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Berhane A, Belachew T. Determinants of neural tube defects among women who gave birth in hospitals in Eastern Ethiopia: evidence from a matched case control study. BMC Womens Health 2023; 23:662. [PMID: 38071290 PMCID: PMC10710723 DOI: 10.1186/s12905-023-02796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Neural tube defects (NTDs) are severe birth defects caused by nutritional, genetic or environmental factors. Because NTDs continue to have a significant health and economic impact on children and community at large, it is crucial to investigate potential risk factors in order to develop novel approaches to NTDs prevention. Determinants for the development of NTDs differ by country, region as well as within the country. The objective of this study was to identify the determinants of NTDs among newborns delivered in three hospitals found in eastern Ethiopia. METHODS A hospital-based matched case-control study was conducted among 138 cases and 138 control women who delivered in three teaching hospitals in Eastern Ethiopia in 2021. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Cases were mothers who delivered a neonate with any type of NTDs regardless of gestational age or fetal viability, whereas controls were mothers who delivered an apparently healthy newborn. Chi-square was used to assess the significant difference between the two groups. Conditional logistic regression model was used to generate adjusted odds ratio with its corresponding 95% confidence intervals and compare the two groups. RESULTS Anencephaly (51.4%) and spinal bifida (34.1%) were the most frequently observed NTDs. None of study participants took preconception folic acid supplementation. Being a non-formal mothers (AOR = 0.34, 95% CI: 0.12-0.92, P = 0.034), rural residence, (AOR = 3.4, 95% CI: 1.18-9.78, P = 0.023), history of spontaneous abortion (AOR = 2.95, 95% CI: 1.15-7.55, P = 0.023), having severe anemia (AOR = 3.4, 95% CI: 1.17-9.87, P = 0.024), history of fever or cold (AOR = 2.75; 95% CI: 1.05-7.15, P = 0.038), and an exposure to various agro-chemicals (AOR = 3.39, 95% CI: 1.11-10.3, P = 0.032) were independent determinants of NTDs. CONCLUSION AND RECOMMENDATION In this study, NTDs were associated to several determinant factors in the area, including residential area, history of spontaneous abortion, severe anemia, fever/cold, antibiotic use before or during early pregnancy, and exposure to agrochemicals. Addressing the identified determinants is critical in averting the incidence of NTDs in the study area. Moreover, more research is needed to investigate women's dietary practices as well as the practice of preconception folic acid supplementation for pregnant women in Ethiopia's current health care system.
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Affiliation(s)
- Anteneh Berhane
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Fite MB, Assefa N, Mengiste B. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Arch Public Health 2021; 79:219. [PMID: 34861892 PMCID: PMC8643002 DOI: 10.1186/s13690-021-00711-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia is one of the world's leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was carried out very prudently in order to give up the pooled prevalence and determinants of anemia in Sub-Saharan Africa. METHODOLOGY To carry out this ephemeral systematic review and meta-analysis, a correlated literature review was done from various sources, PubMed Medline and Google Scholar Journals. Anemia related searching engine was used to make the study more evocative and intensive. We used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to evaluate the quality of the study in relations of their inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was tracked to conduct this study. The pooled effect size was computed using the review manager and Compressive Meta-analysis software. RESULTS Twenty-fife studies, which encompassed 15,061 pregnant women, were chosen for the analysis. From those an overall prevalence of anemia in pregnancy in SSA was 35.6%. However, the result from meta-analysis showed that women who were infected with intestinal parasite were 3.59 times more likely to develop anemia compared to those who were not infected [OR:3.59, 95% CI (2.44,5.28)].The result showed that women who had no iron and folic-acid supplementation were 1.82 times more likely to develop anemia compared to those women who had iron and folic-acid supplementation {OR:1.82, 95% CI (1.22,2.70]. Women who had women were in third trimester pregnancy were 2.37 times more likely to develop anemia compared to those who were in first and second trimester [OR:2.37, 95% CI (1.78, 3.24)]. Women who had low dietary diversity score were 3.59 times more likely to develop anemia compared to those who had high dietary diversity score [OR: 3.59, 95% CI (2.44, 5.28]. CONCLUSIONS Our finding from this systematic review and meta-analysis displays the high case in prevalence of anemia among pregnant women in Sub-Saharan Africa. Predictors for this includes: intestinal parasite, iron and folic-acid supplementation, third trimester pregnancy and dietary diversified intake score were statistically correlated positively with anemia in pregnancy. These need cautious evaluation of impact of prevention effort for operational policy, programs and design nutrition intrusions for refining maternal food consumption during pregnancy. Also, dietary education intrusion requires to be prearranged to satisfy the desires of pregnant women. The finding of this work will be used as an evidences for policy makers of Africa; entirely for maternal and child health care. Lastly, we suggested further investigations to be carried out in the area of the study for more rigorous and comprehensive recommendations.
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Affiliation(s)
- Meseret Belete Fite
- Department of Public health, Institute of Health Science, Wollega University, Nekemte, Ethiopia.
| | - Nega Assefa
- Department of Public health, School of public health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- Department of Public health, School of public health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Steinl GK, Gandelman JS, Katzman PJ, Ru Y, Guillet R, Pressman E, Cooper EM, O'Brien KO. Umbilical Cord Coiling in High-risk Pregnancies: Associations With Determinants of Adverse Birth Outcomes and Iron Status. Pediatr Dev Pathol 2018; 21:537-547. [PMID: 29652240 DOI: 10.1177/1093526618770318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes, but the etiology of these findings remains poorly characterized. This study was undertaken to examine associations between cord coiling and maternal iron (Fe) status and to identify potential determinants of hypo- and hypercoiling in 2 higher risk obstetric groups: pregnant adolescents (≤18 years, n = 92) and adult women carrying twins (n = 49), triplets (n = 11), or quadruplets (n = 1). Umbilical cords were classified as hypo-, normo-, or hypercoiled using digital photographs to assess gross appearance. Hypocoiling and hypercoiling were observed in 44% (n = 86/195) and 13% (n = 26/195) of the combined study population. The prevalence of hypocoiling among women carrying multiples was over 3-fold higher than the prevalence in singleton pregnancies based on the published data. Within the entire study population, hypocoiling was associated with a lower gestational age at birth when compared to normocoiling and hypercoiling (36.3 ± 3.6 weeks [n = 86] vs 37.8 ± 2.7 [n = 83], P < .01, and 38.2 ± 2.6 [n = 26], P < .01, respectively), whereas hypercoiling was associated with significantly lower serum ferritin when compared to normocoiling ( P < .01) and hypocoiling ( P < .001). In the multiples cohort only, hypercoiling was significantly associated with multiparity ( P < .01) and lower birth weight ( P < .05). Further studies are needed to identify the determinants and consequences of cord coiling.
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Affiliation(s)
- Gabrielle K Steinl
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | | | - Philip J Katzman
- 2 School of Medicine, University of Rochester, Rochester, New York
| | - Yuan Ru
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Ronnie Guillet
- 2 School of Medicine, University of Rochester, Rochester, New York
| | - Eva Pressman
- 2 School of Medicine, University of Rochester, Rochester, New York
| | | | - Kimberly O O'Brien
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
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Iron Metabolism in African American Women in the Second and Third Trimesters of High-Risk Pregnancies. J Obstet Gynecol Neonatal Nurs 2016; 46:148-158. [PMID: 27836659 DOI: 10.1016/j.jogn.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. DESIGN Longitudinal pilot study. SETTING Large, university-based, urban Midwestern U.S. medical center. PARTICIPANTS Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic. METHODS Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation. Anthropometric and survey data were obtained via self-report. Descriptive statistics were calculated from these data, and changes in the clinical parameters between the second and third trimesters were evaluated via paired t tests. Associations among demographic, reproductive, anthropometric, inflammatory, and iron-related parameters were also assessed in each trimester. RESULTS The mean age of participants was 28.3 (± 6.8) years, and mean prepregnancy body mass index was 31.9 (± 10.7) kg/m2. In the longitudinal analysis, significant (p < .05) declines in serum iron, ferritin, transferrin saturation, and C-reactive protein were observed between the second and third trimesters. There was no statistically significant change in hepcidin between trimesters. When using a ferritin level cut-point of less than 15 ng/ml and soluble transferrin receptor level of greater than 28.1 nmol/L, 48% of the participants (14 of 29) were classified with iron deficiency in the third trimester. CONCLUSION In this pilot study, iron deficiency was prevalent among a small cohort of African American women with high-risk pregnancies. Hepcidin concentrations were greater than previously reported in healthy, pregnant, primarily White women, which suggests decreased iron bioavailability in this high-risk group.
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Marvin-Dowle K, Burley VJ, Soltani H. Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries. BMC Pregnancy Childbirth 2016; 16:268. [PMID: 27629406 PMCID: PMC5024513 DOI: 10.1186/s12884-016-1059-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. METHODS A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11-19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. RESULTS The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0-83.1) to be significantly below recommendations (p = 0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39-84). CONCLUSIONS This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition.
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Affiliation(s)
- Katie Marvin-Dowle
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | | | - Hora Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
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Vitamin B12 and placental expression of transcobalamin in pregnant adolescents. Placenta 2016; 45:1-7. [PMID: 27577703 DOI: 10.1016/j.placenta.2016.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcobalamin is a key placental protein involved in transport of vitamin B12 to the fetus. However, few data currently exist on the ability of the placenta to modify vitamin B12 transporter expression, particularly in high-risk populations such as pregnant adolescents. OBJECTIVE This study was conducted to determine the impact of maternal and neonatal serum vitamin B12 concentrations on placental transcobalamin (TC) expression in a cohort of healthy pregnant adolescents in the United States. DESIGN Serum vitamin B12 concentrations were measured in maternal blood samples at mid-gestation (26.4 ± 2.8 weeks) and delivery (39.8 ± 1.4 weeks) and infant cord blood samples at birth. Placentas were collected at delivery and TC mRNA expression (ΔΔCt) and TC protein abundance (TC:α-actin) were evaluated. Linear and binomial regression models were used to examine the associations of maternal serum (mid-gestation, delivery) and cord blood vitamin B12 concentrations with placental TC mRNA expression and protein abundance (n = 63). RESULTS Maternal serum vitamin B12 concentrations at mid-gestation or delivery were not significantly associated with placental TC mRNA expression or TC protein abundance (p > 0.05). Higher placental TC protein abundance was associated with increased cord blood vitamin B12 concentrations (p = 0.003). CONCLUSIONS Higher placental TC protein abundance was associated with higher cord blood vitamin B12 concentrations, suggesting a potential role in vitamin B12 transport to the fetus.
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Cao C, Pressman EK, Cooper EM, Guillet R, Westerman M, O'Brien KO. Prepregnancy Body Mass Index and Gestational Weight Gain Have No Negative Impact on Maternal or Neonatal Iron Status. Reprod Sci 2015; 23:613-22. [PMID: 26423600 DOI: 10.1177/1933719115607976] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the impact of maternal obesity and excessive gestational weight gain (GWG) on maternal and neonatal iron status and to explore the possible mediating role of inflammation on hepcidin. METHODS This analysis included 230 pregnant adolescents (13-18 years) enrolled in either a longitudinal or a cross-sectional study. Prepregnancy body mass index (ppBMI) and GWG were obtained from medical records. Maternal iron status (hemoglobin, serum iron, ferritin, transferrin receptor, total body iron, and hepcidin) and inflammation (interleukin-6 [IL-6] and leptin) were assessed at midgestation (26.2 ± 3.3 weeks) in the longitudinal cohort and at delivery (39.8 ± 1.3 weeks) in both study cohorts. Cord blood was collected in both studies and analyzed for iron indicators. RESULTS Approximately 40% of the adolescents entered pregnancy overweight or obese. Multivariate analysis identified ppBMI as a negative predictor of serum iron at midgestation (P = .009) and a positive predictor of serum hepcidin at delivery (P = .02). None of the other maternal iron status indicators were significantly associated with ppBMI or GWG. Serum IL-6 was significantly positively associated with hepcidin at delivery (P = .0001) but not at midgestation. There was a positive relationship between ppBMI and cord hemoglobin (P = .03). CONCLUSION These results suggest that adiposity-related inflammation does not override the iron-mediated signals that regulate hepcidin production during pregnancy, and in this adolescent cohort, there is no strong evidence for a detrimental effect of maternal obesity and excessive weight gain on iron status in the offspring at birth.
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Affiliation(s)
- Chang Cao
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Elizabeth M Cooper
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Ronnie Guillet
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
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Emegoakor FCJ, Iyoke CA, Ezegwui HU, Ezugwu FO, Umeora OU, Ibeagha IO. Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria. J Blood Med 2015; 6:261-7. [PMID: 26425110 PMCID: PMC4581776 DOI: 10.2147/jbm.s82411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Low serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia. Objective To determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria. Study design A hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0. Results Two-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20). Conclusion There was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery.
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Affiliation(s)
- Fausta Chioma J Emegoakor
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Chukwuemeka Anthony Iyoke
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Hyginus Uzo Ezegwui
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Frank Okechukwu Ezugwu
- Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Park Lane, Enugu, Nigeria
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Garcia-Valdes L, Campoy C, Hayes H, Florido J, Rusanova I, Miranda MT, McArdle HJ. The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy. Int J Obes (Lond) 2015; 39:571-8. [PMID: 25614087 DOI: 10.1038/ijo.2015.3] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/08/2014] [Accepted: 12/16/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity is associated with decreased iron status, possibly due to a rise in hepcidin, an inflammatory protein known to reduce iron absorption. In animals, we have shown that maternal iron deficiency is minimised in the foetus by increased expression of placental transferrin receptor (pTFR1), resulting in increased iron transfer at the expense of maternal iron stores. OBJECTIVE This study examines the effect of obesity during pregnancy on maternal and neonatal iron status in human cohorts and whether the placenta can compensate for decreased maternal iron stores by increasing pTFR1 expression. SUBJECTS/METHODS A total of 240 women were included in this study. One hundred and fifty-eight placentas (Normal: 90; Overweight: 37; Obese: 31) were collected at delivery. Maternal iron status was measured by determining serum transferrin receptor (sTFR) and ferritin levels at 24 and 34 weeks and at delivery. Hepcidin in maternal and cord blood was measured by ELISA and pTFR1 in placentas by western blotting and real-time RT-PCR. RESULTS Low iron stores were more common in obese women. Hepcidin levels (ng ml(-1)) at the end of the pregnancy were higher in obese than normal women (26.03±12.95 vs 18.00±10.77, P<0.05). Maternal hepcidin levels were correlated with maternal iron status (sTFR r=0.2 P=0.025), but not with neonatal values. mRNA and protein levels of pTFR1 were both inversely related to maternal iron status. For mRNA and all women, sTFR r=0.2 P=0.044. Ferritin mRNA levels correlated only in overweight women r=-0.5 P=0.039 with hepcidin (r=0.1 P=0.349), irrespective of maternal body mass index (BMI). CONCLUSIONS The data support the hypothesis that obese pregnant women have a greater risk of iron deficiency and that hepcidin may be a regulatory factor. Further, we show that the placenta responds to decreased maternal iron status by increasing pTFR1 expression.
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Affiliation(s)
- L Garcia-Valdes
- 1] The Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, UK [2] Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
| | - C Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
| | - H Hayes
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, UK
| | - J Florido
- Department Obstetrics and Gynaecology, School of Medicine, University of Granada, Granada, Spain
| | - I Rusanova
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
| | - M T Miranda
- Department of Biostatistics, School of Medicine, University of Granada, Granada, Spain
| | - H J McArdle
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, UK
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Molloy AM, Einri CN, Jain D, Laird E, Fan R, Wang Y, Scott JM, Shane B, Brody LC, Kirke PN, Mills JL. Is low iron status a risk factor for neural tube defects? ACTA ACUST UNITED AC 2014; 100:100-6. [PMID: 24535840 DOI: 10.1002/bdra.23223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/08/2014] [Accepted: 01/13/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Folic acid supplements can protect against neural tube defects (NTDs). Low folate and low vitamin B12 status may be maternal risk factors for having an NTD affected pregnancy. However, not all NTDs are preventable by having an adequate folate/ B12 status and other potentially modifiable factors may be involved. Folate and vitamin B12 status have important links to iron metabolism. Animal studies support an association between poor iron status and NTDs, but human data are scarce. We examined the relevance of low iron status in a nested NTD case-control study of women within a pregnant population-based cohort. METHODS Pregnant women were recruited between 1986 and 1990, when vitamin or iron supplementation in early pregnancy was rare. Blood samples, taken at an average of 14 weeks gestation, were used to measure ferritin and hemoglobin in 64 women during an NTD affected pregnancy and 207 women with unaffected pregnancies. RESULTS No significant differences in maternal ferritin or hemoglobin concentrations were observed between NTD affected and nonaffected pregnancies (case median ferritin 16.9 µg/L and hemoglobin 12.4 g/dl versus 15.4 µg/L and 12.3g/dl in controls). As reported previously, red cell folate and vitamin B12 concentrations were significantly lower in cases. Furthermore, there was no significant association of iron status with type of NTD lesion (anencephaly or spina bifida). CONCLUSION We conclude that low maternal iron status during early pregnancy is not an independent risk factor for NTDs. Adding iron to folic acid for periconceptional use may improve iron status but is not likely to prevent NTDs.
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Affiliation(s)
- Anne M Molloy
- The Institute of Molecular Medicine, School of Medicine, Trinity College Dublin, Ireland
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Abstract
It has been nearly 15 years since the first review on pregnancy and iron deficiency was published in Nutrition Reviews. Many unresolved issues raised in that seminal review have been addressed. New proteins involved in nonheme and heme iron transport have been identified in the enterocyte, and information on the roles of these proteins in the placenta is evolving. The systemic iron regulatory hormone, hepcidin, has since been identified as a key regulator of iron homeostasis. Additional data on the efficacy and consequences of prenatal iron supplementation are available. Emerging data on developmental changes in iron absorption across early infancy have further emphasized the need to ensure that the iron endowment of the neonate at birth is optimal. This is especially important, given growing evidence linking neonatal iron status with subsequent cognitive and neurobehavioral outcomes. Along with the many advances, new questions and gaps in knowledge have been identified. This review summarizes new data on maternal iron utilization across pregnancy as it impacts the pregnant woman and the iron status of the neonate at birth.
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Affiliation(s)
- Chang Cao
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA
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12
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Coe CL, Lubach GR, Busbridge M, Chapman RS. Optimal iron fortification of maternal diet during pregnancy and nursing for investigating and preventing iron deficiency in young rhesus monkeys. Res Vet Sci 2013; 94:549-54. [PMID: 23312499 DOI: 10.1016/j.rvsc.2012.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/28/2012] [Accepted: 11/22/2012] [Indexed: 01/01/2023]
Abstract
The realization that pregnant and infant monkeys were challenged by high nutritional needs for iron led vendors to markedly increase iron concentrations in commercial diets. Yet, no systematic research was conducted to investigate the consequences of this important dietary change. Hematology and iron panels were determined for 142 infant rhesus monkeys gestated and reared on 3 different diets varying in iron concentration (180, 225 or 380 mg Fe/kg). Anemia was significantly more prevalent in offspring from females fed the 180 and 225 mg Fe/kg diets (32-41% versus 0 for the 380 mg Fe/kg diet, P<0.001). Higher hepcidin levels were protective against iron overload in infants from the 380 mg Fe/kg condition. These findings indicate a highly fortified diet during pregnancy continues to have postnatal benefits for the growing infant. However, for those interested in iron deficiency, lower iron diets provide a reliable way to generate anemic infant monkeys for research.
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Affiliation(s)
- Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI 53715, United States.
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Dunlop AL, Kramer MR, Hogue CJR, Menon R, Ramakrishan U. Racial disparities in preterm birth: an overview of the potential role of nutrient deficiencies. Acta Obstet Gynecol Scand 2012; 90:1332-41. [PMID: 21910693 DOI: 10.1111/j.1600-0412.2011.01274.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To give an overview of the literature for evidence of nutrient deficiencies as contributors to the disparity in preterm birth (PTB) between African-American and Caucasian women. DESIGN Structured literature survey. METHODS We searched MEDLINE to identify observational and experimental studies that evaluated the relation between nutrient intake and/or supplementation and PTB. For nutrients for which studies supported an association, we searched MEDLINE for studies of the prevalence of deficiency in the USA by race. MAIN OUTCOME MEASURES Summarized findings on nutrients for which there is both evidence of a role in PTB and variability in the prevalence of deficiency by race. RESULTS Nutrient deficiencies for which there are varying levels of evidence for an association with PTB and a greater burden among African-American compared with Caucasian women include deficiencies of iron, folic acid, zinc, vitamin D, calcium and magnesium, and imbalance of ω-3 and ω-6 polyunsaturated fatty acids. There are inadequate high-quality studies that investigate the role of nutrient deficiencies in PTB, their potential interaction with other risks, the proportion of excess risk for which they account, and whether supplementation can reduce the risk of, and racial disparities in, PTB in US populations. CONCLUSION Deficiencies of several nutrients have varying levels of evidence of association with PTB and are of greater burden among African-American compared with Caucasian women. Although further research is needed, strategies that improve the nutritional status of African-American women may be a means of addressing a portion of the racial disparity in PTB.
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Affiliation(s)
- Anne L Dunlop
- Department of Family and Preventive Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Mei Z, Cogswell ME, Looker AC, Pfeiffer CM, Cusick SE, Lacher DA, Grummer-Strawn LM. Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Am J Clin Nutr 2011; 93:1312-20. [PMID: 21430118 DOI: 10.3945/ajcn.110.007195] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Total body iron calculated from serum ferritin and soluble transferrin receptor concentrations allows for the evaluation of the full range of iron status. OBJECTIVE We described the distribution of total body iron and the prevalence of iron deficiency (ID) on the basis of total body iron in US pregnant women. DESIGN We examined data from the National Health and Nutrition Examination Survey (NHANES) in 1999-2006 for 1171 pregnant women. RESULTS ID prevalence (±SE) in US pregnant women, which was defined as total body iron <0 mg/kg, was 18.0 ± 1.4%. Pregnant women in the first trimester had a higher mean total body iron than did pregnant women in the second or third trimesters. ID prevalence in pregnant women increased significantly with each trimester (6.9 ± 2.2%, 14.3 ± 2.1%, and 29.5 ± 2.7% in the first, second, and third trimesters, respectively). Pregnant women with parity ≥2 had the lowest mean total body iron and the highest prevalence of ID compared with values for pregnant women with parity of 0 or 1. The ID prevalence in non-Hispanic white pregnant women was significantly lower than in Mexican American or non-Hispanic black pregnant women. The mean total body iron and the prevalence of ID did not differ by educational level or by family income. CONCLUSIONS To our knowledge, these are the first data on total body iron distributions for a representative sample of US pregnant women. Low total body iron is more prevalent in pregnant women in the second or third trimesters, in Mexican American pregnant women, in non-Hispanic black pregnant women, and in women with parity ≥2.
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Affiliation(s)
- Zuguo Mei
- National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724., USA.
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15
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Young MF, Griffin I, Pressman E, McIntyre AW, Cooper E, McNanley T, Harris ZL, Westerman M, O’Brien KO. Utilization of iron from an animal-based iron source is greater than that of ferrous sulfate in pregnant and nonpregnant women. J Nutr 2010; 140:2162-6. [PMID: 20980658 PMCID: PMC2981003 DOI: 10.3945/jn.110.127209] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Heme iron absorption during pregnancy and the role of hepcidin in regulating dietary heme iron absorption remains largely unexplored. The objective of this research was to examine relative differences in heme (animal based) and nonheme (ferrous sulfate) iron utilization. This study was undertaken in 18 pregnant (ages 16-32 y; wk 32-35 of gestation) and 11 nonpregnant women (ages 18-27 y). Women were randomly assigned to receive both an animal-based heme meal (intrinsically labeled (58)Fe pork) and labeled ferrous sulfate ((57)Fe) fed on alternate days. Blood samples obtained 2 wk postdosing were used to assess iron status indicators and serum hepcidin and iron utilization based on RBC incorporation of iron isotopes. Heme iron utilization was significantly greater than nonheme iron utilization in the pregnant (47.7 ± 14.4 vs. 40.4 ± 13.2%) and nonpregnant women (50.1 ± 14.8 vs. 15.3 ± 9.7%). Among pregnant women, utilization of nonheme iron was associated with iron status, as assessed by the serum transferrin receptor concentration (P = 0.003; r(2) = 0.43). In contrast, heme iron utilization was not influenced by maternal iron status. In the group as a whole, women with undetectable serum hepcidin had greater nonheme iron utilization compared with women with detectable serum hepcidin (P = 0.02; n = 29); however, there were no significant differences in heme iron utilization. Our study suggests that iron utilization from an animal-based food provides a highly bioavailable source of dietary iron for pregnant and nonpregnant women that is not as sensitive to hepcidin concentrations or iron stores compared with ferrous sulfate.
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Affiliation(s)
- Melissa F. Young
- Cornell University, Division of Nutritional Sciences, Ithaca, NY 14853
| | - Ian Griffin
- USDA/Agricultural Research Service Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030
| | - Eva Pressman
- The University of Rochester School of Medicine, Rochester, NY 14642
| | | | - Elizabeth Cooper
- The University of Rochester School of Medicine, Rochester, NY 14642
| | - Thomas McNanley
- The University of Rochester School of Medicine, Rochester, NY 14642
| | - Z. Leah Harris
- Vanderbilt University Medical Center, Department of Pediatrics, Nashville, TN 37232
| | | | - Kimberly O. O’Brien
- Cornell University, Division of Nutritional Sciences, Ithaca, NY 14853,To whom correspondence should be addressed: E-mail:
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Impact of maternal and neonatal iron status on placental transferrin receptor expression in pregnant adolescents. Placenta 2010; 31:1010-4. [DOI: 10.1016/j.placenta.2010.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 02/05/2023]
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17
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Charles AM, Campbell-Stennett D, Yatich N, Jolly PE. Predictors of anemia among pregnant women in Westmoreland, Jamaica. Health Care Women Int 2010; 31:585-98. [PMID: 20526925 PMCID: PMC2995917 DOI: 10.1080/07399331003710541] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anemia in pregnancy is a worldwide problem, but it is most prevalent in the developing world. This research project was conducted to determine the predictors of anemia in pregnant women in Westmoreland, Jamaica. A cross-sectional study design was conducted, and descriptive, bivariate, and multiple logistic regression analyses were used. Body mass index (BMI), mid-upper arm circumference (MUAC), and the number of antenatal care visits showed a statistically significant association with anemia. Based on the results, we believe that maintaining a healthy body weight, and frequently visiting an ANC, will help to lower the prevalence of anemia among pregnant women in Westmoreland.
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Affiliation(s)
- Alyson M Charles
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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18
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Baker PN, Wheeler SJ, Sanders TA, Thomas JE, Hutchinson CJ, Clarke K, Berry JL, Jones RL, Seed PT, Poston L. A prospective study of micronutrient status in adolescent pregnancy. Am J Clin Nutr 2009; 89:1114-24. [PMID: 19244368 DOI: 10.3945/ajcn.2008.27097] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adolescents are more likely than adults to consume energy-dense, micronutrient-poor diets and to experience adverse pregnancy outcomes. OBJECTIVES The objectives were to assess micronutrient intake and blood biomarkers prospectively in pregnant adolescents recruited to the About Teenage Eating (ATE) Study and to determine associations with pregnancy outcome. DESIGN Pregnant adolescents (n = 500) were recruited from 2 UK inner city populations. Dietary intake was assessed with three 24-h dietary recalls, and micronutrient status was assessed by measurement of third trimester blood biomarkers. Pregnancy outcomes included small-for-gestational age (SGA) birth and preterm delivery. RESULTS Median iron and folate intakes were lower than UK and US recommended amounts. Folate and vitamin B-12 status were lower in smokers, despite no differences in dietary intake. Serum folate was <7.0 nmol/L in 12% of subjects, and serum total homocysteine (tHcy) was elevated (>10 micromol/L) in 20% of subjects. Fifty-two percent of the subjects had iron deficiency anemia, and 30% had serum 25-hydroxyvitamin D concentrations <25 nmol/L. The incidence of SGA birth was higher in subjects with poorer folate status (red blood cell folate, P = 0.003; serum folate, P = 0.02; tHcy, P = 0.01; simple regression) and those with low folate intakes, regardless of the inclusion (P = 0.021) or exclusion (P = 0.049) of intake from supplements (simple regression). Adjustment for confounding variables confirmed the independence of these associations. The risk of SGA birth was also higher in subjects with low food iron intake (P = 0.049), but not when intake included iron from supplements (P = 0.21). The risk of SGA birth was lower in subjects with iron deficiency anemia (P = 0.002). CONCLUSION Poor micronutrient intake and status increase the risk of SGA births in pregnant adolescents.
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Affiliation(s)
- Philip N Baker
- Maternal and Fetal Health Research Group, School of Laboratory and Clinical Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
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Ma AG, Schouten EG, Zhang FZ, Kok FJ, Yang F, Jiang DC, Sun YY, Han XX. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic Acid supplements. J Nutr 2008; 138:1946-50. [PMID: 18806105 DOI: 10.1093/jn/138.10.1946] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In rural China, many pregnant women in their third trimester suffer from anemia (48%) and iron deficiency (ID; 42%), often with coexisting deficiencies of retinol and riboflavin. We investigated the effect of retinol and riboflavin supplementation in addition to iron plus folic acid on anemia and subjective well-being in pregnant women. The study was a 2-mo, double-blind, randomized trial. Subjects (n = 366) with anemia [hemoglobin (Hb) </= 105 g/L] were randomly assigned to 4 groups, all receiving 60 mg/d iron and 400 mug/d folic acid. The iron+folic acid (IF) group (n = 93) served as reference, the iron+folic acid+retinol group (IFA) (n = 91) was treated with 2000 mug retinol, the iron+folic acid+riboflavin group (IFB) (n = 91) with 1.0 mg riboflavin, and the iron+folic acid+retinol+riboflavin group (IFAB) (n = 91) with retinol and riboflavin. After the 2-mo intervention, the Hb concentration increased in all 4 groups (P < 0.001). The increase in the IFAB group was 5.4 +/- 1.1 g/L greater than in the IF group (P < 0.001). The reduced prevalence of anemia (Hb < 110g/L) and ID anemia were significantly greater in the groups supplemented with retinol and /or riboflavin than in the IF group. Moreover, gastrointestinal symptoms were less prevalent in the IFA group than in the IF group (P < 0.05) and improved well-being was more prevalent in the groups receiving additional retinol and/or riboflavin than in the IF group (P < 0.05). Thus, a combination of iron, folic acid, retinol, and riboflavin was more effective than iron plus folic acid alone. Multimicronutrient supplementation may be worthwhile for pregnant women in rural China.
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Affiliation(s)
- Ai G Ma
- Institute of Human Nutrition, Medical College of Qingdao University, 266021 Qingdao, China.
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20
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Baumann-Blackmore NL, Goetz E, Blohowiak SE, Zaka O, Kling PJ. Cord blood zinc protoporphyrin/heme ratio in minority neonates at risk for iron deficiency. J Pediatr 2008; 153:133-6. [PMID: 18571551 DOI: 10.1016/j.jpeds.2008.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 01/03/2008] [Accepted: 01/28/2008] [Indexed: 11/16/2022]
Abstract
We measured cord blood zinc protoporphyrin/heme (ZnPP/H) and plasma ferritin in healthy African-American and Hispanic newborns, matched by gestation with Caucasian newborns. In these at-risk minorities, cord ZnPP/H was higher and plasma ferritin lower, supporting the feasibility of screening newborns at-risk for iron deficiency at birth.
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Everette M. Investigation of the Correlates of Iron Deficiency Among Non-Pregnant Child-Bearing Age Females, (18–49 years) Using the National Health and Nutrition Examination Survey III – National Data Set (NHANES III-1988–1994). Ecol Food Nutr 2008. [DOI: 10.1080/03670240701702966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Moran VH. Nutritional status in pregnant adolescents: a systematic review of biochemical markers. MATERNAL & CHILD NUTRITION 2007; 3:74-93. [PMID: 17355441 PMCID: PMC6860744 DOI: 10.1111/j.1740-8709.2007.00081.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Adolescent pregnancy is a major public health challenge for many industrialized countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutritional status of this population. The aim of this paper was to conduct a systematic review of the current evidence relating to the biochemical markers of nutritional status of pregnant adolescents living in industrialized countries. Six papers were identified that fulfilled the inclusion criteria, the majority of which were conducted in the United States. The studies were of variable quality and most failed to control for potential confounders which may have strongly influenced the findings. Due to limited research, conclusions cannot be drawn about the zinc and calcium status of pregnant adolescents, and data on folate and vitamin B(12) status appeared conflicting. There was some consensus among studies, however, to suggest that indicators of anaemia and iron status were compromised in pregnant adolescents, particularly during the third trimester of pregnancy. Chronological age did not appear to influence nutritional status, although there was some evidence to suggest that increasing gynaecologic age may positively influence plasma ferritin levels. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of the role of socio-economic support on pregnant adolescents' nutritional status. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent healthcare providers, academics, professional organizations, policymakers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimized.
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Affiliation(s)
- Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, Faculty of Health, University of Central Lancashire, Preston, UK.
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