu Q, Wen S, Tao Y, Ma J, Li S, Lin T, Wen F, Li Z, Huang R, Feng Z, He C, Wang W, Liang X, Xu L, Shen Y, Hong N, Xu R, Liu S. The risk factor for adverse pregnancy outcomes and its impact on clinical effect in IgA nephropathy: A retrospective observational study. Nephrology (Carlton) 2024. [PMID: 39254037 DOI: 10.1111/nep.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
AIM IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long-term renal outcome of pregnant IgAN patients remained unclear. METHODS We performed a retrospective observational study covering 2003-2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO. RESULTS In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome. CONCLUSION Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO.
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Affiliation(s)
- Fengxia Zhang
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Zhiyong Xie
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Siqi Peng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Bohou Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Boxi Chen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuting Deng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ye Yuan
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiong Wu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Sichun Wen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yiming Tao
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianchao Ma
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Sijia Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ting Lin
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Feng Wen
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhuo Li
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Renwei Huang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhonglin Feng
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chaosheng He
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wenjian Wang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lixia Xu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yue Shen
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Niechao Hong
- Department of Nephrology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ruiquan Xu
- Department of Urology, First Affifiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Iolascon A, Andolfo I, Russo R, Sanchez M, Busti F, Swinkels D, Aguilar Martinez P, Bou-Fakhredin R, Muckenthaler MU, Unal S, Porto G, Ganz T, Kattamis A, De Franceschi L, Cappellini MD, Munro MG, Taher A. Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. Hemasphere 2024; 8:e108. [PMID: 39011129 PMCID: PMC11247274 DOI: 10.1002/hem3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.
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Affiliation(s)
- Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Mayka Sanchez
- Department of Basic Sciences, Iron metabolism: Regulation and Diseases Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine and Azienda Ospedaliera Universitaria Integrata of Verona, EuroBloodNEt Referral Center for Iron Disorders, Policlinico G.B. Rossi University of Verona Verona Italy
| | - Dorine Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory (TML 830) Radboud University Medical Center Nijmegen The Netherlands
| | - Patricia Aguilar Martinez
- Department of Hematological Biology, Reference Center on Rare Red Cell Disorders Montpellier University Hospital Montpellier France
| | - Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Martina U Muckenthaler
- Molecular Medicine Partnership Unit European Molecular Biology Laboratory Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg Heidelberg Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg Germany
| | - Sule Unal
- Department of Pediatric Hematology Hacettepe University Ankara Turkey
| | - Graça Porto
- HematologyServiço de Imuno-hemoterapia, CHUdSA-Centro Hospitalar Universitário de Santo António Porto Portugal
| | - Tomas Ganz
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National & Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Lucia De Franceschi
- Department of Medicine University of Verona & AOUI Verona, Policlinico GB Rossi Verona Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital Milan Italy
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology David Geffen School of Medicine Los Angeles California USA
| | - Ali Taher
- Division of Hematology-Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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3
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Arora M, Mehndiratta M, Almeida EA, Kotru M, Gupta B. Gene expression of iron transporters, markers of vascularization and structural integrity in placenta of mothers with and without anemia. Mol Biol Rep 2024; 51:652. [PMID: 38734792 DOI: 10.1007/s11033-024-09609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To compare the mRNA expression of placental iron transporters (TfR-1 and FPN), markers of placental vascularization (VEGF and sFLT1) and marker of structural integrity (LMN-A) in term women with and without iron deficiency anemia. MATERIALS AND METHODS A total of 30 pregnant women were enrolled; 15 cases of iron deficiency anemia (Hb 7-10.9 gm/dL) and 15 gestational age matched healthy controls (Hb ≥ 11 gm/dL). Peripheral venous blood was collected for assessment of hemoglobin levels and serum iron profile. Placental tissue was used for assessing the mRNA expression of TfR-1, FPN, VEGF, sFLT-1 and LMN-A via real time PCR. RESULTS Placental expression of TfR-1, VEGF and LMN-A was increased in pregnant women with anemia compared to healthy pregnant controls. Placental expression of sFLT-1 was decreased in pregnant women with anemia compared to healthy pregnant controls. There was no change in the placental expression of FPN. CONCLUSION The increased expression of TfR-1, VEGF and LMN-A in cases of iron deficiency anemia are most likely to be compensatory in nature to help maintain adequate fetal iron delivery. WHAT DOES THIS STUDY ADDS TO THE CLINICAL WORK Compensatory changes in the placenta aimed at buffering transport of iron to the fetus are seen in pregnant women with anemia compared to healthy pregnant controls.
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Affiliation(s)
- Madhav Arora
- University College of Medical Sciences & GTB Hospital, University of Delhi, Delhi, India
| | - Mohit Mehndiratta
- Department of Biochemistry, University College of Medical Sciences & GTB Hospital, University of Delhi, Delhi, 110095, India.
| | - Edelbert Anthonio Almeida
- Department of Biochemistry, University College of Medical Sciences & GTB Hospital, University of Delhi, Delhi, 110095, India
| | - Mrinalini Kotru
- Department of Pathology, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Bindiya Gupta
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & GTB Hospital, University of Delhi, Delhi, India
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Al Mansoori A, Bataineh MF, Al Momani H, Ali HI. Micronutrient Status in Pregnant Women after Metabolic Bariatric Surgery in the United Arab Emirates: A Prospective Study. Nutrients 2023; 16:72. [PMID: 38201902 PMCID: PMC10781104 DOI: 10.3390/nu16010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Metabolic bariatric surgery (MBS) helps reduce comorbidities, such as hypertension and gestational diabetes, and is more effective than diet management for women with obesity-related health issues. Vitamin B12, vitamin D, and iron play important roles in ensuring the health of a neonate. However, pregnancies occurring after MBS may face complications related to micronutrient deficiencies, particularly of vitamins B12 and D and iron. This study aimed to investigate the vitamin B12, vitamin D, ferritin, and iron status of pregnant women who underwent MBS compared with women without MBS history. The study included 217 pregnant women (105 with a history of MBS and 112 without a history of MBS) who visited a major maternity hospital in Abu Dhabi, United Arab Emirates (UAE) between July 2021 and November 2022. The maternal vitamin B12, vitamin D, iron, and ferritin levels were measured twice, initially during the first or second trimester and subsequently during the third trimester. The iron was measured once during the pregnancy. Vitamin B12 deficiency was higher among pregnant women with MBS history compared to non-bariatric pregnant women (24.4% vs. 3.9%, p < 0.001). Women with a history of MBS had a higher prevalence of vitamin D deficiency (62.3% vs. 37.7%, p < 0.002). Linear regression analysis indicated that vitamin B12 levels decreased by 55 pg/mL in women with a history of MBS and by 4.6 pg/mL with a unit increase in body mass index (kg/m2). Furthermore, vitamin D levels in women with a history of MBS decreased by 4.9 ng/mL during pregnancy. Metabolic bariatric surgery is associated with vitamin B12, vitamin D, and iron deficiencies during pregnancy.
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Affiliation(s)
- Amna Al Mansoori
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (A.A.M.); (M.F.B.)
| | - Mo’ath F. Bataineh
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (A.A.M.); (M.F.B.)
| | - Hazem Al Momani
- Weight Management Unit, NMC Royal Khalifa Hospital, Abu Dhabi P.O. Box 35233, United Arab Emirates;
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (A.A.M.); (M.F.B.)
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5
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Bahr TM, Tan S, Smith E, Beauman SS, Schibler KR, Grisby CA, Lowe JR, Bell EF, Laptook AR, Shankaran S, Carlton DP, Rau C, Baserga MC, Flibotte J, Zaterka-Baxter K, Walsh MC, Das A, Christensen RD, Ohls RK. Serum ferritin values in neonates <29 weeks' gestation are highly variable and do not correlate with reticulocyte hemoglobin content. J Perinatol 2023; 43:1368-1373. [PMID: 37596391 PMCID: PMC10825191 DOI: 10.1038/s41372-023-01751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To compare serum ferritin and RET-He values among extremely low gestational age neonates ELGANs with other markers of iron-deficient erythropoiesis. STUDY DESIGN This is a secondary analysis of the NICHD Darbepoetin Trial. Study data from placebo recipients who had a serum ferritin, a RET-He, and a mean corpuscular volume (MCV) measurement within a 24-hour period were analyzed for correlation. RESULTS Mixed linear regression models showed no association between ferritin and RET-He at both early (β = 0.0016, p = 0.40) and late (β = -0.0001, p = 0.96) time points. Positive associations were observed between RET-He and MCV at baseline, early, and late time points (p < 0.01, =0.01, <0.001, respectively), while ferritin was not associated with MCV at any time point. CONCLUSIONS Our study shows that RET-He is better correlated with MCV as a marker of iron-limited erythropoiesis than ferritin. The results suggest that ferritin is limited as a marker of iron sufficiency in premature infants. STUDY IDENTIFICATION FDA IND Number 100138; ClinicalTrials.gov number NCT03169881; NRN ID number NICHD-NRN-0058 (Darbe).
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Sandra S Beauman
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Kurt R Schibler
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cathy A Grisby
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean R Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Abbot R Laptook
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - David P Carlton
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Carrie Rau
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Mariana C Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - John Flibotte
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Zaterka-Baxter
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Michele C Walsh
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
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Sangkhae V, Fisher AL, Ganz T, Nemeth E. Iron Homeostasis During Pregnancy: Maternal, Placental, and Fetal Regulatory Mechanisms. Annu Rev Nutr 2023; 43:279-300. [PMID: 37253681 PMCID: PMC10723031 DOI: 10.1146/annurev-nutr-061021-030404] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pregnancy entails a large negative balance of iron, an essential micronutrient. During pregnancy, iron requirements increase substantially to support both maternal red blood cell expansion and the development of the placenta and fetus. As insufficient iron has long been linked to adverse pregnancy outcomes, universal iron supplementation is common practice before and during pregnancy. However, in high-resource countries with iron fortification of staple foods and increased red meat consumption, the effects of too much iron supplementation during pregnancy have become a concern because iron excess has also been linked to adverse pregnancy outcomes. In this review, we address physiologic iron homeostasis of the mother, placenta, and fetus and discuss perturbations in iron homeostasis that result in pathological pregnancy. As many mechanistic regulatory systems have been deduced from animal models, we also discuss the principles learned from these models and how these may apply to human pregnancy.
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Affiliation(s)
- Veena Sangkhae
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
| | - Allison L Fisher
- Endocrine Unit and Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas Ganz
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
| | - Elizabeta Nemeth
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
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7
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Pai RD, Chong YS, Clemente-Chua LR, Irwinda R, Huynh TNK, Wibowo N, Gamilla MCZ, Mahdy ZA. Prevention and Management of Iron Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert Consensus. Nutrients 2023; 15:3125. [PMID: 37513543 PMCID: PMC10383547 DOI: 10.3390/nu15143125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The lack of standardized clinical practice impeding the optimal management of iron deficiency (ID) and iron deficiency anemia (IDA) in women is a global concern, particularly in the Asia-Pacific region. The aim of this study was to determine best practices through a Delphi consensus process. In Round 1, panelists were asked to rate their level of agreement with 99 statements across four domains: identification, diagnosis and assessment, prevention, and treatment of ID/IDA in women. In Round 2, panelists reappraised their ratings in view of the collective feedback and responses to Round 1. After two rounds, consensus (≥85% agreement) was reached for 84% of the Delphi statements. Experts agreed on the role of presenting symptoms and risk factors in prompting assessments of anemia and iron status in women. Experts repeatedly called for prevention, recommending preventive iron supplementation for pregnant women irrespective of anemia prevalence levels, and for non-pregnant adult women, adolescent girls, and perimenopausal women living in areas with a high prevalence of anemia. Experts unanimously agreed to prescribing oral ferrous iron as first-line therapy for uncomplicated ID/IDA. The recommendations and clinical pathway algorithms generated should be used to inform clinical practice and standardize the care of women at risk or presenting with ID/IDA in the Asia-Pacific region.
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Affiliation(s)
- Rishma Dhillon Pai
- Department of Obstetrics and Gynaecology, Lilavati Hospital, Mumbai 400050, India;
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | | | - Rima Irwinda
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | - Trang Nguyen Khanh Huynh
- Department of Obstetrics and Gynecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh 700000, Vietnam;
| | - Noroyono Wibowo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia—Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (R.I.); (N.W.)
| | | | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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8
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Variation Patterns of Hemoglobin Levels by Gestational Age during Pregnancy: A Cross-Sectional Analysis of a Multi-Center Retrospective Cohort Study in China. Nutrients 2023; 15:nu15061383. [PMID: 36986113 PMCID: PMC10054432 DOI: 10.3390/nu15061383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Pregnancy anemia is a global health concern. However, to our knowledge, there still has little consensus on the reference value of hemoglobin levels. Particularly, little evidence from China was accessible in most existing guidelines. Objective: To evaluate hemoglobin levels and anemia prevalence of pregnant women in China and offer evidence for anemia and its reference values in China. Methods: A multi-center retrospective cohort study was conducted among 143,307 singleton pregnant women aged 15–49 at 139 hospitals in China, with hemoglobin concentrations routinely tested at each prenatal visit. Subsequently, a restricted cubic spline was performed to reveal a non-linear variation of hemoglobin concentrations during the gestational week. The Loess model was used to describe the changes in the prevalence of different degrees of anemia with gestational age. Multivariate linear regression model and Logistic regression model were applied to explore influencing factors of gestational changes in hemoglobin level and anemia prevalence, respectively. Results: Hemoglobin varied nonlinearly with gestational age, and the mean hemoglobin levels decreased from 125.75 g/L in the first trimester to 118.71 g/L in the third trimester. By analyzing hemoglobin levels with gestational age and pregnancy period, we proposed new criteria according to 5th percentile hemoglobin concentration in each trimester as a reference for anemia, with 108 g/L, 103 g/L, and 99 g/L, respectively. According to WHO’s criteria, the prevalence of anemia sustainably increased with gestational age, with 6.2% (4083/65,691) in the first trimester, 11.5% (7974/69,184) in the second trimester and 21.9% (12,295/56,042) in the third trimester, respectively. In subsequent analysis, pregnant women in non-urban residents, multiparity, and pre-pregnancy underweight tended to have lower hemoglobin levels. Conclusions: This research, the first large-sample study to present a set of gestational age-specific reference centiles for hemoglobin levels in China, could be used to obtain a better understanding of the overall levels of hemoglobin in Chinese healthy pregnant women and ultimately offer clues for a more precise hemoglobin reference value of anemia in China.
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9
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Abioye AI, Hughes MD, Sudfeld CR, Premji Z, Aboud S, Hamer DH, Roberts DJ, Duggan CP, Fawzi WW. The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia. Eur J Nutr 2023; 62:987-1001. [PMID: 36344770 PMCID: PMC9987582 DOI: 10.1007/s00394-022-03029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Whether anemia type modifies the risk of pregnancy and newborn outcomes and the effectiveness of iron supplementation is unclear. We examined the association of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) on the risks of these outcomes and the extent to which anemia type modifies the impact of prenatal iron supplementation. METHODS This was a secondary analysis of a placebo-controlled trial of iron supplementation among 1450 HIV-negative women in Tanzania. Eligibility criteria included gestational age < 27 weeks, hemoglobin > 85 g/L, and ferritin > 12 µg/L. Individuals were categorized as non-anemia, IDA or NIDA using hemoglobin, ferritin and CRP. Analyses were conducted using regression models and likelihood ratio tests. RESULTS Compared to the non-anemia group, delivery hemoglobin was lower by 15 g/L (95% CI 10.9, 19.3) in the baseline IDA group, and 7.3 g/L (95% CI 3.1, 11.5) in the baseline NIDA group. The RRs of anemia severity, iron deficiency, placental malaria, stillbirths, perinatal mortality, birthweight, and preterm birth were not different among women in the baseline NIDA group (vs. non-anemia) compared to the baseline IDA group (vs. non-anemia). The difference in the mean delivery hemoglobin for iron supplementation and placebo arms was 8 g/L (95% CI 6, 11) in the non-anemia group, 7 g/L (95% CI 2, 13) in the NIDA group, and 16 g/L (95% CI 10, 22) in the IDA group. CONCLUSION Iron supplementation is effective even among pregnant women with NIDA. TRIAL REGISTRATION NCT01119612 (May 7, 2010).
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Affiliation(s)
- Ajibola Ibraheem Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Michael D Hughes
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davidson H Hamer
- Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Lee D, Jung W, Shin DW. Association of Coffee or Green Tea with Ferritin or Hemoglobin in Premenopausal Women. Korean J Fam Med 2023; 44:87-94. [PMID: 36966738 PMCID: PMC10040265 DOI: 10.4082/kjfm.22.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/05/2022] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This study aimed to examine the association between coffee or green tea consumption and ferritin or hemoglobin levels in premenopausal women. METHODS We used the fifth Korea National Health and Nutrition Examination Survey (2010-2012), and a total of 4,322 individuals were surveyed. In women of reproductive age, average ferritin and hemoglobin levels were calculated according to coffee or green tea consumption. Covariates included in the analysis were demographic variables, such as age, body mass index, education, drinking, smoking, history of hypertension, history of diabetes diagnosis, physical activity, total energy intake, and daily iron intake. RESULTS In 4,322 participants, the average hemoglobin level was 12.90±0.02 g/dL, and the average level of ferritin was 31.95±0.67 ng/mL. As a result of testing, correlation between ferritin and coffee intake and difference in ferritin levels according to coffee consumption was significant (P<0.05). In this study, a post hoc test indicated that ferritin level significantly differed between one and two cups, two and three cups, and three and one cup groups (overall P<0.001). Additionally, there was a negative correlation between ferritin level and coffee intake; ferritin level decreased by 2.09 ng/mL with a one-cup increase in daily coffee consumption. CONCLUSION In premenopausal women, coffee intake is associated with low serum ferritin levels. Our results indicate that drinking >2 cups of coffee significantly affect ferritin levels in Korean premenopausal women.
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Affiliation(s)
- Dagyeong Lee
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonyoung Jung
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
- Corresponding Author: Dong Wook Shin https://orcid.org/0000-0001-8128-8920 Tel: +82-2-3410-5252, Fax: +82-2-3410-0388, E-mail:
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11
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Seo H, Yoon SY, ul-Haq A, Jo S, Kim S, Rahim MA, Park HA, Ghorbanian F, Kim MJ, Lee MY, Kim KH, Lee N, Won JH, Song HY. The Effects of Iron Deficiency on the Gut Microbiota in Women of Childbearing Age. Nutrients 2023; 15:nu15030691. [PMID: 36771397 PMCID: PMC9919165 DOI: 10.3390/nu15030691] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Iron deficiency anemia (IDA) is the most prevalent and common nutritional deficiency worldwide and is a global health problem with significant risk, particularly among women of reproductive age. Oral iron supplementation is the most widely used and cost-effective treatment for iron deficiency and IDA. However, there are limitations regarding side effects such as enteritis, treatment compliance, and bioavailability. Intestinal microbiome characteristic research has been recently conducted to overcome these issues, but more is needed. Against this background, a metagenomics study on the 16S gene in the feces of young women vulnerable to IDA was conducted. As a result of analyzing 16 normal subjects and 15 IDA patients, significant differences in bacterial community distribution were identified. In particular, a significant decrease in Faecalibacterium was characteristic in IDA patients compared with normal subjects. Furthermore, in the case of patients who recovered from IDA following iron supplementation treatment, it was confirmed that Faecalibacterium significantly recovered to normal levels. However, no significance in beta diversity was seen compared with before treatment. There were also no differences in the beta diversity results between the recovered and normal subjects. Therefore, intestinal dysbiosis during the disease state was considered to be restored as IDA improved. Although the results were derived from a limited number of subjects and additional research is needed, the results of this study are expected to be the basis for developing treatment and prevention strategies based on host-microbiome crosstalk in IDA.
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Affiliation(s)
- Hoonhee Seo
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Seug Yun Yoon
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Asad ul-Haq
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Sujin Jo
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Sukyung Kim
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Md Abdur Rahim
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Hyun-A Park
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Fatemeh Ghorbanian
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
| | - Min Jung Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Min-Young Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Kyoung Ha Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Namsu Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
| | - Jong-Ho Won
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
- Correspondence: (J.-H.W.); (H.-Y.S.)
| | - Ho-Yeon Song
- Probiotics Microbiome Convergence Center, Soonchunhyang University, Asan-si 31538, Republic of Korea
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan-si 31151, Republic of Korea
- Correspondence: (J.-H.W.); (H.-Y.S.)
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12
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Benson AE, Shatzel JJ, Ryan KS, Hedges MA, Martens K, Aslan JE, Lo JO. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109:633-642. [PMID: 36153674 PMCID: PMC9669178 DOI: 10.1111/ejh.13870] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
Iron deficiency and/or iron deficiency anemia (IDA) complicate nearly 50% of pregnancies globally, negatively impacting both maternal and fetal outcomes. Iron deficiency can cause a range of symptoms that range from aggravating to debilitating including fatigue, poor quality of life, pagophagia, and restless leg syndrome. Iron deficiency and IDA are also associated with maternal complications including preterm labor, increased rates of cesarean delivery, postpartum hemorrhage, and maternal death. Fetal complications include increased rates of low birth weight and small for gestational age newborns. Prenatal maternal anemia has also been associated with autism spectrum disorders in the neonate, although causation is not established. Deficiency in the newborn is associated with compromised memory, processing, and bonding, with some of these deficits persisting into adulthood. Despite the prevalence and consequences associated with iron deficiency in pregnancy, data show that it is routinely undertreated. Due to the physiologic changes of pregnancy, all pregnant individuals should receive oral iron supplementation. However, the bioavailability of oral iron is poor and it is often ineffective at preventing and treating iron deficiency. Likewise, it frequently causes gastrointestinal symptoms that can worsen the quality of life in pregnancy. Intravenous iron formulations administered in a single or multiple dose series are now available. There is increasing data suggesting that newer intravenous formulations are safe and effective in the second and third trimesters and should be strongly considered in pregnant individuals without optimal response to oral iron repletion.
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Affiliation(s)
- Ashley E Benson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Kim S Ryan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Madeline A Hedges
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph E Aslan
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Jamie O Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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13
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Bradley R, Lakpa KL, Burd M, Mehta S, Katusic MZ, Greenmyer JR. Fetal Alcohol Spectrum Disorder and Iron Homeostasis. Nutrients 2022; 14:4223. [PMID: 36296909 PMCID: PMC9607572 DOI: 10.3390/nu14204223] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 09/19/2023] Open
Abstract
Prenatal alcohol exposure results in a spectrum of behavioral, cognitive, and morphological abnormalities collectively referred to as fetal alcohol spectrum disorder (FASD). FASD presents with significant phenotypic variability and may be modified by gestational variables such as maternal nutritional status. Iron serves a critical function in the development of and processes within central nervous system (CNS) structures. Gestational iron deficiency alters CNS development and may contribute to neurodevelopmental impairment in FASD. This review explores the relationship between iron deficiency and fetal alcohol spectrum disorder as described in small animal and human studies. Consideration is given to the pathophysiologic mechanisms linking iron homeostasis and prenatal alcohol exposure. Existing data suggest that iron deficiency contributes to the severity of FASD and provide a mechanistic explanation linking these two conditions.
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Affiliation(s)
- Regan Bradley
- School of Medicine, University of North Dakota, Grand Forks, ND 58201, USA
| | - Koffi L. Lakpa
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53706, USA
| | - Michael Burd
- School of Medicine, University of North Dakota, Grand Forks, ND 58201, USA
| | - Sunil Mehta
- Mayo Clinic, Developmental and Behavioral Pediatrics, Psychiatry and Psychology, Rochester, MN 55905, USA
| | - Maja Z. Katusic
- Mayo Clinic, Pediatric and Adolescent Medicine, Rochester, MN 55905, USA
| | - Jacob R. Greenmyer
- Mayo Clinic, Pediatric and Adolescent Medicine, Rochester, MN 55905, USA
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14
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Sangkhae V, Yu V, Coffey R, O’Brien KO, Ganz T, Nemeth E. Erythroferrone contributes to iron mobilization for embryo erythropoiesis in iron-deficient mouse pregnancies. Am J Hematol 2022; 97:1348-1358. [PMID: 36071577 PMCID: PMC9462668 DOI: 10.1002/ajh.26680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023]
Abstract
Erythroferrone (ERFE) is an erythroblast-secreted regulator of iron metabolism. The production of ERFE increases during stress erythropoiesis, leading to decreased hepcidin expression and mobilization of iron. Pregnancy requires a substantial increase in iron availability to sustain maternal erythropoietic expansion and fetal development and is commonly affected by iron deficiency. To define the role of ERFE during iron-replete or iron-deficient pregnancy, we utilized mouse models expressing a range of ERFE levels: transgenic (TG) mice overexpressing ERFE, wild-type (WT), and ERFE knockout (KO) mice. We altered maternal iron status using diets with low or standard iron content and performed the analysis at E18.5. Iron deficiency increased maternal ERFE in WT pregnancy. Comparing different maternal genotypes, ERFE TG dams had lower hepcidin relative to their liver iron load but similar hematological parameters to WT dams on either diet. In ERFE KO dams, most hematologic and iron parameters were comparable to WT, but mean corpuscular volume (MCV) was decreased under both iron conditions. Similar to dams, TG embryos had lower hepcidin on both diets, but their hematologic parameters did not differ from those of WT embryos. ERFE KO embryos had lower MCV than WT embryos on both diets. The effect was exacerbated under iron-deficient conditions where ERFE KO embryos had higher hepcidin, lower Hb and Hct, and lower brain iron concentration compared to WT embryos, indicative of iron restriction. Thus, under iron-deficient conditions, maternal and embryo ERFE facilitate iron mobilization for embryonic erythropoiesis.
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Affiliation(s)
- Veena Sangkhae
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vivian Yu
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard Coffey
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Tomas Ganz
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeta Nemeth
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Disordered Maternal and Fetal Iron Metabolism Occurs in Preterm Births in Human. DISEASE MARKERS 2022; 2022:1664474. [PMID: 36046373 PMCID: PMC9423993 DOI: 10.1155/2022/1664474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background. Increasing evidence reveals that iron deficiency during pregnancy causes adverse pregnancy outcomes. Thus far, the mechanisms underlying iron deficiency-associated preterm birth are mostly limited to animal studies. Whether the suggested mechanisms exist in human requires further investigation. The goal of this study was to characterize the iron metabolism in both the maternal side and fetal side in pregnant women with preterm birth. Methods. Serum and placenta samples were collected from 42 pregnant women divided into four groups according to the gestational week. Indicators of iron metabolism, including serum iron, serum hepcidin, placental tissue iron, ferroportin (FPN), transferrin receptor 1 (TfR1), and ferritin, were surveyed using enzyme-linked immunosorbent assays (Elisa), Western blots, and real-time quantitative polymerase chain reactions (qRT-PCR). Results. Significant reduction of maternal serum iron was observed in women with preterm birth relative to those with full-term birth, indicative of worsen iron deficiency in those mothers with preterm birth. Meanwhile, the maternal hepcidin levels were notably diminished in women with preterm birth, whereas the fetal hepcidin levels were comparable between the two groups. Moreover, the placental iron stores were remarkably reduced in the preterm group, associated with reduced concentration of TfR1 and increased FPN concentration relative to the normal controls. In other words, the ratio of placental FPN mass to TfR1 mass (PIDI index) was strikingly increased in the preterm group. Conclusions. Dysregulated iron homeostasis in both the maternal and fetal sides was implicated in preterm births, and disordered regulations in maintaining the placental iron equilibrium were also presumed to account for the compromised fetal iron supply.
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16
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An H, Chen H, Li Z, Zhang L, Zhang Y, Liu J, Ye R, Li N. Association of Preconception Blood Pressure with the Risk of Anemia in Children under Five Years of Age: A Large Longitudinal Chinese Birth Cohort. Nutrients 2022; 14:nu14132640. [PMID: 35807821 PMCID: PMC9268260 DOI: 10.3390/nu14132640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hypertension during pregnancy may increase the risk of anemia in the offspring. However, few studies have investigated the effects of elevated blood pressure during the preconception period on childhood anemia. This large population-based birth cohort study was performed to determine whether abnormal preconception blood pressure has long-term consequences for childhood health. Data were obtained from the China–US Collaborative Project for Neural Tube Defect Prevention. The study consisted of 40,638 women with singleton live births who were registered in a monitoring system before pregnancy in southern China during the period 1993–1996. Children were assessed by hemoglobin measurement at approximately 53 months of age. The incidences of childhood anemia were 19.80% in the hypertension group and 16.07% in the non-hypertension group. Compared with the non-hypertension group, the hypertension group had an increased risk of childhood anemia (adjusted risk ratio (RR): 1.25; 95% confidence interval (CI): 1.11–1.41). After categorization according to blood pressure, combined systolic and diastolic hypertension was associated with a significantly increased risk of childhood anemia, compared with normotension (adjusted RR: 1.37; 95% CI: 1.16–1.63). Compared with women who had normal blood pressure, the adjusted RRs for childhood anemia were 1.20 (95% CI: 1.13–1.28), 1.26 (95% CI: 1.08–1.47), and 1.38 (95% CI: 1.14–1.67) among women with prehypertension, stage-1 hypertension, and stage-2 hypertension, respectively. Our results suggest a linear association between prepregnancy hypertension and the risk of childhood anemia in the Chinese population. Interventions targeting preconception blood pressure may have a positive effect on childhood health.
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Affiliation(s)
- Hang An
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Huiting Chen
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Zhiwen Li
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Le Zhang
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yali Zhang
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Jianmeng Liu
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Rongwei Ye
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (R.Y.); (N.L.); Tel.: +86-10-82801172 (N.L.)
| | - Nan Li
- Ministry of Health Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100191, China; (H.A.); (H.C.); (Z.L.); (L.Z.); (Y.Z.); (J.L.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (R.Y.); (N.L.); Tel.: +86-10-82801172 (N.L.)
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Is iron deficiency a risk factor for postpartum depression? A case-control study in the Gaza Strip, Palestine. Public Health Nutr 2022; 25:1631-1638. [PMID: 34462043 PMCID: PMC9991634 DOI: 10.1017/s1368980021003761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aims to investigate the association between iron body status and postpartum depression (PPD) among mothers during the postpartum period. DESIGN This is a case-control study. SETTING Governmental primary health care centres in the Gaza Strip, Palestine. PARTICIPANTS This study involved 300 mothers a month after delivery, with one 150 mothers that were recruited in the cases group who were diagnosed with PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥ 10. The control group included 150 mothers did not have PPD (EPDS < 10). Body iron status is represented by the index of sTfR/log ferritin. RESULTS Among PPD mothers, 43·3 % had low ferritin level v. 15·3 % for controls (P < 0·001) and cases v. controls difference in mean Hb level was -0·61 (95 % CI -0·86, -0·35). The results of the multiple logistic regression reported that there is a statistically significant association between PPD and the body iron status existed, as mothers who suffered from iron deficiency (ID) were three times more likely to have PPD (ORadj 3·25; P = 0·015). Furthermore, the results of the final regression model showed that the other factors that can lead to PPD are absence of psychological guidance services (ORadj 8·54; P = 0·001), suffering from undesired feeling in the last pregnancy (ORadj 1·77; P = 0·034), in addition to having one of the mental health disorders in the last pregnancy (P = 0·001). CONCLUSION Body iron status might be a risk factor for postpartum depression and other possibilities of reverse causality may worsen the condition.
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18
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Venkata Surekha M, Sujatha T, Gadhiraju S, Uday Kumar P, Siva Prasad M, Sailaja G, Bhaskar V, Srinivas T. Expression of iron transport protein Divalent metal transporter 1 (DMT1) increases in response to maternal iron deficiency anemia in near term to term placenta. J Matern Fetal Neonatal Med 2022; 35:1045-1053. [PMID: 32223474 DOI: 10.1080/14767058.2020.1742317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Iron deficiency anemia (IDA) is the most prevalent nutritional deficiency disorder in pregnant women. During pregnancy, placental transport protein Divalent metal transporter1 (DMT1) plays a crucial role in transit of iron across placenta. The developing fetus is observed to be immune to anemia despite presence of anemia in the mother. Hence, we planned the present study to explore the effect of maternal IDA on the expression of DMT1 in the placenta. MATERIALS AND METHODS Two hundred pregnant women recruited, were divided into anemic and nonanemic groups based on their predelivery hemoglobin levels (<11 g/dL and ≥11 g/dL respectively). After delivery, placental expression of DMT1 was studied by immunohistochemistry and mRNA analysis and neonatal anthropometry was performed. RESULTS Of the 200 women recruited, 58.8% were anemic with 60.35% having moderate anemia. Most of the red cell parameters were observed to be higher in cord blood than mothers. DMT1 protein immunohistochemical expression showed a statistically significant increase with increasing severity of anemia. Similarly, placental mRNA expression levels of DMT1 gene were observed to be higher in anemic mothers in comparison with nonanemic mothers. CONCLUSION Our study thus demonstrated a definite increase in expression of DMT1 at both protein and mRNA levels in term placenta, in maternal IDA.
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Affiliation(s)
- Mullapudi Venkata Surekha
- National Institute of Nutrition, Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | - Thathapudi Sujatha
- National Institute of Nutrition, Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | | | - Putcha Uday Kumar
- National Institute of Nutrition, Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | - Mudili Siva Prasad
- Biochemistry Division, National Institute of Nutrition, Hyderabad, India
| | - Gummadi Sailaja
- National Institute of Nutrition, Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | - V Bhaskar
- Division of Bio-Statistics, National Institute of Nutrition, Hyderabad, India
| | - Thimmapuram Srinivas
- National Institute of Nutrition, Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
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Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, Wang X, Jiang H, Wang X, Lu J, Ge L, Dong S, Zhuang Y, Zhao Y, Wei Y, Ma X, Qiao J. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Netw Open 2022; 5:e2147046. [PMID: 35113162 PMCID: PMC8814908 DOI: 10.1001/jamanetworkopen.2021.47046] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from China's Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China. EXPOSURES Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L. MAIN OUTCOMES AND MEASURES The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth). Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of these outcomes among pregnant females with varying severity of anemia. RESULTS Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption (mild: adjusted OR [aOR], 1.36 [95% CI, 1.34-1.38]; moderate: aOR, 1.98 [95% CI, 1.93-2.02]; severe: aOR, 3.35 [95% CI, 3.17-3.54]), preterm birth (mild: aOR, 1.08 [95% CI, 1.07-1.08]; moderate: aOR, 1.18 [95% CI, 1.17-1.19]; severe: aOR, 1.36 [95% CI, 1.32-1.41]), severe postpartum hemorrhage (mild: aOR, 1.45 [95% CI, 1.43-1.47]; moderate: aOR, 3.53 [95% CI, 3.47-3.60]; severe: 15.65 [95% CI, 15.10-16.22]), and fetal malformation (mild: aOR, 1.15 [95% CI, 1.14-1.17]; moderate: aOR, 1.19 [95% CI, 1.16-1.21]; severe: aOR, 1.62 [95% CI, 1.52-1.73]). Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock (moderate: aOR, 1.50 [95% CI, 1.41-1.60]; severe: aOR, 14.98 [95% CI, 13.91-16.13]), ICU admission (moderate: aOR, 1.08 [95% CI, 1.01-1.16]; severe: aOR, 2.88 [95% CI, 2.55-3.25]), maternal death (moderate: aOR, 0.45 [95% CI, 0.30-0.65]; severe: aOR, 1.56 [95% CI, 0.97-2.48], fetal growth restriction (moderate: aOR, 0.80 [95% CI, 0.78-0.82]; severe: aOR, 1.08 [95% CI, 1.00-1.17]), and stillbirth (moderate: aOR,0.79 [95% CI, 0.76-0.81]; severe: aOR, 1.86 [95% CI, 1.75-1.98]), and mild anemia was associated with decreased risks (maternal shock: aOR, 0.67 [95% CI, 0.63-0.71]; ICU admission: aOR, 0.80 [95% CI, 0.76-0.84]; maternal death: aOR, 0.37 [95% CI, 0.29-0.49]; fetal growth restriction: aOR, 0.79 [95% CI, 0.77-0.80]; stillbirth: aOR, 0.59 [95% CI, 0.58-0.61]) after adjusting for sociodemographic characteristics and other complications during pregnancy. CONCLUSIONS AND RELEVANCE The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved.
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Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Mengxing Sun
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Yijie Guo
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shang Ma
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Hai Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Xiaoxia Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jie Lu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lin Ge
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Shu Dong
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yu Zhuang
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Xudong Ma
- Department of Healthcare Quality Evaluation, Bureau of Medical Administration, National Health Commission of the People’s Republic of China, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
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20
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Liu X, An H, Li N, Li Z, Zhang Y, Zhang L, Li H, Liu J, Ye R. Preconception Hemoglobin Concentration and Risk of Low Birth Weight and Small-for-Gestational-Age: A Large Prospective Cohort Study in China. Nutrients 2022; 14:nu14020271. [PMID: 35057452 PMCID: PMC8780179 DOI: 10.3390/nu14020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/18/2022] Open
Abstract
Less is known about the impact of maternal preconception anemia on birth outcomes. We aimed to examine associations between preconception hemoglobin (Hb) concentrations with risk of low birth weight (LBW) and small-for-gestational-age (SGA). This study was from a large population-based prospective cohort in China and included 124,725 women with singleton live births delivered at gestational ages of 28–45 weeks who were registered before pregnancy. Maternal Hb concentrations were measured during registration, and other health-related information was recorded prospectively. Logistic regression was used to evaluate the associations between preconception Hb concentrations with risk of LBW and SGA, adjusting for potential confounders. The results showed women with preconception anemia accounted for 22.28%. The incidences of LBW/SGA were 2.37%/6.30% among anemic women, and 2.01%/5.48% among non-anemic women, respectively. Preconception mild anemia increased by 17% (95% confidence interval (CI): 1.06, 1.28) and 14% (95% CI: 1.07, 1.21) the risk for LBW and SGA, while moderate-to-severe anemia had no significant association with LBW and SGA. Compared with the 120–129 g/L group, a U-shaped association was observed between preconception Hb concentrations with LBW and SGA. In conclusion, not only maternal anemia but also elevated Hb concentrations before pregnancy contribute to an increased risk of LBW and SGA.
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Affiliation(s)
- Xiaojing Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Hang An
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (N.L.); (Z.L.)
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (N.L.); (Z.L.)
| | - Yali Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Le Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Hongtian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Jianmeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Rongwei Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
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21
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Venkata Surekha M, Sujatha T, Gadhiraju S, Kotturu SK, Siva Prasad M, Sarada K, Bhaskar V, Uday Kumar P. Effect of Maternal Iron Deficiency Anaemia on the Expression of Iron Transport Proteins in the Third Trimester Placenta. Fetal Pediatr Pathol 2021; 40:581-596. [PMID: 32096669 DOI: 10.1080/15513815.2020.1725942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
BackgroundDuring pregnancy, iron is transferred from mother to fetus with placental iron transport proteins (Transferrin receptor, Divalent metal transporter/DMT1, ferroportin/FPN1 and Zyklopen). The aim of the study was to evaluate the effect of maternal iron deficiency anemia on placental iron transporters. Study Design: Two hundred pregnant women, in third trimester of pregnancy were divided into anemic (Hemoglobin/Hb < 11g/dl) and non-anemic groups (Hb ≥ 11 g/dl). After delivery, placental expression of iron transport proteins were studied by immunohistochemistry and by mRNA analysis. Results: Of the 200 subjects, 59% were anemic. All 3 placental proteins showed statistically significant increase in immunohistochemical expression, proportionate to the severity of maternal anemia. The mRNA expression of DMT-1 gene was only significantly elevated in placentas of anemic mothers. Conclusion: Although in our study mRNA expression of only the DMT-1 gene was significantly high, immunohistochemically however all the 3 proteins showed significantly higher expression in placentas of anemic mothers.
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Affiliation(s)
| | - Thathapudi Sujatha
- Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | | | | | - Mudili Siva Prasad
- Biochemistry Division, National Institute of Nutrition, Hyderabad, India
| | - K Sarada
- Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
| | - Varanasi Bhaskar
- Statistics Division, National Institute of Nutrition, Hyderabad, India
| | - Putcha Uday Kumar
- Pathology and Microbiology Division, National Institute of Nutrition, Hyderabad, India
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22
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Wu W, Lu J, Ruan X, Ma C, Lu W, Luo Y, Luo D, Mu X. Maternal essential metals, thyroid hormones, and fetal growth: Association and mediation analyses in Chinese pregnant women. J Trace Elem Med Biol 2021; 68:126809. [PMID: 34153934 DOI: 10.1016/j.jtemb.2021.126809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Essential metals play critical roles in fetal growth and development, but results from human studies are inconsistent. Additionally, whether maternal thyroid hormone (TH) levels mediate the associations between essential metals and fetal growth remains unknown. METHODS Data for analysis were extracted from the Information System of Guangdong Women and Children Hospital between January 2017 and December 2019. Maternal levels of essential metals [copper (Cu), zinc (Zn), magnesium (Mg), and iron (Fe)] and THs were measured at the second trimester. Multivariate linear models were introduced to evaluate the potential associations between maternal essential metals, thyroid functions, and fetal growth, and the possible mediation effects of thyroid functions were explored in the median analyses. RESULTS A total of 4186 mother-infant pairs were included in the present study. Maternal Fe levels were found to significantly increase birth weight in 272.91 g (95 % CI: 15.59, 530.22) among anemia group. Maternal Cu levels were positively associated with increased free triiodothyronine/free thyroxine ratio (FT3/FT4). Negative associations of Fe and Mg levels with thyroid-stimulating hormone (TSH) concentrations were observed, accompanied with the positive associations in relation to FT3, FT4 and FT3/FT4 ratio. Mediation analyses suggested that 72.01 % of the associations between Fe levels and birth length might be mediated by FT3 levels. Additionally, 25.85 % of the Cu-birth length association and 44.53 % of the Fe-birth length association could be explained by FT3/FT4 ratio. CONCLUSION Our findings suggest that maternal Cu, Mg, and Fe levels can alter TH concentrations, and maternal FT3 and FT3/FT4 ratio might be potential mediators on the developmental effects of Cu and Fe levels.
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Affiliation(s)
- Weixiang Wu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China
| | - Jianhua Lu
- Department of Information, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xiaolin Ruan
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China
| | - Congli Ma
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China
| | - Weiming Lu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China
| | - Yasha Luo
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China
| | - Dan Luo
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou, 511443, China
| | - Xiaoping Mu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511443, China.
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23
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Helman SL, Wilkins SJ, McKeating DR, Perkins AV, Whibley PE, Cuffe JSM, Simmons DG, Fuqua BK, Vulpe CD, Wallace DF, O'Callaghan JL, Pelzer ES, Anderson GJ, Frazer DM. The Placental Ferroxidase Zyklopen Is Not Essential for Iron Transport to the Fetus in Mice. J Nutr 2021; 151:2541-2550. [PMID: 34114013 DOI: 10.1093/jn/nxab174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The ferroxidase zyklopen (Zp) has been implicated in the placental transfer of iron to the fetus. However, the evidence for this is largely circumstantial. OBJECTIVES This study aimed to determine whether Zp is essential for placental iron transfer. METHODS A model was established using 8- to 12-wk-old pregnant C57BL/6 mice on standard rodent chow in which Zp was knocked out in the fetus and fetal components of the placenta. Zp was also disrupted in the entire placenta using global Zp knockout mice. Inductively coupled plasma MS was used to measure total fetal iron, an indicator of the amount of iron transferred by the placenta to the fetus, at embryonic day 18.5 of gestation. Iron transporter expression in the placenta was measured by Western blotting, and the expression of Hamp1, the gene encoding the iron regulatory hormone hepcidin, was determined in fetal liver by real-time PCR. RESULTS There was no change in the amount of iron transferred to the fetus when Zp was disrupted in either the fetal component of the placenta or the entire placenta. No compensatory changes in the expression of the iron transport proteins transferrin receptor 1 or ferroportin were observed, nor was there any change in fetal liver Hamp1 mRNA. Hephl1, the gene encoding Zp, was expressed mainly in the maternal decidua of the placenta and not in the nutrient-transporting syncytiotrophoblast. Disruption of Zp in the whole placenta resulted in a 26% increase in placental size (P < 0.01). CONCLUSIONS Our data indicate that Zp is not essential for the efficient transfer of iron to the fetus in mice and is localized predominantly in the maternal decidua. The increase in placental size observed when Zp is knocked out in the entire placenta suggests that this protein may play a role in placental development.
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Affiliation(s)
- Sheridan L Helman
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, Australia
| | - Sarah J Wilkins
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Daniel R McKeating
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, Australia
| | - Anthony V Perkins
- School of Medical Science, Griffith University, Gold Coast Campus, Southport, Australia
| | - Page E Whibley
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - James S M Cuffe
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Australia
| | - David G Simmons
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Australia
| | - Brie K Fuqua
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher D Vulpe
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Daniel F Wallace
- School of Biomedical Sciences, Queensland University of Technology, Gardens Point, Australia
| | - Jessica L O'Callaghan
- School of Biomedical Sciences, Queensland University of Technology, Gardens Point, Australia
| | - Elise S Pelzer
- School of Biomedical Sciences, Queensland University of Technology, Gardens Point, Australia
| | - Gregory J Anderson
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Chemistry and Molecular Bioscience, The University of Queensland, St. Lucia, Australia
| | - David M Frazer
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Biomedical Sciences, The University of Queensland, St. Lucia, Australia.,School of Biomedical Sciences, Queensland University of Technology, Gardens Point, Australia
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24
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Mezdoud A, Agli AN, Oulamara H. Trans-placental exchanges of serum iron, hemoglobin and ferritin at the end of gestation in the human species. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Sangkhae V, Fisher AL, Chua KJ, Ruchala P, Ganz T, Nemeth E. Maternal hepcidin determines embryo iron homeostasis in mice. Blood 2020; 136:2206-2216. [PMID: 32584957 PMCID: PMC7645983 DOI: 10.1182/blood.2020005745] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/07/2020] [Indexed: 12/21/2022] Open
Abstract
Iron disorders are associated with adverse pregnancy outcomes, yet iron homeostatic mechanisms during pregnancy are poorly understood. In humans and rodents, the iron-regulatory hormone hepcidin is profoundly decreased in pregnant mothers, which is thought to ensure adequate iron availability for transfer across placenta. However, the fetal liver also produces hepcidin, which may regulate fetal iron endowment by controlling placental iron export. To determine the relative contribution of maternal vs embryo hepcidin to the control of embryo iron endowment in iron-sufficient or iron-overloaded mice, we generated combinations of mothers and embryos that had or lacked hepcidin. We found that maternal, but not embryonic, hepcidin determined embryo and placental iron endowment in a healthy pregnancy. We further determined that inflammation can counteract pregnancy-dependent suppression of maternal hepcidin. To establish how essential maternal hepcidin suppression is for embryo iron homeostasis, we mimicked the range of maternal hepcidin activity by administering a hepcidin peptide mimetic to pregnant mice. This also allowed us to determine the effect of isolated maternal hepcidin excess on pregnancy, in the absence of other confounding effects of inflammation. Higher doses of hepcidin agonist caused maternal iron restriction and anemia, lower placenta and embryo weight, embryo anemia, and increased embryo mortality. Low agonist doses did not cause maternal anemia but still adversely affected the embryo, causing anemia, tissue iron deficiency (including in the brain), and decreased weight. Our studies demonstrate that suppression of maternal hepcidin during pregnancy is essential for maternal and embryo iron homeostasis and health.
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Affiliation(s)
- Veena Sangkhae
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
| | - Allison L Fisher
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
- Molecular, Cellular & Integrative Physiology Graduate Program, University of California, Los Angeles, Los Angeles, CA
| | - Kristine J Chua
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
| | - Piotr Ruchala
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
| | - Tomas Ganz
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
| | - Elizabeta Nemeth
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine and
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26
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Georgieff MK. Iron deficiency in pregnancy. Am J Obstet Gynecol 2020; 223:516-524. [PMID: 32184147 DOI: 10.1016/j.ajog.2020.03.006] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
Iron is essential for the function of all cells through its roles in oxygen delivery, electron transport, and enzymatic activity. Cells with high metabolic rates require more iron and are at greater risk for dysfunction during iron deficiency. Iron requirements during pregnancy increase dramatically, as the mother's blood volume expands and the fetus grows and develops. Thus, pregnancy is a condition of impending or existing iron deficiency, which may be difficult to diagnose because of limitations to commonly used biomarkers such as hemoglobin and ferritin concentrations. Iron deficiency is associated with adverse pregnancy outcomes, including increased maternal illness, low birthweight, prematurity, and intrauterine growth restriction. The rapidly developing fetal brain is at particular risk of iron deficiency, which can occur because of maternal iron deficiency, hypertension, smoking, or glucose intolerance. Low maternal gestational iron intake is associated with autism, schizophrenia, and abnormal brain structure in the offspring. Newborns with iron deficiency have compromised recognition memory, slower speed of processing, and poorer bonding that persist despite postnatal iron repletion. Preclinical models of fetal iron deficiency confirm that expected iron-dependent processes such as monoamine neurotransmission, neuronal growth and differentiation, myelination, and gene expression are all compromised acutely and long term into adulthood. This review outlines strategies to diagnose and prevent iron deficiency in pregnancy. It describes the neurocognitive and mental health consequences of fetal iron deficiency. It emphasizes that fetal iron is a key nutrient that influences brain development and function across the lifespan.
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Affiliation(s)
- Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.
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Abstract
Although iron deficiency continues to pose a problem for pregnant women and fetal development, an incomplete understanding of placental adaptation to limited iron availability has hindered efforts to identify optimal supplementation strategies. In this issue of the JCI, Sangkhae et al. used mouse models and human placentas to explore maternal, placental, and fetal responses to alterations in iron status during pregnancy. The authors identified molecular mechanisms that limit placental ability to upregulate iron transport in the setting of severe iron deficiency and explored a potential marker of placental maladaptation.
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Affiliation(s)
| | - Robert E Fleming
- Department of Pediatrics and the.,Edward A. Doisy Department of Biochemistry and Molecular Biology, St. Louis University School of Medicine, St. Louis, Missouri, USA
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Grzeszczak K, Kwiatkowski S, Kosik-Bogacka D. The Role of Fe, Zn, and Cu in Pregnancy. Biomolecules 2020; 10:E1176. [PMID: 32806787 PMCID: PMC7463674 DOI: 10.3390/biom10081176] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.
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Affiliation(s)
- Konrad Grzeszczak
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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Kwan STC, Kezer CA, Helfrich KK, Saini N, Huebner SM, Flentke GR, Kling PJ, Smith SM. Maternal iron nutriture modulates placental development in a rat model of fetal alcohol spectrum disorder. Alcohol 2020; 84:57-66. [PMID: 31734307 DOI: 10.1016/j.alcohol.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Abstract
Prenatal alcohol exposure (PAE) causes developmental abnormalities known as fetal alcohol spectrum disorder (FASD). Maternal iron status modulates the severity of these defects in the offspring. Because the placenta is central in supporting fetal development, we investigated whether maternal iron status similarly modulates alcohol's effects in the placenta. We hypothesized that PAE causes placental insufficiency by decreasing placental weight and efficiency, and we hypothesized that these are worsened by maternal iron deficiency (ID) and alleviated by dietary iron fortification (IF). We also determined whether altered placental iron flux and inflammatory balance contribute to placental insufficiency. Pregnant Long-Evans rats consumed an iron-deficient (ID; 2-6 ppm), iron-sufficient (IS; 100 ppm), or iron-fortified (IF; 500 ppm) diet. Alcohol (5 g/kg body weight) or isocaloric maltodextrin (MD) was gavaged daily from gestational day (GD) 13.5-19.5. Placental outcomes were evaluated on GD20.5. PAE reduced fetal weight (p < 0.0001), placental weight (p = 0.0324), and placental efficiency (p = 0.0043). PAE downregulated placental transferrin receptor (p = 0.0032); it also altered placental Il1b and Tnf expression and the Il6:Il10 ratio (p = 0.0337, 0.0300, and 0.0034, respectively) to generate a response favoring inflammation. ID-PAE further reduced fetal growth and placental efficiency and induced a heightened pro-inflammatory placental profile. IF did not rescue the alcohol-reduced fetal weight, but it normalized placental efficiency and decreased placental inflammation. These placental cytokines correlated with fetal and placental growth, and explained 45% of the variability in fetal weight and 20% of the variability in placental efficiency. In summary, alcohol induces placental insufficiency and is associated with a pro-inflammatory cytokine profile exacerbated by maternal ID and mitigated by maternal IF. Because the placenta is closely linked to intrauterine growth, the placental insufficiency reported here may correlate with the lower birth weights in a subgroup of individuals who experienced PAE.
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Affiliation(s)
- Sze Ting Cecilia Kwan
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, United States
| | - Camille A Kezer
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, United States
| | - Kaylee K Helfrich
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, United States
| | - Nipun Saini
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, United States
| | - Shane M Huebner
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, United States
| | - George R Flentke
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, United States
| | - Pamela J Kling
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, 53715, United States
| | - Susan M Smith
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, 28081, United States; Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, United States.
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Zerfu TA, Baye K, Faber M. Dietary diversity cutoff values predicting anemia varied between mid and term of pregnancy: a prospective cohort study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:44. [PMID: 31836026 PMCID: PMC6911293 DOI: 10.1186/s41043-019-0196-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Correcting anemia during pregnancy often requires integrating food and non-food-based approaches. Nonetheless, little is known about specific dietary diversity (DD) cutoff values predicting risk of anemia during the different trimesters of pregnancy. OBJECTIVE We aimed to determine the lowest possible DD cutoff values associated with risk of maternal anemia at mid and term of pregnancy in a rural resource limited setting of Ethiopia. DESIGN A multi-center prospective cohort study was conducted enrolling 432 eligible pregnant women from eight rural health centers selected from four districts in Arsi zone, Central Ethiopia. Women were classified into exposed (n = 216) and unexposed (n = 216) groups, based on Women's Individual Dietary Diversity (WIDD) score, and were followed from mid to term of pregnancy. The cutoff values for WIDD corresponding to the lowest risk of anemia were defined by receiver operating characteristic (ROC) curve analysis. Logistic regressions were also fitted to identify food groups associated with low anemia risk during pregnancy. RESULTS The overall prevalence of anemia increased from 28.6 to 32.4% between mid and term of pregnancy. Calculatedly, using the ROC curve analysis, the minimum WIDD score associated with lower risk of anemia was three and four respectively at these periods. Not consuming animal source foods [adjusted odds ratio (AOR), 2.36; 95% confidence interval (CI), 1.35-4.14], pre-existing anemia (AOR 28.56; 95% CI, 14.33, 56.79), and low DD during pregnancy (AOR, 2.22; 95% CI, 1.09-4.52) were associated with risk of anemia at term. CONCLUSION The cutoff for WIDD score predicting risk of anemia varied significantly, increasing from three to four, between mid and term of pregnancy. Additional population-based observational and experimental studies validating the metrics are needed before policy level recommendations. TRIAL REGISTRATION This trial was registered at clinicaltrials.gov as NCT02620943.
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Affiliation(s)
- Taddese Alemu Zerfu
- Center for Food Science and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA.
- College of Medicine and Health Sciences and Referral Hospital, Dilla University, Dila, Ethiopia.
- Maternal and Child Wellbeing Unit, African Population and Health Research Center (APHRC), P.O. Box 10787-00100, Nairobi, Kenya.
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Palanog AD, Calayugan MIC, Descalsota-Empleo GI, Amparado A, Inabangan-Asilo MA, Arocena EC, Sta. Cruz PC, Borromeo TH, Lalusin A, Hernandez JE, Acuin C, Reinke R, Swamy BPM. Zinc and Iron Nutrition Status in the Philippines Population and Local Soils. Front Nutr 2019; 6:81. [PMID: 31231657 PMCID: PMC6568233 DOI: 10.3389/fnut.2019.00081] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
The Philippines is one of the major rice-producing and rice-consuming countries of Asia. A large portion of its population depends on rice for their daily caloric intake and nutritional needs. The lack of dietary diversity among poor communities has led to nutritional consequences, particularly micronutrient deficiencies. Iron-deficiency anemia (IDA) and zinc deficiency (ZnD) are two serious nutritional problems that affect the health and economic sector of the country. Since rice dominates the Filipino diet by default, biofortification of rice will help improve the micronutrient status. The Philippine government has proactively initiated various programs and policies to address micronutrient deficiencies, particularly through fortification of basic food commodities. Biofortification, the fortification of rice with micronutrients through breeding, is considered the most sustainable and cost-effective strategy that can benefit large vulnerable populations. However, developing promising genotypes with micronutrient-enriched grains should be coupled with improving micronutrient bioavailability in the soil in order to optimize biofortification. This review documents the prevailing soil Zn-deficiency problems in the major rice production areas in the Philippines that may influence the Zn nutritional status of the population. The article also reports on the biofortification efforts that have resulted in the development of two biofortified varieties approved for commercial release in the Philippines. As nutritional security is increasingly recognized as a priority area, greater efforts are required to develop biofortified rice varieties that suit both farmers' and consumers' preferences, and that can address these critical needs for human health in a sustainable and cost-effective manner.
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Affiliation(s)
- Alvin D. Palanog
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
- PhilRice Negros, Philippine Rice Research Institute, Science City of Muñoz, Philippines
| | - Mark Ian C. Calayugan
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
| | - Gwen Iris Descalsota-Empleo
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
- College of Agriculture, University of Southern Mindanao, Kabacan, Philippines
| | - Amery Amparado
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
| | | | - Emily C. Arocena
- PhilRice Negros, Philippine Rice Research Institute, Science City of Muñoz, Philippines
| | - Pompe C. Sta. Cruz
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
| | - Teresita H. Borromeo
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
| | - Antonio Lalusin
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
| | - Jose E. Hernandez
- College of Agriculture and Food Science, University of the Philippines, Los Baños, Philippines
| | - Cecilia Acuin
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
| | - Russell Reinke
- Strategic Innovation Platform, International Rice Research Institute, Los Baños, Philippines
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Bahr TM, Christensen RD, Ward DM, Meng F, Jackson LK, Doyle K, Christensen DR, Harvey AG, Yaish HM. Ferritin in serum and urine: A pilot study. Blood Cells Mol Dis 2019; 76:59-62. [PMID: 30777730 DOI: 10.1016/j.bcmd.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
Serum ferritin reflects total body iron stores, thus a low serum ferritin is used as a parameter of iron deficiency. In healthy adults in Japan, urine ferritin levels were about 5% of serum ferritin levels, with a correlation coefficient of 0.79. It is not known whether a low urine ferritin could serve as a non-invasive screen for iron deficiency. If so, this might be useful for neonates and young children, avoiding phlebotomy to screen for iron deficiency. However, for urinary ferritin screening to be feasible, ferritin must be measurable in the urine and correlate with serum ferritin. Testing should also clarify whether the iron content of ferritin in serum and urine are similar. In this pilot feasibility study we measured ferritin in paired serum and urine samples of healthy adult males, healthy term neonates, growing preterm neonates, and children who had very high serum ferritin levels from liver disorders or iron overload. We detected ferritin in every urine sample, and found a correlation with paired serum ferritin (Spearman correlation coefficient 0.78 of log10-transformed values). These findings suggest merit in further studying urinary ferritin in select populations, as a potential non-invasive screen to assess iron stores.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
| | - Robert D Christensen
- Division of Neonatology, University of Utah, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA; Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
| | - Diane M Ward
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Fanjing Meng
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Laurie K Jackson
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Kelly Doyle
- Department of Pathology, University of Utah, Salt Lake City, UT, USA; Central Laboratories, Intermountain Medical Center, Murray, UT, USA
| | | | - Anne G Harvey
- Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
| | - Hassan M Yaish
- Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Xu L, Li MY, Shen YL. [Research advances in the relationship between iron deficiency and neurodevelopment in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:1070-1074. [PMID: 30573000 PMCID: PMC7389500 DOI: 10.7499/j.issn.1008-8830.2018.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
Iron deficiency (ID) is the most common micronutrient deficiency in children. Due to insufficient iron storage at birth and rapid catch-up growth after birth, preterm infants tend to have a high incidence rate of ID. During the critical period of brain development, ID alters iron-dependent neurometabolism, neurochemistry, neuroanatomy, and gene/protein profiles. This affects the central nervous system and causes the change in neurocognitive and behavioral development. Iron supplementation in infancy cannot reverse neurodevelopmental impairment caused by perinatal ID. The influence of ID on neurodevelopment is time- and region-specific, and in the high-risk population, early diagnosis and optimal iron treatment may help with the recovery of brain function and improve quality of life and long-term prognosis in preterm infants.
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Affiliation(s)
- Lin Xu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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35
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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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36
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Baker BC, Hayes DJ, Jones RL. Effects of micronutrients on placental function: evidence from clinical studies to animal models. Reproduction 2018; 156:R69-R82. [PMID: 29844225 DOI: 10.1530/rep-18-0130] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/29/2018] [Indexed: 12/23/2022]
Abstract
Micronutrient deficiencies are common in pregnant women due to low dietary intake and increased requirements for fetal development. Low maternal micronutrient status is associated with a range of pregnancy pathologies involving placental dysfunction, including fetal growth restriction (FGR), small-for-gestational age (SGA), pre-eclampsia and preterm birth. However, clinical trials commonly fail to convincingly demonstrate beneficial effects of supplementation of individual micronutrients, attributed to heterogeneity and insufficient power, potential interactions and lack of mechanistic knowledge of effects on the placenta. We aimed to provide current evidence of relationships between selected micronutrients (vitamin D, vitamin A, iron, folate, vitamin B12) and adverse pregnancy outcomes, combined with understanding of actions on the placenta. Following a systematic literature search, we reviewed data from clinical, in vitro and in vivo studies of micronutrient deficiency and supplementation. Key findings are potential effects of micronutrient deficiencies on placental development and function, leading to impaired fetal growth. Studies in human trophoblast cells and rodent models provide insights into underpinning mechanisms. Interestingly, there is emerging evidence that deficiencies in all micronutrients examined induce a pro-inflammatory state in the placenta, drawing parallels with the inflammation detected in FGR, pre-eclampsia, stillbirth and preterm birth. Beneficial effects of supplementation are apparent in vitro and in animal models and for combined micronutrients in clinical studies. However, greater understanding of the roles of these micronutrients, and insight into their involvement in placental dysfunction, combined with more robust clinical studies, is needed to fully ascertain the potential benefits of supplementation in pregnancy.
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Affiliation(s)
- Bernadette C Baker
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Dexter Jl Hayes
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca L Jones
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet 2018; 298:75-82. [PMID: 29740690 PMCID: PMC5995983 DOI: 10.1007/s00404-018-4782-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the efficacy and safety of intravenous ferric carboxymaltose administration to pregnant women with varying severities of iron deficiency anemia and iron deficiency without anemia. Methods In this prospective observational study of local obstetric practice, we analyzed data from 863 pregnant women with iron deficiency according to anemia status and severity. All women were treated with intravenous ferric carboxymaltose in pregnancy. Treatment efficacy was assessed by repeat hemoglobin measurements at 3 and 6 week post-infusion and ferritin levels, where available. Safety was assessed by analysis of adverse events, fetal heart rate monitoring, and newborn health outcome data. Results Ferric carboxymaltose significantly increased hemoglobin in women with mild, moderate, and severe iron deficiency anemia and women with iron deficiency alone at 3 and 6 week post-infusion (p < 0.01 for all). No hemoconcentration occurred in iron-deficient women without anemia. No serious adverse events were recorded, with minor temporary side effects (including local skin irritation, nausea, and headache) occurring in 96 (11%) women. No adverse fetal or neonatal outcomes were observed. Conclusions Ferric carboxymaltose infusion corrects iron deficiency or various degrees of iron deficiency anemia efficaciously and safely pregnant women, and does not cause hemoconcentration.
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Helfrich KK, Saini N, Kling PJ, Smith SM. Maternal iron nutriture as a critical modulator of fetal alcohol spectrum disorder risk in alcohol-exposed pregnancies. Biochem Cell Biol 2018; 96:204-212. [PMID: 29017023 PMCID: PMC5914169 DOI: 10.1139/bcb-2017-0206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Alcohol consumption during pregnancy places the fetus at risk for permanent physical, cognitive, and behavioral impairments, collectively termed fetal alcohol spectrum disorder (FASD). However, prenatal alcohol exposure (PAE) outcomes vary widely, and growing evidence suggests that maternal nutrition is a modifying factor. Certain nutrients, such as iron, may modulate FASD outcomes. Untreated gestational iron deficiency (ID) causes persistent neurodevelopmental deficits in the offspring that affect many of the same domains damaged by PAE. Although chronic alcohol consumption enhances iron uptake and elevates liver iron stores in adult alcoholics, alcohol-abusing premenopausal women often have low iron reserves due to menstruation, childbirth, and poor diet. Recent investigations show that low iron reserves during pregnancy are strongly associated with a worsening of several hallmark features in FASD including reduced growth and impaired associative learning. This review discusses recent clinical and animal model findings that maternal ID worsens fetal outcomes in response to PAE. It also discusses underlying mechanisms by which PAE disrupts maternal and fetal iron homeostasis. We suggest that alcohol-exposed ID pregnancies contribute to the severe end of the FASD spectrum.
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Affiliation(s)
- Kaylee K Helfrich
- a UNC Nutrition Research Institute and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nipun Saini
- a UNC Nutrition Research Institute and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Pamela J Kling
- b Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Susan M Smith
- a UNC Nutrition Research Institute and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Peripartum Care of the Jehovah's Witness Patient. Clin Obstet Gynecol 2018; 60:394-404. [PMID: 28121643 DOI: 10.1097/grf.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postpartum hemorrhage is a leading cause of maternal mortality. Jehovah's Witnesses (JWs) refuse allogeneic blood transfusion, and thus treatment of hemorrhagic complications in this patient population is complex. Recognition and respect for religious beliefs are essential when caring for the JW parturient and several ethical and legal considerations must be taken into account. Interdisciplinary teamwork and communication as well as active patient participation are critical in the decision-making process for JW patients. Various techniques and technologies are available to optimize red blood cell mass, minimize bleeding, increase tolerance to anemia and support multiorgan derangements derived from antepartum and postpartum hemorrhage.
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Expression of hepcidin and ferroportin in full term placenta of pregnant cows. Theriogenology 2017; 103:90-97. [PMID: 28780484 DOI: 10.1016/j.theriogenology.2017.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/04/2017] [Accepted: 07/25/2017] [Indexed: 12/29/2022]
Abstract
Hepcidin (HEP) and ferroportin (FPN) play a central role in systemic iron homeostasis. The HEP/FPN axis controls both extracellular iron concentration and total body iron levels. HEP is synthesized mainly by hepatocytes and controls the absorption of dietary iron and the distribution of iron to the various cell types; its synthesis is regulated by both iron and innate immunity. FPN is a membrane protein and the major exporter of iron from mammalian cells, including iron recycling macrophages, iron absorbing duodenal enterocytes, and iron storing hepatocytes. HEP limits the pool of extracellular iron by binding FPN and mediating its degradation, thus preventing its release from intracellular sources. Here we investigated, for the first time, the molecular and morphological expression of HEP and FPN in placenta of pregnant cows at term. Their expression has been evaluated investigating their mRNAs by reverse transcriptase PCR (RT-PCR). Sequencing of related amplicons revealed a 100% identity with HEP and FPN sequences from Bos taurus as reported in the GeneBank (mRNASequence ID: NM_001114508.2 and ID: NM_001077970.1, respectively). HEP and FPN proteins have also been revealed by Western blot analysis and immunohistochemistry. The strongest immunoreactivity for both proteins was observed in the cytoplasm of the trophoblastic cells of the villi and the caruncular crypts of the placentome. Hep mRNA was more representative in caruncular rather cotyledonar areas; on the contrary, Fpn mRNA was more expressed in cotyledonar rather than in caruncular areas. Transcripts of ferritin, transferrin and its receptor have been also documented by real time RT-PCR. HEP and FPN placental proteins may play a dual role. HEP/FPN axis seems to have a central role in infections, with microorganisms within macrophages or that survive in the bloodstream or other cellular spaces. In addition, HEP may be responsible for iron flux regulation as a molecular bridge for iron trafficking and response to infection. FPN may also have a significant role for embryonic development, growth and organogenesis.
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41
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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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Jobarteh ML, McArdle HJ, Holtrop G, Sise EA, Prentice AM, Moore SE. mRNA Levels of Placental Iron and Zinc Transporter Genes Are Upregulated in Gambian Women with Low Iron and Zinc Status. J Nutr 2017; 147:1401-1409. [PMID: 28515164 PMCID: PMC5483961 DOI: 10.3945/jn.116.244780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/12/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
Background: The role of the placenta in regulating micronutrient transport in response to maternal status is poorly understood. Objective: We investigated the effect of prenatal nutritional supplementation on the regulation of placental iron and zinc transport. Methods: In a randomized trial in rural Gambia [ENID (Early Nutrition and Immune Development)], pregnant women were allocated to 1 of 4 nutritional intervention arms: 1) iron and folic acid (FeFol) tablets (FeFol group); 2) multiple micronutrient (MMN) tablets (MMN group); 3) protein energy (PE) as a lipid-based nutrient supplement (LNS; PE group); and 4) PE and MMN (PE+MMN group) as LNS. All arms included iron (60 mg/d) and folic acid (400 μg/d). The MMN and PE+MMN arms included 30 mg supplemental Zn/d. In a subgroup of ∼300 mother-infant pairs, we measured maternal iron status, mRNA levels of genes encoding for placental iron and zinc transport proteins, and cord blood iron levels. Results: Maternal plasma iron concentration in late pregnancy was 45% and 78% lower in the PE and PE+MMN groups compared to the FeFol and MMN groups, respectively (P < 0.001). The mRNA levels of the placental iron uptake protein transferrin receptor 1 were 30–49% higher in the PE and PE+MMN arms than in the FeFol arm (P < 0.031), and also higher in the PE+MMN arm (29%; P = 0.042) than in the MMN arm. Ferritin in infant cord blood was 18–22% lower in the LNS groups (P < 0.024). Zinc supplementation in the MMN arm was associated with higher maternal plasma zinc concentrations (10% increase; P < 0.001) than in other intervention arms. mRNA levels for intracellular zinc-uptake proteins, in this case zrt, irt-like protein (ZIP) 4 and ZIP8, were 96–205% lower in the PE+MMN arm than in the intervention arms without added zinc (P < 0.025). Furthermore, mRNA expression of ZIP1 was 85% lower in the PE+MMN group than in the PE group (P = 0.003). Conclusion: In conditions of low maternal iron and in the absence of supplemental zinc, the placenta upregulates the gene expression of iron and zinc uptake proteins, presumably in order to meet fetal demands in the face of low maternal supply. The ENID trial was registered at www.controlled-trials.com as ISRCTN49285450.
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Affiliation(s)
- Modou Lamin Jobarteh
- Medical Research Council Unit The Gambia, Banjul, The Gambia.,Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Harry J McArdle
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Grietje Holtrop
- Biomathematics and Statistics Scotland (BioSS), Aberdeen, United Kingdom; and
| | - Ebrima A Sise
- Medical Research Council Unit The Gambia, Banjul, The Gambia
| | | | - Sophie E Moore
- Medical Research Council Unit The Gambia, Banjul, The Gambia; .,Division of Women's Health, King's College London, London, United Kingdom
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MacQueen BC, Christensen RD, Ward DM, Bennett ST, O’Brien EA, Sheffield MJ, Baer VL, Snow GL, Lewis KAW, Fleming RE, Kaplan J. The iron status at birth of neonates with risk factors for developing iron deficiency: a pilot study. J Perinatol 2017; 37:436-440. [PMID: 27977019 PMCID: PMC5389916 DOI: 10.1038/jp.2016.234] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Small-for-gestational-age (SGA) neonates, infants of diabetic mothers (IDM) and very-low-birth weight premature neonates (VLBW) are reported to have increased risk for developing iron deficiency and possibly associated neurocognitive delays. STUDY DESIGN We conducted a pilot study to assess iron status at birth in at-risk neonates by measuring iron parameters in umbilical cord blood from SGA, IDM, VLBW and comparison neonates. RESULTS Six of the 50 infants studied had biochemical evidence of iron deficiency at birth. Laboratory findings consistent with iron deficiency were found in one SGA, one IDM, three VLBW, and one comparison infant. None of the infants had evidence of iron deficiency anemia. CONCLUSIONS Evidence of biochemical iron deficiency at birth was found in 17% of screened neonates. Studies are needed to determine whether these infants are at risk for developing iron-limited erythropoiesis, iron deficiency anemia or iron-deficient neurocognitive delay.
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Affiliation(s)
- BC MacQueen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - RD Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA,Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA,Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - DM Ward
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - ST Bennett
- Department of Pathology, Intermountain Medical Center, Murray, KY, USA
| | - EA O’Brien
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA,Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - MJ Sheffield
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - VL Baer
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - GL Snow
- Statistical Data Center, LDS Hospital, Salt Lake City, UT, USA
| | - KA Weaver Lewis
- Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - RE Fleming
- Department of Pediatrics and Edward A. Doisy Department of Biochemistry and Molecular Biology, St Louis University, St Louis, MO, USA
| | - J Kaplan
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Mikolić A, Schönwald N, Piasek M. Cadmium, iron and zinc interaction and hematological parameters in rat dams and their offspring. J Trace Elem Med Biol 2016; 38:108-116. [PMID: 27601230 DOI: 10.1016/j.jtemb.2016.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/01/2016] [Accepted: 08/23/2016] [Indexed: 01/23/2023]
Abstract
The effects of cadmium (Cd) were evaluated in offspring exposed from birth until weaning (neonatal day 0-21) and 4 weeks after exposure cessation focusing on iron (Fe) and zinc (Zn) levels in organs and hematological parameters. Wistar female rats were administered 50mg Cd/L in drinking water (Cd-exposed) for 4 weeks before mating and during 3 weeks of gestation plus 3 weeks of lactation. Controls were supplied drinking water. At birth, part of Cd-exposed dams' litters was cross-fostered to control dams (CCd group) and their control litters were cross-fostered to Cd-exposed dams (CdC group). This procedure enabled to discern the effects of gestational, lactational and gestational plus lactational Cd exposure until weaning in F1 offspring. Elements were analyzed by atomic absorption spectrometry; hematological parameters manually; and histopathological changes by light microscopy. Gestational plus lactational exposure in Cd-exposed dams and their offspring increased Cd and decreased Fe levels, increased Zn in dams and decreased Zn and body weights in 11- and 21-day pups. In 21-day weanling pups, decreased red blood cell (RBC) count, hemoglobin and hematocrit values and increased reticulocytes in peripheral blood were also found with concomitant histopathological finding of extramedullary hematopoiesis in the liver. In cross-fostered pups with gestational exposure (CCd pups), Fe in the liver decreased on day 11 and Zn increased in the kidney on day 21 whereas in pups with lactational exposure (CdC pups) Zn in the brain decreased on day 11 and Fe decreased in the liver and brain on day 21. Regardless of exposure cessation at weaning, in offspring with gestational plus lactational exposure (Cd-exposed) body weights, kidney and brain Fe levels and RBC and hemoglobin remained decreased in blood until puberty. Furthermore Zn levels increased in the liver, kidney and brain. It was concluded that gestational plus lactational Cd exposure caused decreases in Fe and Zn levels and hematotoxic effects in F1 offspring more pronouncedly than exposure during either gestational or lactational period alone and the adverse effects of maternally mediated Cd exposure continued after exposure cessation into adulthood.
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45
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Miller EM. The reproductive ecology of iron in women. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 159:S172-95. [PMID: 26808104 DOI: 10.1002/ajpa.22907] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Reproductive ecology focuses on the sensitivity of human reproduction to environmental variation. While reproductive ecology has historically focused on the relationship between energy status and reproductive outcomes, iron status is equally critical to women's reproductive health, given the wide-ranging detrimental effects of iron-deficiency anemia on maternal and infant well-being. This review interprets the vast literature on iron status and women's reproduction through an evolutionary framework. First, it will critique the evidence for iron deficiency caused by blood loss during menstruation, reinterpreting the available data as ecological variation in menses within and between populations of women. Second, it will highlight the scant but growing evidence that iron status is implicated in fertility, a relationship that has deep evolutionary roots. Third, this review proposes a new hypothesis for the transfer of iron from mother to infant via pregnancy and breastfeeding: reproductive iron withholding. In this hypothesis, mothers transfer iron to infants in a manner that helps infants avoid iron-mediated infection and oxidative stress, but trades off with potential risk of maternal and infant iron deficiency. Finally, this review explores two main factors that can modify the relationship between iron status and the gestation-lactation cycle: (1) the relationship between long-term reproductive effort (parity) and iron status and (2) supplementation schemes before and during pregnancy. The review concludes by suggesting continued research into iron homeostasis in women using evolutionary, ecological, and biocultural frameworks.
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Affiliation(s)
- Elizabeth M Miller
- Department of Anthropology, University of South Florida, Tampa, FL, 33620
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46
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Abstract
Iron is an essential element for human development. It is a major requirement for cellular processes such as oxygen transport, energy metabolism, neurotransmitter synthesis, and myelin synthesis. Despite its crucial role in these processes, iron in the ferric form can also produce toxic reactive oxygen species. The duality of iron’s function highlights the importance of maintaining a strict balance of iron levels in the body. As a result, organisms have developed elegant mechanisms of iron uptake, transport, and storage. This review will focus on the mechanisms that have evolved at physiological barriers, such as the intestine, the placenta, and the blood–brain barrier (BBB), where iron must be transported. Much has been written about the processes for iron transport across the intestine and the placenta, but less is known about iron transport mechanisms at the BBB. In this review, we compare the established pathways at the intestine and the placenta as well as describe what is currently known about iron transport at the BBB and how brain iron uptake correlates with processes at these other physiological barriers.
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Affiliation(s)
- Kari A Duck
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - James R Connor
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
- Department of Neurosurgery, Neural and Behavioral Sciences and Pediatrics, Center for Aging and Neurodegenerative Diseases, Penn State Hershey Medical Center, 500 University Drive, MC H110, C3830, Hershey, PA, 17033, USA.
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Rosner J, Gupta M, McGill M, Xue X, Chatterjee P, Yoshida-Hay M, Robeson W, Metz C. Magnesium deficiency during pregnancy in mice impairs placental size and function. Placenta 2016; 39:87-93. [DOI: 10.1016/j.placenta.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/23/2015] [Accepted: 01/08/2016] [Indexed: 02/06/2023]
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Sun MY, Woolley JC, Blohowiak SE, Smith ZR, Siddappa AM, Magness RR, Kling PJ. Dietary-induced gestational iron deficiency inhibits postnatal tissue iron delivery and postpones the cessation of active nephrogenesis in rats. Reprod Fertil Dev 2016; 29:RD15358. [PMID: 26876724 PMCID: PMC5577434 DOI: 10.1071/rd15358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023] Open
Abstract
Gestational iron deficiency (ID) can alter developmental programming through impaired nephron endowment, leading to adult hypertension, but nephrogenesis is unstudied. Iron status and renal development during dietary-induced gestational ID (<6 mg Fe kg-1 diet from Gestational Day 2 to Postnatal Day (PND) 7) were compared with control rats (198 mg Fe kg-1 diet). On PND2-PND10, PND15, PND30 and PND45, blood and tissue iron status were assessed. Nephrogenic zone maturation (PND2-PND10), radial glomerular counts (RGCs), glomerular size density and total planar surface area (PND15 and PND30) were also assessed. Blood pressure (BP) was measured in offspring. ID rats were smaller, exhibiting lower erythrocyte and tissue iron than control rats (PND2-PND10), but these parameters returned to control values by PND30-PND45. Relative kidney iron (µg g-1 wet weight) at PND2-PND10 was directly related to transport iron measures. In ID rats, the maturation of the active nephrogenic zone was later than control. RGCs, glomerular size, glomerular density, and glomerular planar surface area were lower than control at PND15, but returned to control by PND30. After weaning, the kidney weight/rat weight ratio (mg g-1) was heavier in ID than control rats. BP readings at PND45 were lower in ID than control rats. Altered kidney maturation and renal adaptations may contribute to glomerular size, early hyperfiltration and long-term renal function.
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Affiliation(s)
- Mary Y. Sun
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
- Obstetrics and Gynecology Perinatal Research Laboratories, University of Wisconsin, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
| | - Joseph C. Woolley
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
| | - Sharon E. Blohowiak
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
| | - Zachary R. Smith
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
| | - Ashajyothi M. Siddappa
- Department of Pediatrics, Division of Neonatology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
- Center for Neurobehavioral Development, 516 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Ronald R. Magness
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
- Obstetrics and Gynecology Perinatal Research Laboratories, University of Wisconsin, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
| | - Pamela J. Kling
- Departments of Pediatrics, University of Wisconsin, Neonatology, Meriter UnityPoint Hospital, 202 S. Park St., Madison, WI 53715, USA
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Brabin BJ, Gies S, Owens S, Claeys Y, D'Alessandro U, Tinto H, Brabin L. Perspectives on the design and methodology of periconceptional nutrient supplementation trials. Trials 2016; 17:58. [PMID: 26833080 PMCID: PMC4736099 DOI: 10.1186/s13063-015-1124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 12/15/2015] [Indexed: 01/22/2023] Open
Abstract
Periconceptional supplementation could extend the period over which maternal and fetal nutrition is improved, but there are many challenges facing early-life intervention studies. Periconceptional trials differ from pregnancy supplementation trials, not only because of the very early or pre-gestational timing of nutrient exposure but also because they generate subsidiary information on participants who remain non-pregnant. The methodological challenges are more complex although, if well designed, they provide opportunities to evaluate concurrent hypotheses related to the health of non-pregnant women, especially nulliparous adolescents. This review examines the framework of published and ongoing randomised trial designs. Four cohorts typically arise from the periconceptional trial design--two of which are non-pregnant and two are pregnant--and this structure provides assessment options related to pre-pregnant, maternal, pregnancy and fetal outcomes. Conceptually the initial decision for single or micronutrient intervention is central--as is the choice of dosage and content--in order to establish a comparative framework across trials, improve standardisation, and facilitate interpretation of mechanistic hypotheses. Other trial features considered in the review include: measurement options for baseline and outcome assessments; adherence to long-term supplementation; sample size considerations in relation to duration of nutrient supplementation; cohort size for non-pregnant and pregnant cohorts as the latter is influenced by parity selection; integrating qualitative studies and data management issues. Emphasis is given to low resource settings where high infection rates and the possibility of nutrient-infection interactions may require appropriate safety monitoring. The focus is on pragmatic issues that may help investigators planning a periconceptional trial.
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Affiliation(s)
- Bernard J Brabin
- Clinical Division, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, UK.
- Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sabine Gies
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Stephen Owens
- Northumbria Healthcare NHS Foundation Trust, North Shields, NE29 8NH, UK.
| | - Yves Claeys
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Umberto D'Alessandro
- Medical Research Council Unit (MRC), Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, UK.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Halidou Tinto
- Clinical Research Unit of Nanoro (URCN/IRSS), Nanoro, Burkina Faso.
| | - Loretta Brabin
- Institute of Cancer Sciences, University of Manchester, Manchester, UK.
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50
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Schreinemachers DM, Ghio AJ. Effects of Environmental Pollutants on Cellular Iron Homeostasis and Ultimate Links to Human Disease. ENVIRONMENTAL HEALTH INSIGHTS 2016; 10:35-43. [PMID: 26966372 PMCID: PMC4782969 DOI: 10.4137/ehi.s36225] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 05/04/2023]
Abstract
Chronic disease has increased in the past several decades, and environmental pollutants have been implicated. The magnitude and variety of diseases may indicate the malfunctioning of some basic mechanisms underlying human health. Environmental pollutants demonstrate a capability to complex iron through electronegative functional groups containing oxygen, nitrogen, or sulfur. Cellular exposure to the chemical or its metabolite may cause a loss of requisite functional iron from intracellular sites. The cell is compelled to acquire further iron critical to its survival by activation of iron-responsive proteins and increasing iron import. Iron homeostasis in the exposed cells is altered due to a new equilibrium being established between iron-requiring cells and the inappropriate chelator (the pollutant or its catabolite). Following exposure to environmental pollutants, the perturbation of functional iron homeostasis may be the mechanism leading to adverse biological effects. Understanding the mechanism may lead to intervention methods for this major public health concern.
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