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Delaney KM, Guillet R, Pressman EK, Caulfield LE, Zavaleta N, Abrams SA, O'Brien KO. Iron absorption during pregnancy is underestimated when iron utilization by the placenta and fetus is ignored. Am J Clin Nutr 2020; 112:576-585. [PMID: 32614379 PMCID: PMC7458780 DOI: 10.1093/ajcn/nqaa155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Maternal iron absorption during pregnancy can be evaluated using RBC incorporation of orally administered stable iron isotope. This approach underestimates true maternal absorption of iron as it does not account for absorbed iron that is transferred to the fetus or retained within the placenta. OBJECTIVE Our objective was to re-evaluate maternal iron absorption after factoring in these losses and identify factors associated with iron partitioning between the maternal, neonatal, and placental compartments. METHODS This study utilized data from stable iron isotope studies carried out in 68 women during the third trimester of pregnancy. Iron status indicators and stable iron isotopic enrichment were measured in maternal blood, umbilical cord blood, and placental tissue when available. Factors associated with iron isotope partitioning between the maternal, neonatal, and placental compartments were identified. RESULTS On average, true maternal absorption of iron increased by 10% (from 19% to 21%) after accounting for absorbed iron present in the newborn (P < 0.001), and further increased by 7%, (from 39% to 42%, P < 0.001) after accounting for iron retained within the placenta. On average, 2% of recovered tracer was present in the placenta and 6% was found in the newborn. Net transfer of iron to the neonate was higher in women with lower total body iron (standardized β = -0.48, P < 0.01) and lower maternal hepcidin (standardized β = -0.66, P < 0.01). In women carrying multiple fetuses, neonatal hepcidin explained a significant amount of observed variance in net placental transfer of absorbed iron (R = 0.95, P = 0.03). CONCLUSIONS Maternal RBC iron incorporation of an orally ingested tracer underestimated true maternal iron absorption. The degree of underestimation was greatest in women with low body iron. Maternal hepcidin was inversely associated with maternal RBC iron utilization, whereas neonatal hepcidin explained variance in net transfer of iron to the neonatal compartment.These trials were registered at clinicaltrials.gov as NCT01019096 and NCT01582802.
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Affiliation(s)
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura E Caulfield
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
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Li JY, Wang PH, Vitale SG, Chen SN, Marranzano M, Cianci A, Lin LT, Tsui KH. Pregnancy-induced hypertension is an independent risk factor for meconium aspiration syndrome: A retrospective population based cohort study. Taiwan J Obstet Gynecol 2019; 58:396-400. [PMID: 31122532 DOI: 10.1016/j.tjog.2018.11.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Meconium aspiration syndrome (MAS), possibly resulting from fetal hypoxia, is a respiratory distress disorder in the infant. Pregnancy-induced hypertension (PIH) can cause placental dysfunction and lead to fetal hypoxia, which may induce the development of MAS. Therefore, the aim of this study was to determine the association between PIH and MAS and to identify the predictive risk factors. MATERIALS AND METHODS This was a retrospective cohort study. We selected patients with newly diagnosed PIH and a matched cohort group from the Taiwan National Health Insurance Research Database (NHIRD), from January 1, 2000 till December 31, 2013. For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. The incidence of meconium aspiration syndrome was assessed in both groups. RESULTS Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients who experienced PIH had a higher incidence of MAS than did those without PIH. According to a multivariate analysis, PIH (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.49-1.93, p < 0.0001) was independently associated with increased risk of MAS. Additionally, age ≥30 years (OR = 1.26, 95% CI = 1.12-1.42, p = 0.0001), nulliparity (OR = 1.13, 95% CI = 1.01-1.27, p = 0.0367) and patients with diabetes mellitus (OR = 3.09, 95% CI = 1.35-7.09, p = 0.0078) were also independent risk factors of MAS. CONCLUSION Patients with PIH obtained higher subsequent risk for the development of MAS than those without PIH. Besides, age ≥30 years, nulliparity and patients with diabetes mellitus are the independent risk factors of developing MAS.
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Affiliation(s)
- Ju-Yueh Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - San-Nung Chen
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Biological Science, National Sun Yat-sen University, Kaohsiung City, Taiwan.
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan.
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Timur H, Tokmak A, Taflan S, Hançerlioğullari N, Laleli B, İnal HA, Moraloğlu Ö, Danişman N. Investigation of maternal and cord blood erythropoietin and copeptin levels in low-risk term deliveries complicated by meconium-stained amniotic fluid. J Matern Fetal Neonatal Med 2016; 30:665-669. [DOI: 10.1080/14767058.2016.1182973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Hakan Timur
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Aytekin Tokmak
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Selen Taflan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Necati Hançerlioğullari
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Bergen Laleli
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Hasan Ali İnal
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Özlem Moraloğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
| | - Nuri Danişman
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Health Research and Education Hospital, Ankara, Turkey
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Monen L, Hasaart TH, Kuppens SM. The aetiology of meconium-stained amniotic fluid: pathologic hypoxia or physiologic foetal ripening? (Review). Early Hum Dev 2014; 90:325-8. [PMID: 24794302 DOI: 10.1016/j.earlhumdev.2014.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite the many efforts to study the (patho)physiology of meconium release before delivery, it still remains an indistinct subject. Some studies have reported a relationship between hypoxia and MSAF, whilst others have not. The most common association found however, is between MSAF and the term of gestation. METHODS MEDLINE, EMBASE and the Cochrane library were electronically searched. Papers about the (patho)physiology of meconium-stained amniotic fluid in English were included. Papers about management strategies were excluded (see elsewhere this issue). RESULTS Different theories have been proposed including acute or chronic hypoxia, physiologic foetal ripening and peripartum infection. CONCLUSION We suggest that meconium-stained amniotic fluid should be regarded as a symptom rather than a syndrome becoming more prevalent with increasing term and which might be associated with higher levels of infection or asphyxia.
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Affiliation(s)
- L Monen
- Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, the Netherlands; Department of Medical Health Psychology, Tilburg University, Tilburg, the Netherlands.
| | - T H Hasaart
- Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, the Netherlands
| | - S M Kuppens
- Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, the Netherlands
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