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Ćuk A, Rumora L, Mikulić I, Penava N, Cvetković I, Pušić A, Mikulić V, Ljubić K, Tomić V. Serum concentration of ferroportin in women of reproductive age. Biochem Med (Zagreb) 2024; 34:030701. [PMID: 39171088 PMCID: PMC11334195 DOI: 10.11613/bm.2024.030701] [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: 10/17/2023] [Accepted: 05/06/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Ferroportin (Fpn) is the only known iron exporter and plays an essential role in iron homeostasis. Serum concentrations of Fpn in health and/or diseased states are still mostly unknown. Therefore, the aim of this study was to determine the concentration of Fpn in the serum of women of reproductive age (WRA) for the first time, and to establish whether there is a difference in the concentration of Fpn according to ferritin status. Materials and methods This research included 100 WRA (18-45 years, C-reactive protein (CRP) < 5 mg/L, hemoglobin > 120 g/L). Serum Fpn was measured using Enzyme Linked Immunosorbent Assay (ELISA) method on the analyzer EZ Read 800 Plus (Biochrom, Cambridge, UK). Reference interval was calculated using the robust method. Results The median concentration of Fpn in the whole study group was 9.74 (5.84-15.69) µg/L. The subgroup with ferritin concentration > 15 µg/L had a median Fpn concentration 15.21 (10.34-21.93) µg/L, which significantly differed from Fpn concentration in the subgroup with ferritin concentration ≤ 15 µg/L (5.93 (4.84-8.36) µg/L, P < 0.001). The reference limits for the Fpn were 2.26-29.81 µg/L with 90% confidence intervals (CI) of 1.78 to 2.83 and 25.37 to 34.33, respectively. Conclusions The proposed reference interval could help in the future research on iron homeostasis both in physiological conditions and in various disorders, because this is the first study that measured Fpn concentration in a certain gender and age group of a healthy population.
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Affiliation(s)
- Ana Ćuk
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Lada Rumora
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ivanka Mikulić
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Nikolina Penava
- Department of Obstetrics and Gynecology, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
| | - Ivona Cvetković
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ante Pušić
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Vinka Mikulić
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Kristina Ljubić
- Department of Laboratory Diagnostics, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Vajdana Tomić
- Department of Obstetrics and Gynecology, Clinical Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
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La Verde M, Luciano M, Fordellone M, Brandi C, Carbone M, Di Vincenzo M, Lettieri D, Palma M, Marrapodi MM, Scalzone G, Torella M. Is there a correlation between prepartum anaemia and an increased likelihood of developing postpartum depression? A prospective observational study. Arch Gynecol Obstet 2024; 310:1099-1108. [PMID: 38345767 PMCID: PMC11258048 DOI: 10.1007/s00404-023-07344-7] [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: 08/07/2023] [Accepted: 12/12/2023] [Indexed: 07/19/2024]
Abstract
PURPOSE Postpartum depression (PPD) represents a significant challenge to maternal and child health. Early screening for PPD is essential to ensure appropriate treatment and support. The present study aimed to assess whether maternal prepartum anaemia influences the likelihood of developing PPD within 3 days after delivery. METHODS In collaboration with the Department of Psychiatry, a prospective observational study was carried out at the Gynaecology and Obstetrics Department of the University of Campania "Luigi Vanvitelli" in Naples. A total of 211 full-term pregnant women were enrolled, and their predelivery haemoglobin value was recorded. Women with gestational diabetes, hypertension, pre-eclampsia, intrauterine growth restriction, intellectual disability, or pre-existing diagnosis of psychotic spectrum disorder were excluded. Participants provided written informed consent to fill out the Edinburgh Postnatal Depression Scale (EPDS) 3 days after delivery. EPDS cut-off score of ≥ 10 was used to identify women at risk of developing PPD. Statistical analysis was performed using Student's t test, the Wilcoxon Rank Sum test, and linear regression. RESULTS The participants were categorized into 2 groups based on EPDS scores: EPDS < 10 (176 patients) or EPDS ≥ 10 (35 patients). The two groups showed homogeneity in terms of socio-demographic and clinical characteristics. The mean haemoglobin values of anaemic pregnant women in the EPDS ≤ 10 group (11.78 ± 1.39 g/dl) and the EPDS > 10 group (11.62 ± 1.27 g/dl) were not significantly different (p = 0.52). There was no significant correlation between the predelivery haemoglobin value and the EPDS postpartum score of < 10 or ≥ 10. The Wilcoxon Rank Sum test and the estimated coefficients of the linear regression model did not show any statistical relationship between continuous and binary haemoglobin values. CONCLUSIONS Our study found that maternal prepartum anaemia did not negatively impact the likelihood of developing postpartum depressive symptoms, in the first 3 days after delivery.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Mario Fordellone
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania, "L. Vanvitelli", Naples, Italy
| | - Davide Lettieri
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Pediatric Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Gaetano Scalzone
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Kirthan JPA, Somannavar MS. Pathophysiology and management of iron deficiency anaemia in pregnancy: a review. Ann Hematol 2024; 103:2637-2646. [PMID: 37787837 DOI: 10.1007/s00277-023-05481-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother's blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.
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Affiliation(s)
- J P Akshay Kirthan
- Department of Biochemistry, JN Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belgaum, 590010, Karnataka, India.
| | - Manjunath S Somannavar
- Department of Biochemistry, JN Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belgaum, 590010, Karnataka, India
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Satué K, Fazio E, Damiá E, Medica P, Cravana C. Correlation between erythrocyte parameters and iron status in cyclic Spanish Purebred mares. Vet Res Commun 2024; 48:2677-2681. [PMID: 38635104 DOI: 10.1007/s11259-024-10376-2] [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: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
The aim of this study was to evaluate the serum iron status and its relation to hematological indexes in cyclic mares. Blood samples were taken from 40 Spanish Purebred mares on days - 5, 0, + 5 and + 16 of their cycle. Concentration of transferrin (TRF) was significantly lower on day 0 than on days + 5 and + 16, transferrin saturation (TSAT) decreased significantly on days 0 and + 16 compared to day - 5, total iron-binding capacity (TIBC) on day + 16 was significantly higher than those on days - 5 and 0, and on day + 5 it was also significantly higher than that on day 0, unsaturated iron-binding capacity (UIBC) was reduced on day + 16 compared to days - 5 and 0, red blood cell (RBC) count on day + 16 was higher than that on days - 5 and 0 (p < 0.05), with no differences in the concentration of hemoglobin (HB) and packed cell volume (PCV). TRF and TIBC (r = 0.95), RBC and HB (r = 0.64), RBC and PCV (r = 0.78), and HB and PCV (r = 0.63) were positively and significantly correlated (P < 0.05). The estrous cycle in the Spanish Purebred mare is characterized by an increase in TRF and TIBC during the follicular phase and an increase in TSAT, UIBC and RBC in the luteal phase, without changes in other hematological parameters. The coordinated activity of these parameters guarantees an adequate iron (Fe) transfer and utilization during follicular development, ovulation, and the luteal period in the mare. Therefore, the estrous cycle must be considered in the evaluation of the mare's iron status, in light of significant changes observed both in early and at late luteal phases. The magnitude of these changes and the meaning to the physiology of the mares showed that in cyclic mares, hematological parameters and indicators of iron status evolve differently depending on the phase of the cycle, and their interpretation can help to veterinarians involved in equine practice.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Tirant lo Blanc, 7, Alfara del Patriarca, Valencia, 46115, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, Messina, 98168, Italy
| | - Elena Damiá
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Tirant lo Blanc, 7, Alfara del Patriarca, Valencia, 46115, Spain
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, Messina, 98168, Italy
| | - Cristina Cravana
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, Messina, 98168, Italy
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Moumin NA, Shepherd E, Liu K, Makrides M, Gould JF, Green TJ, Grzeskowiak LE. The Effects of Prenatal Iron Supplementation on Offspring Neurodevelopment in Upper Middle- or High-Income Countries: A Systematic Review. Nutrients 2024; 16:2499. [PMID: 39125379 PMCID: PMC11314290 DOI: 10.3390/nu16152499] [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: 07/13/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Iron supplementation is commonly recommended for the prevention and treatment of maternal iron deficiency (ID) or iron deficiency anemia (IDA). However, the impacts of prophylactic of therapeutic prenatal iron supplementation on child neurodevelopment in upper middle-income (UMI) and high-income countries (HICs), where broad nutritional deficiencies are less common, are unclear. To investigate this, we conducted a systematic review, searching four databases (Medline, CINAHL, EMBASE, Cochrane Library) through 1 May 2023. Randomized controlled trials (RCTs) assessing oral or intravenous iron supplementation in pregnant women reporting on child neurodevelopment (primary outcome: age-standardized cognitive scores) were eligible. We included three RCTs (five publications) from two HICs (Spain and Australia) (N = 935 children; N = 1397 mothers). Due to clinical heterogeneity of the RCTs, meta-analyses were not appropriate; findings were narratively synthesized. In non-anemic pregnant women, prenatal iron for prevention of IDA resulted in little to no difference in cognition at 40 days post-partum (1 RCT, 503 infants; very low certainty evidence). Similarly, the effect on the intelligence quotient at four years was very uncertain (2 RCTs, 509 children, very low certainty evidence). No RCTs for treatment of ID assessed offspring cognition. The effects on secondary outcomes related to language and motor development, or other measures of cognitive function, were unclear, except for one prevention-focused RCT (302 children), which reported possible harm for children's behavioral and emotional functioning at four years. There is no evidence from UMI countries and insufficient evidence from HICs to support or refute benefits or harms of prophylactic or therapeutic prenatal iron supplementation on child neurodevelopment.
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Affiliation(s)
- Najma A. Moumin
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- Discipline of Pediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Emily Shepherd
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Kai Liu
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia;
- Lifelong Health, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- Discipline of Pediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Jacqueline F. Gould
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- Discipline of Pediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Tim J. Green
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- College of Nursing and Allied Health, Caring Futures Institute, Flinders University, Adelaide, SA 5042, Australia
| | - Luke E. Grzeskowiak
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; (N.A.M.); (E.S.); (M.M.); (J.F.G.); (T.J.G.)
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia
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O'Toole F, Sheane R, Reynaud N, McAuliffe FM, Walsh JM. Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines. Int J Gynaecol Obstet 2024; 166:214-227. [PMID: 38069617 DOI: 10.1002/ijgo.15270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 06/27/2024]
Abstract
Iron deficiency anemia (IDA) in pregnancy is a common diagnosis that is associated with adverse obstetric and neonatal outcomes. There remains uncertainty regarding how best to screen for, prevent, and treat established IDA in pregnancy. There is no consensus on the benefits of routine iron supplementation in pregnancy, with concerns regarding potential harmful effects of routine iron supplementation in women who are iron replete. Fourteen international guidelines were selected and appraised and compared by a multidisciplinary team. The AGREE II GRS tool was used. Each reviewer independently made their own assessment, and the scores from 1 to 7 were also collated and averaged for an overall score incorporating seven domains: process of development, clarity of presentation, completeness of reporting, clinical validity, and overall quality. The reviewers' scores were also individually compared according to discipline. The mean score across all the guidelines was 4.4 (range 3.5-6.5). Only half of the guidelines recommend routine iron in pregnancy. In terms of screening recommendations, five guidelines recommend screening with ferritin in addition to a full blood count in pregnancy, two recommend selective screening with ferritin for at risk groups only, and one guideline suggests using ferritin where feasible. Although many of the guidelines recommend similar doses of oral elemental iron of 100-200 mg daily for the treatment of established IDA in pregnancy, two recommend twice or three times daily dosing. Only five guidelines give hemoglobin rises to expect within specific timeframes. There remains a need to clarify the optimal screening method, dosing regimen, timing, and route of iron supplementation in pregnancy. Robust randomized controlled data are needed to guide appropriate prevention and management.
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Affiliation(s)
- Fiona O'Toole
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Rachel Sheane
- Department of Dietetics, National Maternity Hospital, Dublin, Ireland
| | - Niamh Reynaud
- Department of Hematology, St Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Jennifer M Walsh
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- Obstetrics & Gynecology, National Maternity Hospital, Dublin, Ireland
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McCarthy EK, Ní Riada C, O'Brien R, Minogue H, McCarthy FP, Kiely ME. Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study. J Hum Nutr Diet 2024. [PMID: 38881396 DOI: 10.1111/jhn.13342] [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: 04/05/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women. METHODS Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics. RESULTS In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important. CONCLUSIONS Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.
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Affiliation(s)
- Elaine K McCarthy
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Clodagh Ní Riada
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Roisin O'Brien
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Hannah Minogue
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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O'Toole FE, Hokey E, McAuliffe FM, Walsh JM. The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study. Eur J Obstet Gynecol Reprod Biol 2024; 297:111-119. [PMID: 38608353 DOI: 10.1016/j.ejogrb.2024.03.005] [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: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The objective of this study was to understand the experience of iron deficiency anaemia requiring oral iron in pregnancy and the factors affecting compliance with oral iron supplementation. Participants' understanding regarding the possible consequences of anaemia in pregnancy was also explored. Feedback on a proposed randomised controlled trial of daily versus alternate day oral iron in pregnancy was sought. MATERIALS & METHODS Following ethical approval, fourteen semi-structured one-to-one interviews were carried out using an interview tool with open-ended questions. Recruitment was carried out through social media and from an antenatal out-patient setting. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS Fatigue emerged as a predominant and troubling symptom. Awareness was often highlighted through friends/family and from healthcare professionals, particularly in first pregnancies. Knowledge surrounding the potential short-term and long-term adverse consequences of untreated anaemia however was limited. Gastro-intestinal side-effects, a previous experience of poor tolerance and forgetfulness all negatively impacted compliance with oral iron supplementation in pregnancy. Routine, a perceived improvement in fatigue with supplementation and reduced dose frequency recurred as themes which positively affected compliance. Pregnancy as a motivating factor recurred as a theme in analysis. The role of diet was felt to be important. Knowledge of iron-rich foods and absorption aids and inhibitors was good, but practice on optimal ingestion of oral iron supplementation varied. Feedback on trial acceptability was positive with the benefit of extra supportive care noted. Incorporating study visits with routine care was advised in view of time constraints. This area of research was perceived as important. CONCLUSION In order to successfully reduce the rates of iron deficiency anaemia in pregnancy, it is crucial that all factors affecting compliance with oral iron are considered. Providing women with the important information on the possible consequences of sub optimally treated anaemia may help to improve this public health issue.
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Affiliation(s)
- F E O'Toole
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland; National Maternity Hospital, Dublin, Ireland.
| | - E Hokey
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - F M McAuliffe
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland; National Maternity Hospital, Dublin, Ireland
| | - J M Walsh
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland; National Maternity Hospital, Dublin, Ireland
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İpek Aytok G, Akkaya Fırat A, Mungan Akın İ, Özel A. How does maternal anemia affect the levels of umbilical cord brain-derived neurotrophic factor? Eur J Obstet Gynecol Reprod Biol 2024; 297:182-186. [PMID: 38677095 DOI: 10.1016/j.ejogrb.2024.04.016] [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: 02/26/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the effect of maternal iron deficiency anemia on the umbilical cord level of brain-derived neurotrophic factor (BDNF), which plays a very important role in the central nervous system. METHODS Our research was planned as a quantitative, prospective, and analytical type of study. A total of 90 volunteers, term, singleton pregnant hospitalized in the Health Sciences University Ümraniye Training and Research Hospital Gynecology and Obstetrics Clinic between September 2021 and August 2022 were included in this study. While 45 of these pregnants were pregnant women with iron deficiency anemia (hemoglobin ≤ 110 g/L and serum ferritin level ≤ 12 μg/L), 45 cases were in the control group without iron deficiency anemia (hemoglobin > 110 g/L, serum ferritin > 12 μg/L). When pregnant were admitted to the hospital, blood samples were taken to analyze hemoglobin, mean cell volume (MCV), iron, unsaturated iron binding capacity, total iron binding capacity, serum ferritin, transferrin, and CRP levels. Also, we noted the maternal age, gravida, parity, birth weight, head circumference, type of birth, 1. minute Apgar score, and 5. minute Apgar score. During the delivery; after the umbilical cord had been clamped and cut, we took 5 cc of umbilical cord blood. Then, we put it in the serum-separating laboratory tubes. After we centrifuged these blood samples, we put the serum parts in the Eppendorf tubes to be stored at -80 degrees Celsius. At the end of the study, we calculated the level of BDNF using special human brain-derived neurotrophic factor ELISA kits. The umbilical cord BDNF levels of the maternal iron deficiency anemia group and the control group were compared statistically. RESULTS When we evaluated the fetal umbilical cord BDNF values of 90 participants, the median value BDNF in the babies of 45 anemic mothers was 3.16 (IQR 0.73), and the median BDNF value of the babies of 45 healthy mothers was 5.37 (IQR 1.02). We found a statistical difference between BDNF and hemoglobin, hematocrit, MCV, and iron values between these two groups. CONCLUSION In conclusion, the BDNF value of the babies of healthy individuals is higher than that of anemic individuals. Our study showed that the amount of BDNF in the umbilical cord blood was significantly affected by maternal iron deficiency anemia.
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Affiliation(s)
- Gökçe İpek Aytok
- Health Sciences University Ümraniye Training and Research Hospital, Department of Gynecology and Obstetrics Ümraniye Istanbul, Turkey
| | - Asuman Akkaya Fırat
- Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Medical Biochemistry Laboratory, Ataşehir Istanbul, Turkey.
| | - İlke Mungan Akın
- Health Sciences University Ümraniye Training and Research Hospital, Department of Pediatric Istanbul, Turkey
| | - Ayşegül Özel
- Health Sciences University Ümraniye Training and Research Hospital, Department of Gynecology and Obstetrics Ümraniye Istanbul, Turkey
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Pop VJM, Krabbe JG, Broeren M, Wiersinga W, Rayman MP. Hypothyroxinaemia during gestation is associated with low ferritin and increased levels of inflammatory markers. Eur Thyroid J 2024; 13:e230163. [PMID: 38330593 PMCID: PMC10959042 DOI: 10.1530/etj-23-0163] [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: 08/30/2023] [Accepted: 02/07/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Pregnancy is a state of physiological inflammation facilitating implantation. Early isolated hypothyroxinaemia (IH) and increased inflammation (including obesity) have been associated with severe obstetric complications. The current study evaluated the association between IH, low ferritin and inflammation parameters (interleukin 6 (IL-6), C-reactive protein (CRP), human chorionic gonadotrophin (hCG) and obesity. Moreover, the course of these parameters throughout pregnancy was evaluated in relation to IH. Methods In the cross-sectional study (A) at 12 weeks, 2759 women participated and 2433 participated in the longitudinal study (B) with assessments at 12, 20 and 28 weeks gestation. At the first trimester, 122 (4.4%) IH women (free thyroxine (FT4) <5th percentile, normal TSH levels) were compared with 2114 (76.6%) reference women (FT4 between tenth and 90th percentiles, normal thyrotrophin (TSH) levels), in study B these figures were 99 (4.1%) and 1847 (75.9%), respectively. Results Cross-sectionally, compared to reference women, IH was independently associated with low ferritin (<5th percentile, OR: 2.6, 95% CI: 1.4-4.9), high CRP (>95th percentile: OR: 1.9, 95% CI: 1.04-3.7), low hCG ( 30, OR: 1.7, 95% CI: 1.12.9) and higher age (OR: 1.1, 95% CI: 1.04-1.15). Longitudinally, compared to reference women, women with IH at 12 weeks gestation showed persistently and significantly lower ferritin and hCG levels, and persistently higher CRP and IL-6 levels throughout gestation. Conclusion Gestational IH could be viewed as a condition of increased inflammation, as reported in non-thyroidal illness syndrome. Less favourable inflammation parameters and low iron status during early gestation in IH women seem to persist throughout gestation.
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Affiliation(s)
- Victor J M Pop
- Department of Medical Psychology, Tilburg University, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Medlon BV, Enschede, The Netherlands
| | - Maarten Broeren
- Department of Clinical Chemistry, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Wilmar Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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11
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Zaugg J, Lopez-Tello J, Musial B, Vaughan OR, Fowden AL, Albrecht C, Sferruzzi-Perri AN. Obesogenic diet in pregnancy disrupts placental iron handling and ferroptosis and stress signalling in association with fetal growth alterations. Cell Mol Life Sci 2024; 81:151. [PMID: 38526599 DOI: 10.1007/s00018-024-05192-5] [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: 11/27/2023] [Revised: 02/07/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
Obesity and gestational diabetes (GDM) impact fetal growth during pregnancy. Iron is an essential micronutrient needed for energy-intense feto-placental development, but if mis-handled can lead to oxidative stress and ferroptosis (iron-dependent cell death). In a mouse model showing maternal obesity and glucose intolerance, we investigated the association of materno-fetal iron handling and placental ferroptosis, oxidative damage and stress signalling activation with fetal growth. Female mice were fed a standard chow or high fat, high sugar (HFHS) diet during pregnancy and outcomes were measured at day (d)16 or d19 of pregnancy. In HFHS-fed mice, maternal hepcidin was reduced and iron status maintained (tissue iron levels) at both d16 and d19. However, fetal weight, placental iron transfer capacity, iron deposition, TFR1 expression and ERK2-mediated signalling were reduced and oxidative damage-related lipofuscin accumulation in the placenta was increased in HFHS-fed mice. At d19, whilst TFR1 remained decreased, fetal weight was normal and placental weight, iron content and iron transporter genes (Dmt1, Zip14, and Fpn1) were reduced in HFHS-fed mice. Furthermore, there was stress kinase activation (increased phosphorylated p38MAPK, total ERK and JNK) in the placenta from HFHS-fed mice at d19. In summary, a maternal HFHS diet during pregnancy impacts fetal growth trajectory in association with changes in placental iron handling, ferroptosis and stress signalling. Downregulation of placental iron transporters in HFHS mice may protect the fetus from excessive oxidative iron. These findings suggest a role for alterations in placental iron homeostasis in determining perinatal outcomes of pregnancies associated with GDM and/or maternal obesity.
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Affiliation(s)
- Jonas Zaugg
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, CH-3012, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) TransCure, University of Bern, Bern, Switzerland
| | - Jorge Lopez-Tello
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
| | - Barbara Musial
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
| | - Owen R Vaughan
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
| | - Abigail L Fowden
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
| | - Christiane Albrecht
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, CH-3012, Bern, Switzerland.
- Swiss National Centre of Competence in Research (NCCR) TransCure, University of Bern, Bern, Switzerland.
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK.
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12
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Brynolf A, Sandström A, Edgren G. Risk of recurrent red-cell transfusion in delivery: A nationwide longitudinal study. BJOG 2024; 131:455-462. [PMID: 37749750 DOI: 10.1111/1471-0528.17672] [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: 05/18/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To investigate the risk of recurrent maternal red-cell transfusion in delivery. DESIGN Nationwide long-standing retrospective cohort study. SETTING Swedish medical birth register. POPULATION All registered births from 2000 to 2017 in Sweden. METHODS We included all women with between one and three consecutive registered births from 22 weeks of gestation onwards and all maternal red-cell transfusions in the peripartum period within the defined period of study. Information on gestational and non-gestational comorbidity was collected and we identified any female siblings. In our analyses we compared the risk of red-cell transfusion in delivery in relation to transfusion history and gestational and non-gestational comorbidity. MAIN OUTCOME MEASURES Maternal peripartum red-cell transfusion, defined as a recorded transfusion in the period from 1 day before and 7 days after delivery. RESULTS We included 825 451 women with a total 1 419 909 deliveries, including 786 097 (55.4%) first, 511 398 (36.0%) second and 122 414 (8.6%) third deliveries. Of women with previous obestric transfusion, 8.7% were transfused in a second delivery, compared with 1.7% of women without transfusion or diagnosis of haemorrhage. A previous diagnosis of haemorrhage did not affect the odds ratio of transfusion recurrence. Among women who were transfused in their first two deliveries, 15.5% were transfused in third delivery, corresponding to an 11-fold increase, compared with non-transfused women (adjusted odds ratio aOR 11.5, 95% CI 7.9-16.6). Women with a sister transfused in delivery were at increased risk of transfusion in a second delivery (aOR 1.8, 95% CI 1.6-2.1). CONCLUSIONS Women with previous red-cell transfusion are at an increased risk of red-cell transfusion in a subsequent delivery, compared with women without a history of red-cell transfusion.
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Affiliation(s)
- Anne Brynolf
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics, Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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13
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Saros L, Hart K, Koivuniemi E, Egan B, Raats M, Laitinen K. Micronutrient supplement recommendations in pregnancy vary across a geographically diverse range of countries: a narrative review. Nutr Res 2024; 123:18-37. [PMID: 38228076 DOI: 10.1016/j.nutres.2023.12.012] [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: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16-195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150-200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.
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Affiliation(s)
- Lotta Saros
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland.
| | - Kathryn Hart
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland
| | - Bernadette Egan
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Monique Raats
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; Nutrition and Food Research Center, University of Turku, 20014 Turku, Finland
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14
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Gasull M, Camargo J, Pumarega J, Henríquez-Hernández LA, Campi L, Zumbado M, Contreras-Llanes M, Oliveras L, González-Marín P, Luzardo OP, Gómez-Gutiérrez A, Alguacil J, Porta M. Blood concentrations of metals, essential trace elements, rare earth elements and other chemicals in the general adult population of Barcelona: Distribution and associated sociodemographic factors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 909:168502. [PMID: 37977377 DOI: 10.1016/j.scitotenv.2023.168502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Very little information is available on the population distribution and on sociodemographic predictors of body concentrations of rare earth elements (REE) and other chemicals used in the manufacturing of high-tech devices. OBJECTIVES To analyze the distribution and associated sociodemographic factors of blood concentrations of chemical elements (including some metals, essential trace elements, rare earth elements and other minority elements) in a representative sample of the general population of Barcelona (Spain). METHODS A sample of participants in the Barcelona Health Survey of 2016 (N = 240) were interviewed face-to-face, gave blood, and underwent a physical exam. Concentrations of 50 chemical elements were analyzed by ICP-MS in whole blood samples. RESULTS All 50 chemicals studied, including 26 REE and minority elements, were detected. Lead, silver, arsenic, cadmium, mercury, antimony, strontium, thallium and six essential trace elements were detected in more than 70% of the population. The most frequently detected REE and minority elements were europium (62%), thulium (56%), gold (41%), indium (31%), ruthenium (24%), and tantalum (20%). Less affluent occupational social classes had higher percentages of detection of some REE. Median concentrations of silver, arsenic, cadmium and mercury were: 0.091, 3.01, 0.309, and 3.33 ng/mL, respectively. Women had lower median concentrations than men of lead (1.47 vs. 2.04 μg/dL, respectively), iron and zinc, and higher concentrations of copper and manganese. The influence of sociodemographic characteristics on chemical concentrations differed by sex. CONCLUSIONS While well-known contaminants as lead, mercury, cadmium, or arsenic were detected in the majority of the population, numerous individuals had also detectable concentrations of chemicals as europium, indium, thulium, or gold. Sociodemographic and physical characteristics (sex, age, social class, weight change) influenced concentrations of some chemicals.
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Affiliation(s)
- Magda Gasull
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Judit Camargo
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Pumarega
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Alberto Henríquez-Hernández
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain; CIBER de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Laura Campi
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Manuel Zumbado
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain; CIBER de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Manuel Contreras-Llanes
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente, Universidad de Huelva, Huelva, Spain
| | - Laura Oliveras
- Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Patricia González-Marín
- Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Octavio P Luzardo
- Toxicology Unit, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain; CIBER de Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Anna Gómez-Gutiérrez
- Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Juan Alguacil
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente, Universidad de Huelva, Huelva, Spain
| | - Miquel Porta
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Shukla A, Awasthi NP, Sharma P, Tiwari V, Sharma VK, Raj Kulshrestha M, Singh P, Husain N. Evaluation of Diagnostic Efficacy of Novel Red Blood Cell Parameters as Potential Screening Test for Detecting Latent Iron Deficiency in Blood Donors. Indian J Hematol Blood Transfus 2024; 40:139-145. [PMID: 38312185 PMCID: PMC10831009 DOI: 10.1007/s12288-023-01683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/27/2023] [Indexed: 02/06/2024] Open
Abstract
Iron deficiency anemia (IDA) forms a major share of global burden of anemia. Frequent blood donation is a common iatrogenic cause of iron insufficiency in healthy adults. Serum iron and hemoglobin levels are normal despite low serum ferritin levels, referred to as latent iron deficiency (LID). Aim of the present study was to evaluate the role of novel RBC parameters-percentage of hypochromic RBCs (%HPO), percentage of microcytic RBCs (%MIC), and haemoglobin content of reticulocytes (MCHr) of Abbott Alinity autoanalyzer as indicators of latent iron deficiency in blood donors. 260 consenting and eligible blood donors were included in the study. Complete blood counts including new RBC parameters on Abbott Alinity autoanalyzer and serum iron profile were measured for all donors. Donors were categorized into LID and No LID based on Ferritin and Transferrin saturation (TSAT). Serum transferrin receptors (sTfR) were studied in a subset of samples [LID (n = 46), No LID (n = 18) and IDA (n = 27)]. Statistical analyses was done on IBM SPSS version 22. Among 260 donors, 56 (21.5%) were found to have LID. The difference in mean values for % HPO, % MIC, and MCHr were not found to be statistically significant in LID and No LID groups. sTfR results between LID, No LID and IDA sub-groups revealed significant difference. This study does not support the role of % HPO, % MIC and MCHr measured on Abott Alinity analyzer, as potential screening parameters for LID amongst blood donors. STfr was more informative in this regard. Further research on much larger sample size is required to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01683-w.
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Affiliation(s)
- Abhishek Shukla
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
| | - Namrata Punit Awasthi
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
| | - Pooja Sharma
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
| | - Vandana Tiwari
- Department of Biochemistry, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti nagar, Lucknow, 226010 India
| | - V. K. Sharma
- Blood Bank, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
| | - Manish Raj Kulshrestha
- Department of Biochemistry, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti nagar, Lucknow, 226010 India
| | - Pradyumn Singh
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
| | - Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, 226010 India
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Zhang Y, Guo T, Huang L, He Z, Wang J, Mei H, Huang X, Wang K. Protective effect of Angelica sinensis polysaccharide on pregnant rats suffering from iron deficiency anemia via regulation of the hepcidin-FPN1 axis. Int J Biol Macromol 2024; 256:128016. [PMID: 37967601 DOI: 10.1016/j.ijbiomac.2023.128016] [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: 06/13/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
Iron deficiency anemia (IDA) is a common micronutrient deficiency among pregnant women with deleterious maternal and fetal outcomes. Angelica sinensis polysaccharide (ASP) has been shown to reduce hepcidin expression in IDA rats. However, the role of ASP in the treatment of IDA during pregnancy and its potential mechanisms have not been investigated. Moreover, the effect of ASP on duodenal iron absorption is not clear. The aim of this study was to investigate the preventive efficacy of ASP against IDA during pregnancy and clarify the underlying mechanisms. Our results showed that ASP improved maternal hematological parameters, increased serum iron, maternal tissue iron, and fetal liver iron content, and improved pregnancy outcomes. Additionally, ASP combated oxidative stress caused by iron deficiency by improving the body's antioxidant capacity. Western blot results demonstrated that ASP downregulated hepcidin expression by blocking the BMP6/SMAD4, JAK2/STAT3 and TfR2/HFE signaling pathways, which in turn increased the expression of FPN1 in the liver, spleen, and duodenum and promoted iron cycling in the body. Furthermore, ASP increased the expression of DMT1 and Dcytb in the duodenum, thereby facilitating duodenal iron uptake. Our results suggest that ASP is a potential agent for the prevention and treatment of IDA during pregnancy.
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Affiliation(s)
- Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China
| | - Tingting Guo
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China
| | - Lei Huang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China
| | - Zihao He
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China
| | - Jinglin Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China.
| | - Hao Mei
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China.
| | - Xiao Huang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, PR China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, 430030 Wuhan, PR China.
| | - Kaiping Wang
- Hubei Key Laboratory of Nature Medicinal Chemistry and Resource Evaluation, Tongji Medical College of Pharmacy, Huazhong University of Science and Technology, 430030 Wuhan, PR China.
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17
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Svensson K, Gennings C, Hagenäs L, Wolk A, Håkansson N, Wikström S, Bornehag CG. Maternal nutrition during mid-pregnancy and children's body composition at 7 years of age in the SELMA study. Br J Nutr 2023; 130:1982-1992. [PMID: 37232113 PMCID: PMC10632724 DOI: 10.1017/s0007114523000983] [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: 11/22/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023]
Abstract
Optimal nutrition during pregnancy is vital for both maternal and child health. Our objective was to explore if prenatal diet is associated with children's height and body fat. Nutrient intake was assessed through a FFQ from 808 pregnant women and summarised to a nutrition index, 'My Nutrition Index' (MNI). The association with children's height and body fat (bioimpedance) was assessed with linear regression models. Secondary analysis was performed with BMI, trunk fat and skinfolds. Overall, higher MNI score was associated with greater height (β = 0·47; (95 % CI 0·00, 0·94), among both sexes. Among boys, higher MNI was associated with 0·15 higher BMI z-scores, 0·12 body fat z-scores, 0·11 trunk fat z-scores, and larger triceps, and triceps + subscapular skinfolds (β = 0·05 and β = 0·06; on the log2 scale) (P-value < 0·05). Among girls, the opposite associations were found with 0·12 lower trunk fat z-scores, and smaller subscapular and suprailiac skinfolds (β = -0·07 and β = -0·10; on the log2 scale) (P-value < 0·05). For skinfold measures, this would represent a ± 1·0 millimetres difference. Unexpectedly, a prenatal diet in line with recommended nutrient intake was associated with higher measures of body fat for boys and opposite to girls at a pre-pubertal stage of development.
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Affiliation(s)
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lars Hagenäs
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sverre Wikström
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Centre for Clinical Research and Education, County Council of Värmland, Värmland County, Sweden
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
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18
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S T PK, Lahiri B. Conditional selection of multifactor evidence for the levels of anaemia among women of reproductive age group. EVALUATION AND PROGRAM PLANNING 2023; 100:102344. [PMID: 37437494 DOI: 10.1016/j.evalprogplan.2023.102344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
The study aims at ascertaining the conditional selection of key indicators affecting severe, moderate, mild, and no anaemia levels for women of reproductive age in India. The secondary data for levels of anaemia and personal records of individuals collected for India from the 7th phase of District Health Survey program of the United States Agency for International Development data depository. The data was cleaned and summarised using frequency and percentages. Then the variables were tested for association with levels of anaemia using the Chi-square (χ2) test. The multinomial logistic regression model was employed to ascertain the key indicators through a conditional selection of reference categories. Results suggest that severe anaemia was significantly prevalent among women in the reproductive stage, especially among the 15-29 age groups. Secondary and higher education had a negative effect on the severity of severe, moderate, and mild anaemia. The poorest wealth index stratum had higher and more significant severe anaemia, and households with two adults of the opposite sex had a significant negative effect (β = -0.116, OR = 0.89, p < 0.001) on severe anaemia level while having a significant positive effect on moderate and mild anaemia. Rural households were associated negatively and significantly with moderate and mild anaemia, and nuclear household structures had a higher prevalence of severe anaemia. Therefore, these indicators across different levels of anaemia should be considered for a faster rate of reduction at the national level. Despite several initiatives by the public sector, the anaemia level has remained elevated among women of reproductive age. Education, wealth index, age, pregnancy, relationship structure, household structure, and place of residence were found to be key indicators for the level of anaemia. The significant variables will act as a crucial input to formulate cost-effective public interventions and finally encourage the faster reduction of anaemia levels.
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Affiliation(s)
- Pavan Kumar S T
- College of Community Science, Central Agricultural University, Tura, Meghalaya 794005, India.
| | - Biswajit Lahiri
- College of Fisheries, Central Agricultural University, Lembucherra, Tripura, India
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Hansen R, Sommer VM, Pinborg A, Krebs L, Thomsen LL, Moos T, Holm C. Intravenous ferric derisomaltose versus oral iron for persistent iron deficient pregnant women: a randomised controlled trial. Arch Gynecol Obstet 2023; 308:1165-1173. [PMID: 36107229 PMCID: PMC10435604 DOI: 10.1007/s00404-022-06768-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/22/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To compare the efficacy of intravenous (IV) iron (ferric derisomaltose) with oral iron (ferrous fumarate) in women 14-21 weeks pregnant with persistent iron deficiency (ferritin < 30 µg/L). METHODS In a single-centre, open-label, randomised controlled trial at a Danish hospital, women with persistent iron deficiency after routine oral iron treatment were allocated to receive 1000 mg IV iron (single-dose) or 100 mg elemental oral iron daily. Outcomes were assessed during an 18-week follow-up period. The primary endpoint was the proportion of non-anaemic (haemoglobin [Hb] ≥ 11 g/dL) women throughout follow-up. Other outcomes included changes in haematological parameters, patient-reported fatigue, and quality of life (QoL). Safety was assessed by recording adverse events. RESULTS From July 2017 to February 2020, 100 women were randomised to IV iron and 101 to oral iron. Throughout follow-up, 91% of women were non-anaemic in the IV iron group compared with 73% in the oral iron group (18% difference [95% confidence interval 0.10-0.25]; p < 0.001). The mean Hb increase was significantly greater with IV iron versus oral iron at Weeks 6 (0.4 versus - 0.2 g/dL; p < 0.001), 12 (0.5 versus 0.1 g/dL; p < 0.001), and 18 (0.8 versus 0.5 g/dL; p = 0.01). Improvements in fatigue and QoL were greater with IV iron versus oral iron at Weeks 3 and 6. The incidence of treatment-related adverse events was comparable between treatment groups. CONCLUSION IV iron was superior in preventing anaemia compared with oral iron in pregnant women with persistent iron deficiency; biochemical superiority was accompanied by improved fatigue and QoL. CLINICAL TRIAL REGISTRATION European Clinical Trials Database: EudraCT no.: 2017-000776-29 (3 May 2017); ClinicalTrials.gov: NCT03188445 (13 June 2017). The trial protocol has been published: https://dx.doi.org/10.1186%2Fs13063-020-04637-z .
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Affiliation(s)
- Rebecka Hansen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Veronika Markova Sommer
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anja Pinborg
- Fertility Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Krebs
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Lykke Thomsen
- Department of Clinical and Non-Clinical Research, Pharmacosmos A/S, Holbæk, Denmark
| | - Torben Moos
- Neurobiology and Drug Delivery, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Charlotte Holm
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Begrambekova YL, Mareev YV, Mareev VY, Orlova YA, Kobalava ZD, Karapetyan LV, Galochkin SA, Kazakhmedov ER, Lapshin AA, Garganeeva AA, Kuzheleva EA, Efremushkina AA, Kiseleva EV, Barbarash OL, Pecherina TB, Galyavich AS, Galeeva ZM, Baleeva LV, Koziolova NA, Veclich AS, Duplyakov DV, Maksimova MN, Yakushin SS, Smirnova EA, Sedykh EV, Shaposhnik II, Makarova NA, Zemlyanukhina AA, Skibitsky VV, Fendrikova AV, Skibitsky AV, Spiropoulos NA, Seredenina EM, Eruslanova KA, Kotovskaya YV, Tkacheva ON, Fedin MA. Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)» study. KARDIOLOGIIA 2023; 63:3-13. [PMID: 37815134 DOI: 10.18087/cardio.2023.9.n2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/27/2023] [Indexed: 10/11/2023]
Abstract
Aim To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.
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Affiliation(s)
| | - Yu V Mareev
- National Medical Research Center for Therapy and Preventive Medicine
| | - V Yu Mareev
- Lomonosov Medical Research and Educational Center
| | - Ya A Orlova
- Lomonosov Medical Research and Educational Center
| | - Zh D Kobalava
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - L V Karapetyan
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - S A Galochkin
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - E R Kazakhmedov
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - A A Lapshin
- People's Friendship University of Russia; Vinogradov Municipal Clinical Hospital
| | - A A Garganeeva
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - E A Kuzheleva
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - A A Efremushkina
- Altai State Medical University; Altai Territorial Cardiological Dispensary
| | | | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T B Pecherina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | | | | | | | | | - D V Duplyakov
- Research Institute of Cardiology, Samara State Medical University; Polyakov Samara Regional Clinical Cardiological Dispensary
| | - M N Maksimova
- Polyakov Samara Regional Clinical Cardiological Dispensary
| | - S S Yakushin
- Pavlov Ryazan State Medical University; Ryazan Regional Clinical Cardiological Dispensary
| | - E A Smirnova
- Ryazan Regional Clinical Cardiological Dispensary
| | - E V Sedykh
- Pavlov Ryazan State Medical University; Ryazan Regional Clinical Cardiological Dispensary
| | | | | | | | | | | | | | | | | | | | | | - O N Tkacheva
- Russian Gerontological Research and Clinical Center
| | - M A Fedin
- Russian Gerontological Research and Clinical Center; Pirogov Russian National Research Medical University
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21
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Evanchuk JL, Kozyrskyj A, Hanas N, Goruk S, Vaghef-Mehrabani E, Archundia-Herrera CM, O'Brien KO, Letourneau NL, Giesbrecht GF, Bell RC, Field CJ. Maternal Iron Status Is Dynamic Throughout Pregnancy and Might Predict Birth Outcomes in a Sex Dependent Manner: Results from the Alberta Pregnancy Outcomes and Nutrition (APrON) Cohort Study. J Nutr 2023; 153:2585-2597. [PMID: 37393033 DOI: 10.1016/j.tjnut.2023.06.042] [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: 02/06/2023] [Revised: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Developmental responses to nutrient deprivation may differ by fetal sex. Despite this, relationships between maternal prenatal iron biomarkers and birth outcomes when stratifying by offspring sex are poorly described, especially in healthy cohorts. OBJECTIVES This study aimed to determine associations between maternal iron biomarkers and birth weights (BWs) and birth head circumferences (BHCs) among female and male newborns to assess whether the potential predictive ability of iron biomarkers on birth outcomes differs by offspring sex. METHODS The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study recruited 2189 pregnant individuals from Calgary and Edmonton, Canada. Maternal blood was drawn at each trimester and 3 mo postpartum. Maternal serum ferritin (SF) concentrations were measured using chemiluminescent immunoassays and erythropoietin (EPO), hepcidin, and soluble transferrin receptor (sTfR) using enzyme-linked immunosorbent assays. Ratios of sTfR:SF and hepcidin:EPO were calculated and birth outcomes accessed through delivery records. Directed acyclic graphs informed multivariate regression models. RESULTS The risk of maternal iron deficiency increased throughout pregnancy because ∼61% showed depleted iron stores (SF < 15 μg/L) by the third trimester. Maternal hepcidin, SF, sTfR, and sTfR:SF concentrations changed across time (P < 0.01), and participants carrying female fetuses consistently (across 6 biomarkers) showed a lower iron status during the third trimester compared with those with male fetuses (P < 0.05). Higher maternal SF and hepcidin:EPO during the third trimester was associated with lower BWs in males (P = 0.006 for SF; P = 0.03 for hepcidin:EPO) and females (P = 0.02 for SF; P = 0.02 for hepcidin:EPO). There were additional inverse associations between BWs and third trimester maternal hepcidin (P = 0.03) and hemoglobin (P = 0.004) and between BHCs and maternal SF (second trimester; P < 0.05) and Hb (third trimester P = 0.02) but only in males. CONCLUSIONS Relationships between maternal iron biomarkers and BWs and BHCs may depend on the timing of pregnancy and offpsring sex. There was a high risk of third trimester iron storage depletion among generally healthy pregnant individuals.
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Affiliation(s)
- Jenna L Evanchuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Natalie Hanas
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Goruk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Kimberly O O'Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Nicole L Letourneau
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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Satué K, Fazio E, La Fauci D, Medica P. Hematological indexes and iron status in pregnant mares. Arch Anim Breed 2023; 66:197-205. [PMID: 37560356 PMCID: PMC10407308 DOI: 10.5194/aab-66-197-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
During pregnancy, iron requirements are increased to meet optimal placental and fetal growth and the expansion of the maternal red-cell mass and to prevent complications related to the mother's iron deficiency anemia. Red-cell parameters and iron status provide consistent additional information for diagnosis of iron deficiency conditions. The aim of this study was to evaluate the serum iron status and its relation to hematological indexes in pregnant mares. Blood samples were taken from 31 Spanish Purebred mares over 11 months of pregnancy. Concentrations of iron (Fe), ferritin (Ferr), transferrin (T), and total iron-binding capacity (TIBC) increased significantly and unsaturated iron-binding capacity (UIBC) decreased as the pregnancy progressed without changes in red blood cell (RBC) count, hemoglobin (HB) concentration, packed cell volume (PCV), and transferrin saturation (TSAT). Fe and Ferr were positively correlated (r = 0.21 ). Fe and T (r = 0.69 ) and Fe and TSAT (r = 0.94 ) were positively correlated, and Fe and UIBC were negatively correlated (r = - 0.69 ). T and TIBC were positively correlated (r = 1.00 ). Pregnancy in the Spanish Purebred mare is characterized by a progressive increase in Fe, Ferr, T, and TIBC and a decrease in UIBC without modification in hematological indexes. Hematological parameters and iron status seem to indicate a sufficiency for Fe transport and its related mobilization and utilization during gestation in Spanish Purebred mares.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary
Medicine, CEU Cardenal Herrera University, 46115 Valencia, Spain
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo
Universitario Annunziata, Viale Palatucci 13, 98168 Messina, Italy
| | - Deborah La Fauci
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo
Universitario Annunziata, Viale Palatucci 13, 98168 Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo
Universitario Annunziata, Viale Palatucci 13, 98168 Messina, Italy
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Sukla SK, Mohanty PK, Patel S, Das K, Hiregoudar M, Soren UK, Meher S. Iron profile of pregnant sickle cell anemia patients in Odisha, India. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S11-S17. [PMID: 35216958 PMCID: PMC10433298 DOI: 10.1016/j.htct.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/09/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION During pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. METHODS Twenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer's protocol. The complete blood count was performed. The unpaired 't-test' was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. MAIN RESULTS The studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. CONCLUSION The current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy.
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Affiliation(s)
- Sunil Kumar Sukla
- Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Pradeep Kumar Mohanty
- Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India; Odisha Sickle Cell Project (NHM), Sickle Cell Institute, VIMSAR, Burla, Sambalpur, Odisha, India
| | - Siris Patel
- Odisha Sickle Cell Project (NHM), Sickle Cell Institute, VIMSAR, Burla, Sambalpur, Odisha, India
| | - Kishalaya Das
- Odisha Sickle Cell Project (NHM), Sickle Cell Institute, VIMSAR, Burla, Sambalpur, Odisha, India
| | - Mrutyunjay Hiregoudar
- Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Uttam Kumar Soren
- Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - Satyabrata Meher
- Odisha Sickle Cell Project (NHM), Sickle Cell Institute, VIMSAR, Burla, Sambalpur, Odisha, India.
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Holzer I, Ott J, Beitl K, Mayrhofer D, Heinzl F, Ebenbauer J, Parry JP. Iron status in women with infertility and controls: a case-control study. Front Endocrinol (Lausanne) 2023; 14:1173100. [PMID: 37361544 PMCID: PMC10285297 DOI: 10.3389/fendo.2023.1173100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Iron deficiency is a common problem in subfertile women. The influence of iron status on unexplained infertility is unknown. Methods In a case-control study, 36 women with unexplained infertility and 36 healthy non-infertile controls were included. Parameters of iron status including serum ferritin and a serum ferritin <30 µg/dL served as main outcome parameters. Results Women with unexplained infertility demonstrated a lower transferrin saturation (median 17.3%, IQR 12.7-25.2 versus 23.9%, IQR 15.4-31.6; p= 0.034) and a lower mean corpuscular hemoglobin concentration (median 33.6 g/dL, IQR 33.0-34.1 versus 34.1 g/dL, IQR 33.2-34.7; p= 0.012). Despite the fact that there was no statistically significant difference in median ferritin levels (p= 0.570), women with unexplained infertility had ferritin levels <30µg/L more often (33.3%) than controls (11.1%; p= 0.023). In a multivariate model, unexplained infertility and abnormal thyroid antibodies were associated with ferritin <30µg/L (OR 4.906, 95%CI: 1.181-20.388; p= 0.029 and OR 13.099; 2.382-72.044; p= 0.029, respectively). Conclusion Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.
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Affiliation(s)
- Iris Holzer
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Klara Beitl
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Mayrhofer
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Heinzl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Johanna Ebenbauer
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - John Preston Parry
- Department of Obstetrics and Gynecology, Louisiana State University Health-Shreveport, Shreveport, LA, United States
- Parryscope and Positive Steps Fertility, Madison, MS, United States
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Kaserer A, Castellucci C, Henckert D, Breymann C, Spahn DR. Patient Blood Management in Pregnancy. Transfus Med Hemother 2023; 50:245-255. [PMID: 37435001 PMCID: PMC10331157 DOI: 10.1159/000528390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Patient blood management (PBM) is a multidisciplinary and patient-centered treatment approach, comprising the detection and treatment of anemia, the minimization of blood loss, and the rational use of allogeneic transfusions. Pregnancy, delivery, and the puerperium are associated with increased rates of iron deficiency and anemia, which correlates with worse maternal and fetal outcomes and places pregnant women at increased risk of obstetric hemorrhage. SUMMARY Early screening for iron deficiency before the onset of anemia, as well as the use of oral and intravenous iron to treat iron deficiency anemia, has been shown to be beneficial. Anemia in pregnancy and the puerperium should be treated according to a staged regimen, administering either iron alone or in combination with an off-label use of human recombinant erythropoietin in selected patients. This regimen should be tailored to the needs of each individual patient. Postpartum hemorrhage (PPH) accounts for up to one-third of maternal deaths in both developing and developed countries. Bleeding complications should be anticipated and blood loss reduced by interdisciplinary preventive measures and individually tailored care. It is recommended that facilities have a PPH algorithm, primarily focusing on prevention through use of uterotonics, but also incorporating early diagnosis of the cause of bleeding, optimization of hemostatic conditions, timely administration of tranexamic acid, and integration of point-of-care tests to support the guided substitution of coagulation factors, alongside standard laboratory tests. Additionally, cell salvage has proven beneficial and should be considered for various indications in obstetrics including hematologic disturbances, as well as various forms of placental disorders. KEY MESSAGE This article reviews PBM in pregnancy, delivery, and the puerperium. The concept comprises early screening and treatment of anemia and iron deficiency, a transfusion and coagulation algorithm during delivery, as well as cell salvage.
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Affiliation(s)
- Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Clara Castellucci
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - David Henckert
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christian Breymann
- Zentrum Gyn & Perinatal, Ärztezentrum Seefeld Hirslanden Klinik Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
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Araujo Costa E, de Paula Ayres-Silva J. Global profile of anemia during pregnancy versus country income overview: 19 years estimative (2000-2019). Ann Hematol 2023:10.1007/s00277-023-05279-2. [PMID: 37233775 DOI: 10.1007/s00277-023-05279-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Anemia is a worldwide public health problem that is worst in low- and middle-income countries (LMICs), reaching 60% of prevalence. The etiology of anemia is diverse and multifactorial, with iron deficiency being the most prevalent, and often found in pregnant women. Iron is indispensable for the production of red blood cells and approximately 80% of the available heme iron is used for hemoglobin synthesis in mature erythroblasts. Iron deficiency affects oxygen transport, compromising energy and muscle metabolism and can occur with depletion of iron storage, defective erythropoiesis, and low hemoglobin levels. We analyzed anemia prevalence in pregnant women from 2000 to 2019 worldwide correlating them with current (2022) country income, with especial attention to LMICs using WHO dataset. Our analysis indicates that pregnant women from LMICs had a higher probability (40%) of anemia during pregnancy especially those from Africa and South Asia. Africa and the Americas showed a higher decrease in the prevalence of anemia from 2000 to 2019. The Americas and Europe have a lower prevalence, concentrated in 57% of most upper-middle- and high-income countries. Black women are also more prone to develop anemia during pregnancy, especially if they are from LMICs. However, the prevalence of anemia appears to decrease with an increase in educational level. In conclusion, anemia prevalence fluctuated from 5.2 to 65.7% worldwide in 2019, validating it as a public health problem.
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Affiliation(s)
- Evelyn Araujo Costa
- Distance Education Center of Rio de Janeiro State (CEDERJ), Rio de Janeiro, Brazil
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Satué K, Fazio E, Cravana C, Medica P. Hepcidin, ferritin and iron homeostasis in pregnant Spanish Purebred mares. Theriogenology 2023; 206:78-86. [PMID: 37201298 DOI: 10.1016/j.theriogenology.2023.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
During pregnancy, maternal erythropoietic expansion and fetal development require greater mobilization of available iron (Fe) stores. These adjustments in Fe metabolism in humans and rodents are largely mediated by the hormone hepcidin (Hepc), which controls the expression of ferroportin (Fpn), a transporter responsible for exporting Fe from stores to extracellular fluid and plasma. These mechanisms based on the regulation of Hepc on the availability of Fe during gestation in healthy mares remain unknown. The objective of this study was to determine the existence of interrelationships among concentrations of Hepc, ferritin (Ferr), Fe, and estrone (E1) and progesterone (P4) in Spanish Purebred mares along the whole gestation. Blood samples were taken from 31 Spanish Purebred mares each month, during 11 months of pregnancy. Fe and Ferr significantly increased and Hepc decreased during pregnancy (P < 0.05). The secretion peak of estrone (E1) was reached in the 5th month and progesterone (P4) between the 2nd and 3rd months of gestation (P < 0.05). Fe and Ferr were weakly positively correlated (r = 0.57; P < 0.05). Fe and Ferr were negatively correlated with Hepc (r = -0.80 and r = -0.67, respectively) (P < 0.05). P4 was positively correlated with Hepc (r = 0.53; P < 0.05). Pregnancy in the Spanish Purebred mare was characterized by a progressive increase in Fe and Ferr and a reduction in Hepc concentrations. E1 was partially responsible for the suppression of Hepc; on the other hand, P4 induced its stimulation during pregnancy in the mare.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Tirant lo Blanc, 7, Alfara del Patriarca, 46115, Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Cristina Cravana
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Marcos Puig B, Llopis-Morales J, Picó Y. Effect of Adherence to the Mediterranean Diet on Maternal Iron Related Biochemical Parameters during Pregnancy and Gestational Weight Gain. Life (Basel) 2023; 13:life13051138. [PMID: 37240783 DOI: 10.3390/life13051138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Gestation is a crucial life stage for both women and offspring, and outcomes are affected by many environmental factors, including diet. The Mediterranean dietary pattern (MD) is considered a healthy eating pattern that can provide the nutritional requirements of pregnancy. Meanwhile, iron deficiency anemia is one of the most frequent complications related to pregnancy. This study aimed to evaluate how the level of adherence to the MD influences maternal gestational weight gain and specific iron-related maternal biochemical parameters during the pregnancy. Accordingly, an observational, population-based study using data from pregnant women conducted over the entire course of their pregnancy was carried out. Adherence to the MD was assessed once using the MEDAS score questionnaire. Of the 506 women studied, 116 (22.9%) were classified as demonstrating a high adherence, 277 (54.7%) a medium adherence, and 113 (22.3%) a low adherence to the MD. No differences were observed in gestational weight gain among the MD adherence groups but the adequacy of weight gain did vary among the groups, with the proportions of inadequate (insufficient or excessive) weight gain presenting the most notable differences. Total anemia prevalence was 5.3%, 15.6%, and 12.3%, respectively, during the first, second, and third trimesters. For iron-related biochemical parameters, no differences are observed among the adherence groups during pregnancy. With high adherence to the MD as the reference group, the crude odds of iron deficiency diagnosis are significant in the first trimester for both the medium [OR = 2.99 (1.55-5.75)] and low [OR = 4.39 (2.15-8.96)] adherence groups, with deficient adherence to the Mediterranean dietary pattern being responsible for 66.5% (35.5-82.6) and 77.2% (53.5-88.8) of the risk of iron deficiency diagnosis for medium and low adherence, respectively. However, adjusted odds ratios were not significant, possibly due to the small sample size. Our data suggest that MD adherence could be related to gestational weight gain adequacy and that optimal adherence could reduce iron deficiency and/or anemia during pregnancy in the studied population.
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Affiliation(s)
- María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Beatriz Marcos Puig
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 València, Valencia, Spain
| | - Juan Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
| | - Yolanda Picó
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- Biomedical Research Center in Epidemiology and Public Health Network, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
- Environmental and Food Safety Research Group (SAMA-UV), Desertification Research Centre, (CIDE, CSIC-UV-GV), Moncada-Naquera Road Km 4.5, 46113 Moncada, Valencia, Spain
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29
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Maternal factors associated with iron deficiency without anaemia in early pregnancy: ECLIPSES study. Ann Hematol 2023; 102:741-748. [PMID: 36790457 PMCID: PMC9998312 DOI: 10.1007/s00277-023-05123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
Several population-specific genetic, sociodemographic, and maternal lifestyle factors are related to iron status in early pregnancy, and their identification would allow preventive actions to be taken. The study aimed to identify maternal factors associated with iron deficiency (ID) in early pregnancy in non-anaemic pregnant women from a European Mediterranean country. Cross-sectional study using the initial population of the ECLIPSES study performed in non-anaemic pregnant women before gestational week 12. Serum ferritin (SF) and haemoglobin concentrations were measured to evaluate iron status, and ID was defined as SF < 15 µg/L. Several sociodemographic and lifestyle data were recorded and used as covariates in the multivariate-adjusted regression models. Out of the 791 participants, 13.9% had ID in early pregnancy. Underweight (OR 3.70, 95%CI 1.22, 15.53) and parity (1 child: OR 2.03, 95%CI 1.06, 3.88; ≥ 2 children: OR 6.96, 95%CI 3.09, 15.69) increased the odds of ID, while a high intake of total meat (≥ 108.57 g/day: OR 0.37, 95%CI 0.15, 0.87), red/processed meat (≥ 74.29 g/day: OR 0.70, 95%CI 0.35, 0.98), protein (≥ 65.05 g/day: OR 0.85, 95%CI 0.30, 0.99), and dietary iron (≥ 8.58 mg/day: OR 0.58, 95%CI 0.35, 0.94) protected against it. Smoking was also associated with a reduction in ID odds (OR 0.34, 95%CI 0.12, 0.99). Baseline BMI, parity, smoking, and diet are associated with ID in early pregnancy in non-anaemic women. Pregnancy planning policies should focus on women at higher risk of ID, such as those who are underweight, multiparous, or following vegetarian diets. This clinical trial was registered at www.clinicaltrialsregister.eu as EudraCT number 2012-005,480-28 and at www.clinicaltrials.gov with identification number NCT03196882.
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Aedh AI, Khalil MSM, Abd-Elkader AS, El-Khawanky MM, Alshehri HM, Hussein A, Alghamdi AAL, Hasan A. Reticulocyte Hemoglobin as a Screening Test for Iron Deficiency Anemia: A New Cut-Off. Hematol Rep 2023; 15:201-211. [PMID: 36975734 PMCID: PMC10048437 DOI: 10.3390/hematolrep15010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Latent iron deficiency (LID), in which iron stores in the body are depleted without incidental anemia, poses a key diagnostic challenge. Reticulocyte hemoglobin content (Ret-Hb) is directly correlated with the functionally available iron for heme synthesis in erythroblasts. Consequently, Ret-Hb has been proposed as an efficient iron status marker. Aim: To assess the importance of Ret-Hb in detecting latent iron deficiency as well as its use in screening for iron deficiency anemia. Materials and Methods: A study involving 108 individuals was conducted at Najran University Hospital, 64 of whom had iron deficiency anemia (IDA) and 44 of whom had normal hemoglobin levels. All patients were subjected to complete blood count (CBC), reticulocyte percentage, Ret-Hb, serum iron, total iron binding capacity (TIBC), and serum ferritin measurements. Results: A significant decrease in Ret-Hb level was observed in IDA patients compared to non-anemic individuals, with a cut-off value of 21.2 pg (a value below which indicates IDA). Conclusion: The measurement of Ret-Hb, in addition to CBC parameters and indices, provides an accessible predictive marker for both iron deficiency (ID) and IDA. Lowering the Ret-Hb cut-off could better allow for its use as a screening parameter for IDA.
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Affiliation(s)
- Abdullah I. Aedh
- Internal Medicine Department, College of Medicine, Najran University, Najran 55461, Saudi Arabia; (A.I.A.)
| | - Mohamed S. M. Khalil
- Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Alaa S. Abd-Elkader
- Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed M. El-Khawanky
- Clinical Hematopathology, College of Medicine, Najran University, Najran 55461, Saudi Arabia
| | - Hamdan M. Alshehri
- Internal Medicine Department, College of Medicine, Najran University, Najran 55461, Saudi Arabia; (A.I.A.)
| | - Amr Hussein
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Ali A. Lafi Alghamdi
- Laboratory Department, Prince Mishari bin Saud Hospital, Saudi Ministry of Health, Baljurashi 22888, Saudi Arabia
| | - Abdulkarim Hasan
- Laboratory Department, Prince Mishari bin Saud Hospital, Saudi Ministry of Health, Baljurashi 22888, Saudi Arabia
- Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
- Correspondence: ; Tel./Fax: +20-224012932
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31
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Wu Y, Yang R, Lan J, Wu Y, Huang J, Fan Q, You Y, Lin H, Jiao X, Chen H, Cao C, Zhang Q. Iron overload modulates follicular microenvironment via ROS/HIF-1α/FSHR signaling. Free Radic Biol Med 2023; 196:37-52. [PMID: 36638901 DOI: 10.1016/j.freeradbiomed.2022.12.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Iron is essential for the health of reproductive system, and women with iron overload suffer from ovarian dysfunction and lack effective treatment in fertility preservation. However, the underlying mechanism of the detrimental effects of iron overload on ovarian function remains ambiguous. Here, we confirmed the excess iron in the circumjacent follicle near endometriomas, which negatively impacted the oocyte development in the affected ovaries. Further, by integrating cell line and chronic iron overload mice model, we demonstrated that iron overload can function as a ROS inducer to amplify mitochondria damage, which significantly elevated the release of cytochrome C and ultimately induced the apoptosis of granular cells. Besides, for the first time, our findings revealed that disruption of HIF-1α/FSHR/CYP19A1 signaling was critical for decreased estrogen synthesis of granular cells in response to iron overload, which can lead to apparent oocyte maldevelopment and subfertility. Overall. this study uncovered that iron overload modulated the follicular microenvironment and generated a deleterious effect on female infertility via ROS/HIF-1α/FSHR signaling. These results might provide potential implications for future clinical risk management of patients with endometrioma and hemopathy.
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Affiliation(s)
- Yaoqiu Wu
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Rong Yang
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Jie Lan
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Yingchen Wu
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Jianyun Huang
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Qi Fan
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Yang You
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Haiyan Lin
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Xuedan Jiao
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Hui Chen
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
| | - Chunwei Cao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China; Guangzhou Laboratory, Guangzhou, 510320, China; Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Center for Reproductive Genetics and Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Qingxue Zhang
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
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32
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Liu L, Yan F, Yan H, Wang Z. Impact of iron supplementation on gestational diabetes mellitus: A literature review. Diabetes Obes Metab 2023; 25:342-353. [PMID: 36200449 DOI: 10.1111/dom.14886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/02/2023]
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy, affecting 14% of pregnancies worldwide, and the prevention of pathological hyperglycaemia during pregnancy is meaningful for global public health. The role of iron supplementation in the progression of GDM has been of significant interest in recent years. Iron is a micronutrient that is vital during pregnancy; however, given the toxic properties of excess iron, it is probable that prophylactic iron supplementation will increase the risk of adverse pregnancy outcomes, including GDM. It is critical to clarify the effect of iron supplementation on the risk of GDM. Therefore, in this review, we comprehensively assess the role of iron in pregnancy. This review aimed to analyse the necessity of iron supplementation and maintenance of iron homeostasis during pregnancy, particularly reviewing the role and function of iron in beta cells and examining the mechanisms of excess iron contributing to the pathogenesis of GDM. Moreover, we aimed to discuss the association of haemoglobin and ferritin with GDM and identify priority areas for research.
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Affiliation(s)
- Lulu Liu
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
| | - Feng Yan
- Department of Gynecology, Baoding Maternal and Child Health Hospital, Baoding, China
| | - Hongyuan Yan
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
- Key Laboratory of Medicinal Chemistry and Molecular Diagnosis of Ministry of Education, College of Pharmaceutical Sciences, Hebei University, Baoding, China
| | - Zhiqiang Wang
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
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33
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Lin Y, Wu C, An R, Liu H, Chen M, Tan H, Chen L, Deng J. The association of iron status, supplement iron in the first-trimester pregnancy with gestational diabetes mellitus: A nested case-control study. J Obstet Gynaecol Res 2023; 49:597-605. [PMID: 36443988 DOI: 10.1111/jog.15509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
AIMS The objective of this study was to examine whether the level of iron and iron supplements in the first-trimester pregnancy is associated with gestational diabetes mellitus (GDM). METHODS This was a nested case-control study using data from an established cohort in the Hunan Provincial Maternal and Child Health Hospital (HPMCHH) in South China. A total of 119 patients with GDM and 238 controls were enrolled in the study. Iron status indicators were tested in early pregnancy. Information on iron supplements use was collected by questionnaires. Binary logistic regression was used to obtain odds ratio (OR). The relative excess risk of interaction (RERI) was applied to evaluate the interaction. RESULTS We observed that pregnant women with normal ferritin levels (≥30 ng/ml) and iron supplements were associated with a 3.701-fold increased risk of GDM (OR: 3.701, 95% CI: 1.689-8.112) compared with the ferritin <30 ng/ml and without iron supplements group. Similarly, pregnant women with normal serum iron (SI) levels (≥9 μmol/L) and iron supplements were associated with a 5.447-fold increased risk of GDM (OR: 5.447, 95% CI: 2.246-13.209) compared with the SI < 9 μmol/L and without iron supplement group. We found an additive interaction between ferritin and iron supplements on the presence of GDM (RERI: 1.164, 95%CI: 0.333-1.994) and SI and iron supplements on the risk of GDM (RERI: 6.375, 95%CI: 4.494-8.256). CONCLUSION Pregnant women with normal ferritin or SI levels and iron supplements could significantly increase the risks for GDM.
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Affiliation(s)
- Ying Lin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Chunli Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rongjing An
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huixia Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengshi Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
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34
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Hu TY, Mayasari NR, Cheng TM, Bai CH, Chao JCJ, Huang YL, Wang FF, Skalny AV, Tinkov AA, Chang JS. Polymorphisms of haptoglobin modify the relationship between dietary iron and the risk of gestational iron-deficiency anemia. Eur J Nutr 2023; 62:299-309. [PMID: 35974112 DOI: 10.1007/s00394-022-02987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess whether polymorphisms of haptoglobin (Hp) modify the relationship between dietary iron and the risk of gestational iron-deficiency anemia (IDA). METHODS This study analyzed 1430 singleton pregnant women aged 20 ~ ≤ 48 years from the 2017-2019 National Nutrition and Health Survey of Pregnant Women in Taiwan. Sociodemographic, blood biochemical, Hp phenotype, and 24-h dietary recall data were collected. Erythropoiesis-related total prenatal supplementation was defined as the reported use of multivitamins and minerals, vitamin B complex, folate, and iron. RESULTS Distributions of the Hp 1-1, Hp 2-1, and Hp 2-2 phenotypes were 13.6, 39.8, and 46.5%, respectively. Women with the Hp 1-1 phenotype had the lowest mean levels of serum ferritin (p-trend = 0.017), the highest prevalence of gestational ID (p-trend = 0.033) as well as the highest prevalence of gestational IDA (did not reach statistical differences, p-trend = 0.086). A gene-diet interaction on serum ferritin was observed between the Hp 1 and Hp 2 (2-1/2-2) alleles (p < 0.001). An adjusted multivariate logistic regression showed that compared to those with a normal blood iron status and who reported using erythropoiesis-related total prenatal supplements, those who did not had a 4.05-fold [odds ratio (OR) = 4.05 (95% confidence interval (CI) 2.63-6.24), p < 0.001] increased risk of gestational IDA. The corresponding ORs for carriers of the Hp 1 and Hp 2 alleles were 4.78 (95% CI 1.43-15.99) and 3.79 (95% CI 2.37-6.06), respectively. CONCLUSION Pregnant women who are Hp 1 carriers are at increased risk for developing IDA if they do not meet the recommended dietary allowance for iron or use erythropoiesis-related prenatal supplements.
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Affiliation(s)
- Tzu-Yu Hu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
| | - Noor Rohmah Mayasari
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
| | - Tsai-Mu Cheng
- Graduate Institute of Translational Medicine, College of Medical Sciences and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.,College of Public Health, Master Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan.,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ya-Li Huang
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Fan-Fen Wang
- Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Anatoly V Skalny
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,KG Razumovsky Moscow State University of Technologies and Management, 109004, Moscow, Russia
| | - Alexey A Tinkov
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Yaroslavl State University, Yaroslavl, Russia
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan. .,Chinese Taipei Society for the Study of Obesity (CTSSO), Taipei, Taiwan.
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35
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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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Naveed K, Goldberg N, Shore E, Dhoot A, Gabrielson D, Goodarzi Z, Lin Y, Pai M, Pardy NA, Robinson S, Andreou R, Sood M, Price V, Storm S, Verduyn A, Parker ML, Fralick M, Beriault D, Sholzberg M. Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study. Int J Lab Hematol 2023; 45:377-386. [PMID: 36602151 DOI: 10.1111/ijlh.14016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence-base of iron-related lab test cut-offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. METHODS A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. RESULTS Twenty-six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. CONCLUSION Consensus statements generated through this study corresponded with current evidence-based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.
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Affiliation(s)
- Kanza Naveed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Goldberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eliane Shore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Dhoot
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Natasha A Pardy
- Department of Hematology, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Sue Robinson
- Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roseann Andreou
- Division of Hematology/Oncology, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Manish Sood
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherri Storm
- Academic Family Health Team & Women's and Children's Health Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Verduyn
- Department of Rehabilitative Care, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle L Parker
- DynaLIFE Medical Labs and Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Fralick
- Department of Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Beriault
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
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37
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Milman NT. Effects of iron supplementation to iron depleted and iron replete pregnant Danish women: Defining criteria for identification of women who can manage without supplements: A randomized, placebo-controlled study. J Neonatal Perinatal Med 2023; 16:547-562. [PMID: 37718872 DOI: 10.3233/npm-231210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To define criteria based on iron status parameters for the identification of healthy women who do need/do not need iron supplementation during normal pregnancy. METHODS Randomized, double-blind, placebo-controlled study of 113 women (62 iron-, 51 placebo treated) and their newborns. Iron dose was 66 mg elemental iron as ferrous fumarate daily from 14-18 weeks gestation to delivery. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage, and S-erythropoietin were measured during gestation, prepartum, one week and 8 weeks postpartum. The women were divided in groups according to S-ferritin levels at inclusion:<30,≥30,≥40,≥50 and≥60μg/L. Iron deficiency (ID) was defined as S-ferritin < 15μg/L; iron deficiency anemia (IDA) as S-ferritin < 15μg/L and Hb < 110 g/L. RESULTS Placebo treated women with S-ferritin levels < 30μg/L at inclusion had a much higher incidence of ID/IDA than placebo treated women with S-ferritin levels≥30,≥40,≥50, and≥60μg/L. S-ferritin levels≥40μg/L were associated with a very low risk of ID/IDA and none of the women with levels≥50 and≥60μg/L displayed ID/IDA. CONCLUSIONS Women having S-ferritin < 30μg/L in early pregnancy, have a high risk of ID/IDA and should be recommended ferrous iron supplements in appropriate doses. With increasing iron reserves, i.e., increasing S-ferritin, the need for iron supplements diminishes, and placebo treated women having S-ferritin ≥40μg/L seldom develop IDA. Women with S-ferritin levels≥50 and≥60μg/L or higher, have adequate iron reserves and do not need routine iron prophylaxis in pregnancy. The results support the arguments for an individual iron supplementation guided by iron status, to avoid unwanted side effects of unnecessary iron intake.
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Affiliation(s)
- N T Milman
- Department of Clinical Biochemistry, Naestved Hospital, Zealand University College, Naestved, Denmark
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Milman NT. Iron supplementation in pregnant Danish women revisited: Effects on prepartum and postpartum iron deficiency, anemia, serum erythropoietin; including iron status, erythropoietin and anthropometrics in newborns. A randomized, placebo-controlled study. J Neonatal Perinatal Med 2022; 15:731-744. [PMID: 35811545 DOI: 10.3233/npm-221014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess effects of iron supplementation, 66 mg elemental iron daily as ferrous fumarate, on iron status markers during normal pregnancies. METHODS Randomized, double-blind, placebo-controlled study of 119 women (62 iron-, 57 placebo -treated) and their newborns. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage (TSAT) and S-erythropoietin (S-EPO) were measured at 14-18, 24-27 weeks of gestation, prepartum, 1 and 8 weeks postpartum. RESULT From 24-27 weeks gestation to 8 weeks postpartum, the iron group had higher Hb, S-ferritin and TSAT than the placebo group; prepartum, 11% had iron deficiency (ID) and 0% iron deficiency anemia (IDA) in the iron group, vs 60% and 18% in the placebo group; 8 weeks postpartum 1.6% in the iron group had ID and 1.6% IDA vs 14% and 7% in the placebo group. S-EPO levels in the iron group were lower than in the placebo group (p < 0.001). Mothers prepartum S-EPO values were correlated to newborns cord S-EPO values (p < 0.001). Newborns to iron treated mothers had higher cord S-ferritin levels than those to placebo treated mothers (p = 0.02). Newborn girls had higher cord S-ferritin levels than boys (p < 0.01). There was no impact of iron supplementation on the length of gestation, placental weight, or newborns birth weight. Birth weight was correlated only with mothers' body weight, length of gestation and placental weight. CONCLUSION Iron supplementation had a "positive" impact on iron status and Hb both during pregnancy and postpartum, with a low frequency of ID/IDA and also a "positive" influence on newborns iron status.
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Affiliation(s)
- N T Milman
- Department of Clinical Biochemistry, Naestved Hospital, Zealand University College, Naestved, Denmark
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Lavriša Ž, Hristov H, Hribar M, Koroušić Seljak B, Gregorič M, Blaznik U, Zaletel K, Oblak A, Osredkar J, Kušar A, Žmitek K, Lainščak M, Pravst I. Dietary Iron Intake and Biomarkers of Iron Status in Slovenian Population: Results of SI.Menu/Nutrihealth Study. Nutrients 2022; 14:nu14235144. [PMID: 36501175 PMCID: PMC9741255 DOI: 10.3390/nu14235144] [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: 10/04/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Inadequate iron intake and iron deficiency are recognised as a public health problem in the population at large, and particularly in specific subpopulations. Dietary iron intake was analysed using data of the national Slovenian food consumption study, SI.Menu (n = 1248 subjects; 10−74 years), while iron status was evaluated with laboratory analyses of blood haemoglobin, serum ferritin, and iron concentration in samples, collected in the Nutrihealth study (n = 280, adults). The estimated daily usual population-weighted mean iron intakes ranged from 16.0 mg in adults and the elderly to 16.7 in adolescents, and were lower in females for all three age groups. The main dietary iron sources in all the age groups were bread and bakery products, meat (products), fruit, and vegetables. The highest prevalence of haemoglobin anaemia was observed in females aged 51−64 years (6.7%). Critically depleted iron stores (ferritin concentration < 15 µg/L) were particularly found in premenopausal females (10.1%). Factors influencing low haemoglobin, ferritin, and iron intake were also investigated. We observed significant correlations between iron status with meat and fish intake, and with iron intake from meat and fish, but not with total iron intake. We can conclude that particularly premenopausal females are the most fragile population in terms of inadequate iron intake and iron deficiency, which should be considered in future research and public health strategies.
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Affiliation(s)
- Živa Lavriša
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
| | - Hristo Hristov
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
| | - Maša Hribar
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva Ulica 101, SI-1000 Ljubljana, Slovenia
| | - Barbara Koroušić Seljak
- Computer Systems Department, Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
| | - Matej Gregorič
- National Institute of Public Health, Trubarjeva ulica 2, SI-1000 Ljubljana, Slovenia
| | - Urška Blaznik
- National Institute of Public Health, Trubarjeva ulica 2, SI-1000 Ljubljana, Slovenia
| | - Katja Zaletel
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
- University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Adrijana Oblak
- University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
| | - Joško Osredkar
- University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, SI-1000 Ljubljana, Slovenia
| | - Anita Kušar
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
| | - Katja Žmitek
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
- VIST–Faculty of Applied Sciences, Gerbičeva cesta 51A, SI-1000 Ljubljana, Slovenia
| | - Mitja Lainščak
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
- Department of Internal Medicine, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, SI-9000 Murska Sobota, Slovenia
| | - Igor Pravst
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva Ulica 101, SI-1000 Ljubljana, Slovenia
- VIST–Faculty of Applied Sciences, Gerbičeva cesta 51A, SI-1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-590-68871; Fax: +386-310-07981
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Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study. BMC Public Health 2022; 22:2217. [PMID: 36447164 PMCID: PMC9706931 DOI: 10.1186/s12889-022-14684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Migration is usually accompanied by changes in the social, cultural, and religious environment, socioeconomic status, and housing conditions, all of which affect nutritional health. In a cross-sectional study, we assessed the dietary intake as well as nutritional and health situation in a population of Syrian refugees who have resided in Germany for at least six months up to four years since 2015. The primary aim of this pilot study was to evaluate the nutritional and health status in comparison to reference values. METHODS Between December 2018 and March 2020, 114 adult Syrian refugees were included in the study. The subjects filled out questionnaires on sociodemographic variables, exercise, and nutrition behavior (three-day nutrition record). After a fasting blood draw, the subjects were examined for anthropometric parameters (height, weight, body mass index, waist circumference, waist-hip ratio, and body composition via a bioelectrical impedance analyzer). Various blood markers including iron status, hematological parameters, Vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured. RESULTS About half of the participants (71 male, 43 female) had lived in Germany for less than three years. Over 60% of men and 30% of women were overweight (BMI 25-30 kg/m2) or obese (BMI > 30 kg/m2), while 79% of men and 74% of women observed an elevated body fat mass. The evaluation of the three-day nutrition records revealed an unfavorable supply situation for numerous critical nutrients. More than half of the women (53.5%) had depleted iron stores (serum ferritin < 15 µg/l). The 25-OH-Vitamin D blood levels showed a high prevalence of Vitamin D insufficiency (25-49.9 nmol/l: 38% of men and 21% of women) and deficiency (< 25 nmol/l: 44% of men and 70% of women). 83% of men and 67% of women showed tHcy levels in plasma > 10 nmol/l. Fasting insulin levels and the HOMA-IR index indicate a risk for insulin resistance. Hyperlipidemia was prevalent, especially in males with 24% showing hypertriglyceridemia (> 150 mg/dl) and LDL-hypercholesterolemia (> 130 mg/dl). CONCLUSIONS The nutritional and health status of the cohort of Syrian refugees in Germany examined in this study is unsatisfactory, and many of the investigated refugees are at risk for developing cardiovascular disease and type 2 diabetes mellitus. Further studies are required to investigate the nutritional and health situation of refugees. This is obligatory to find ways to avoid malnutrition with all its associated health, sociodemographic, and economic consequences.
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Tarancon-Diez L, Genebat M, Roman-Enry M, Vázquez-Alejo E, Espinar-Buitrago MDLS, Leal M, Muñoz-Fernandez MÁ. Threshold Ferritin Concentrations Reflecting Early Iron Deficiency Based on Hepcidin and Soluble Transferrin Receptor Serum Levels in Patients with Absolute Iron Deficiency. Nutrients 2022; 14:nu14224739. [PMID: 36432426 PMCID: PMC9692751 DOI: 10.3390/nu14224739] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
(1) Background: The serum ferritin cut-off to define absolute iron deficiency is not well-established. The aim of the present study was to determine a clinically relevant ferritin threshold by using early serum biomarkers of iron deficiency such as hepcidin and the soluble transferrin receptor; (2) Methods: Two hundred and twenty-eight asymptomatic subjects attending a hospital as outpatients between 1st April 2020 and 27th February 2022 were selected. Iron metabolism parameters as part of the blood analysis were requested by their doctor and included in the study. Then, they were classified into groups according to their ferritin levels and iron-related biomarkers in serum were determined, quantified, and compared between ferritin score groups and anemic subjects. (3) Results: Serum ferritin levels below 50 ng/mL establish the point from which the serum biomarker, the soluble transferrin receptor to hepcidin ratio (sTfR/Hep ratio), begins to correlate significantly with ferritin levels. (4) Conclusion: Ferritin levels ≤ 50 ng/mL are indicative of early iron deficiency; hence, this should be considered as a clinically relevant cut-off for iron deficiency.
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Affiliation(s)
- Laura Tarancon-Diez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Miguel Genebat
- Internal Medicine Department, Hospital Fátima, 41012 Sevilla, Spain
| | | | - Elena Vázquez-Alejo
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Maria de la Sierra Espinar-Buitrago
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Manuel Leal
- Internal Medicine Department, Hospital Viamed Santa Ángela de la Cruz, 41014 Sevilla, Spain
- Correspondence: (M.L.); (M.Á.M.-F.)
| | - Mª Ángeles Muñoz-Fernandez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
- Correspondence: (M.L.); (M.Á.M.-F.)
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Tao Y, Kang J, Liu J, Duan J, Wang F, Shi Y, Li Y, Wang C, Xu D, Qu X, Guo J, Ma J, Zhang Y. Association of low birthweight and small for gestational age with maternal ferritin levels: A retrospective cohort study in China. Front Nutr 2022; 9:1002702. [PMID: 36299991 PMCID: PMC9589249 DOI: 10.3389/fnut.2022.1002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Birthweight have profound impacts on health status throughout lifetime, however, the relationship between maternal ferritin level in pregnancy and birthweight of the newborn remains controversial. Objective This retrospective cohort research was to analyze the association between maternal ferritin levels during pregnancy with birthweight outcomes, primarily for low birthweight (LBW) and small for gestational age (SGA). Methods Newborns weighing lower than 2,500 grams were defined as LBW. SGA is defined as birthweight lower than the 10th percentile of the distribution of newborns' birthweight of the same gestational age. Multivariable logistic regressions have been used to explore the association of maternal ferritin levels and birthweight related outcomes, in which the ferritin concentration was logarithm transformed in the model. We further used restricted cubic spline models to explore linear/non-linear dose–response manners of ferritin level and birthweight outcomes. Results A total of 3,566 pregnant women were included in the study. In the results of the present study, we observed that maternal ferritin levels were linearly associated with the risk of LBW (p-trend = 0.005) and SGA (p-trend = 0.04), with the adjusted odds ratios (ORs) of 1.78 (95% CI 1.37–2.32) for LBW and 1.87 (95% CI 1.38–2.54) for SGA with an increase in Ln-ferritin concentrations per unit. The adjusted ORs across quartiles of ferritin levels were 2.14 (95% CI 1.03–4.47) for Quartile 2, 3.13 (95% CI 1.47–6.69) for Quartile 3, and 3.63 (95% CI 1.52–8.68) for Quartile 4 for LBW. The adjusted ORs of LBW and SGA among women using supplemental iron were 0.56 (95% CI 0.38, 0.85) and 0.65 (95% CI 0.40, 1.05) compared with non-users, respectively. Conclusions Our findings found a linear dose–response relationship between ferritin levels and an increased risk of poor birthweight outcomes, suggesting that maternal ferritin level during pregnancy may provide an additional predictor for differentiating poor birthweight related outcomes. Further exploration should be conducted to ensure maternal ferritin thresholds and iron supplement doses.
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Affiliation(s)
- Yun Tao
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Jiawei Kang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Juan Liu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Jie Duan
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Fang Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Yue Shi
- Information Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yujuan Li
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Cheng Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Dan Xu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinlan Qu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianhong Ma
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China,Jianhong Ma
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China,*Correspondence: Yuanzhen Zhang
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Resseguier AS, Guiguet-Auclair C, Debost-Legrand A, Serre-Sapin AF, Gerbaud L, Vendittelli F, Ruivard M. Prediction of Iron Deficiency Anemia in Third Trimester of Pregnancy Based on Data in the First Trimester: A Prospective Cohort Study in a High-Income Country. Nutrients 2022; 14:nu14194091. [PMID: 36235743 PMCID: PMC9572795 DOI: 10.3390/nu14194091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Systematic iron supplementation may be harmful in pregnant women with non-depleted iron. Our objectives were to estimate the prevalence of anemia at the third trimester of pregnancy (T3) and to identify the parameters at the first trimester (T1), which best predict anemia at T3. Methods: This prospective cohort study in France included pregnant women at T1 without non-iron deficiency anemia. Clinical and social characteristics, health-related quality of life, blood count, and a frozen blood sample were collected at T1 and/or T3. Secondly, a matched nested case−control study was built for women with anemia at T3 but not at T1. Multivariate analyses and ROC curves were used to identify the best predictive parameter(s) of anemia at T3. Results: The prevalence of anemia at T3 in the cohort (629 women) was 21.9% (95% CI 18.7−25.2%). In the matched nested case−control study (256 women), hemoglobin (Hb), serum ferritin (SF) and the SF/soluble transferrin receptor ratio at T1 were predictive of anemia at T3 (p < 0.001); however, clinical and social characteristics, as serum hepcidin were not. In multivariate analyses, Hb at T1 was the best predictive biomarker of anemia at T3 with a cut-off value of 120 g/L (specificity 87.5%). Conclusions: The prevalence of anemia at the end of pregnancy remained high in a High-Income Country. Clinical, social, and biochemical parameters did not seem useful to predict anemia at T3 and could not guide iron supplementation. We suggest systematically performing a simple blood count in the first trimester of pregnancy and offering oral iron supplementation for women with Hb < 120 g/L.
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Affiliation(s)
- Anne-Sophie Resseguier
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Internal Medicine Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Public Health Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Réseau de Santé Périnatale d’Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | | | - Laurent Gerbaud
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Public Health Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Françoise Vendittelli
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Réseau de Santé Périnatale d’Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marc Ruivard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
- Internal Medicine Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Correspondence:
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Iglesias-Vázquez L, Hernández-Martínez C, Voltas N, Canals J, Coronel P, Gimeno M, Arija V. Adapting prenatal iron supplementation to maternal needs results in optimal child neurodevelopment: a follow-up of the ECLIPSES Study. BMC Pregnancy Childbirth 2022; 22:710. [PMID: 36115950 PMCID: PMC9482254 DOI: 10.1186/s12884-022-05033-y] [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: 05/12/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Prenatal prescription of standard iron supplements to prevent iron deficiency appears not to be appropriate for all women and their children, as some women may be at risk of iron deficiency and others at risk of iron excess early in pregnancy. The present study aimed to assess whether prenatal iron supplementation adapted to the needs of each pregnant woman affects their child’s neurodevelopment.
Methods
Follow-up of a community-based RCT involving 503 mother–child pairs. Non-anaemic pregnant women recruited in Tarragona (Spain) early in pregnancy were prescribed a daily iron dose based on their initial haemoglobin levels: Stratum 1 (Hb = 110–130 g/L, 80 or 40 mg/d of iron) and Stratum 2 (Hb > 130 g/L, 40 or 20 mg/d of iron). Women receiving 40 mg/d were considered the control group in each Strata. The child’s neurodevelopment was assessed at 40 days of age using the Bayley Scales of Infant Development-III (BSID-III). Adjusted multiple regression models were used.
Results
Multiple regression analyses showed no association between the intervention and control group within each Strata on the BSID-III scores on any of the developmental scales in children, including cognitive, language, and motor development: Stratum 1 (β 1.46, 95%CI -2.15, 5.07; β 1.30, 95%CI -1.99, 4.59; and β 2.04, 95%CI -3.88, 7.96, respectively) and Stratum 2 (β -4.04, 95%CI -7.27, 0.80; β -0.36, 95%CI -3.47, 2.75; and β -3.76, 95%CI -9.30, 1.78, respectively).
Conclusions
In non-anaemic women in early pregnancy, no differences were found in the cognitive, language and motor development of children at 40 days of age between the dose of iron tested in each case –adjusted to initial Hb levels– compared to the dose of the control group. Further studies are guaranteed to confirm our findings.
Trial registration
The ECLIPSES study was registered at www.clinicaltrialsregister.eu as EudraCT number 2012–005,480-28.
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Raut AK, Hiwale KM. Iron Deficiency Anemia in Pregnancy. Cureus 2022; 14:e28918. [PMID: 36225459 PMCID: PMC9541841 DOI: 10.7759/cureus.28918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Through its functions in oxygen delivery, electron transport, and enzymatic activity, iron is crucial for the operation of all cells. High metabolic rate cells need more iron and are more likely to malfunction when there is an iron deficit. Since the mother's blood volume expands during pregnancy, and the fetus grows and develops, there is a sharp increase in the need for iron. Negative pregnancy outcomes, such as increased maternal sickness, low birthweight, preterm, and intrauterine growth restriction, are linked to iron deficiency. IDA, or nutritional iron deficiency anemia, affects more than two billion people worldwide and is the most prevalent disease. Based on the regression-based analysis, the prevalence of anemia in the World Health Organization's global database was calculated to be 14%. According to recent data, there are 17.4% more IDA cases among pregnant women in industrialized countries than in poor ones (up to 56% more cases). Despite the fact that oral iron supplementation is frequently used to treat IDA, not all patients benefit from oral iron therapy. This is caused by a number of things, which include the adverse effects of oral iron, resulting in low compliance and ineffectiveness. In a sizable group of patients taking oral iron preparations, the adverse effects primarily include GI symptoms. Intravenous iron was previously underutilized since it was linked to unfavorable and occasionally dangerous side effects. New type II and III iron complexes have been created recently, though, and they offer superior compliance and toleration in addition to strong efficacy and a good safety profile.
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Fite MB, Bikila D, Habtu W, Tura AK, Yadeta TA, Oljira L, Roba KT. Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study. BMC Nutr 2022; 8:82. [PMID: 35978383 PMCID: PMC9382738 DOI: 10.1186/s40795-022-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the high burden of anemia among pregnant women in low-resource settings like Ethiopia is well documented, evidence is scarce on the underlying causes using biochemical tests. Therefore, this study assessed the iron status and factors associated with iron deficiency (ID) using serum ferritin concentration among pregnant women in Haramaya district, eastern Ethiopia. METHODS A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. The serum ferritin (SF) concentration was measured in the National Biochemical Laboratory of Ethiopia on a fully automated Cobas e411 (German, Japan Cobas 4000 analyzer series) immunoassay analyzer using the electro-chemiluminescence (ECL) method and standard procedures. A log-binomial regression analysis identified variables associated with iron deficiency, and defined as serum ferritin concentration < 15 μg/L (per the World Health Organization recommendation in developing countries). An adjusted risk ratio (aRR), and a 95% confidence interval (CI), were used to report associations. Finally, the p-value < 0.05 was the cut-off point for the significant association. RESULTS A total of 446 pregnant women with a mean age of 24.78 (+ 5.20) were included in the study. A total of 236 (52.91%; 95% CI: 48.16-57.63) had iron deficiency. The overall prevalence of anemia and iron deficiency anemia (IDA) was 45.96% (95% CI: 41.32-50.71) and 28.03% (95% CI: 21.27-32.44), respectively. The risk of iron deficiency was more likely among women with low dietary diversity (aRR = 1.36; 95% CI = 1.07-1.72) and those who skipped meals (aRR = 1.29; 95% CI = 1.05-1.57), but less among women who had antenatal care (aRR = 0.73 (95% CI = 0.61-0.88). CONCLUSION More than half of the pregnant women in eastern Ethiopia had iron deficiency. Improving dietary diversity, meal frequency, and prenatal follow-up is essential to improve the high burden of ID and the adverse effect on pregnant women and the fetus. Moreover, a prospective study comparing maternal and perinatal outcomes among these spectra-iron depletion, ID, and IDA-is crucial for understanding their impact on maternal and perinatal mortality and morbidity.
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Affiliation(s)
- Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Demiraw Bikila
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wossene Habtu
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Iron deficiency anaemia associated with increased placenta praevia and placental abruption: a retrospective case-control study. Eur J Clin Nutr 2022; 76:1172-1177. [PMID: 35301462 DOI: 10.1038/s41430-022-01086-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES A few studies reported association between placenta praevia (PP) and placental abruption (PA) with maternal iron deficiency anaemia (IDA), which is not an established risk factor for these conditions. This retrospective case-control study was performed to determine the relationship between IDA with PP and PA. METHODS Maternal characteristics, risk factors for and incidence of antepartum haemorrhage overall, and PP and PA, were compared between women with IDA only and controls without IDA or haemoglobinopathies matched for exact age and parity (four controls to each index case), who carried singleton pregnancy to ≥22 weeks and managed under our care from 1997 to 2019. RESULTS There were 1,176 women (0.8% of eligible women in the database) with IDA only, who exhibited slightly but significantly different maternal characteristics, and increased antepartum haemorrhage overall (3.4% versus 2.2%, p = 0.031, OR 1.522, 95% CI 1.037-2.234) and PP (1.8% versus 0.9%, p = 0.010, OR 1.953, 95% CI 1.164-3.279), but not PA (1.2% versus 1.1%, p = 0.804, OR 1.077, 95% CI 0.599-1.936). When stratified by parity status, increased PP was found in nulliparous women only. On multivariate analysis adjusting for parity, previous abortion history, overweight and obesity, short stature, other antenatal complications as a composite factor, preterm (<37) delivery, previous caesarean delivery, and infant gender, IDA was associated with PP (aOR 3.485, 95% CI 1.959-6.200) and PA (aOR 2.181, 95% CI 1.145-4.155). CONCLUSIONS Both PP and PA are increased in women with IDA, the prevention of which could be a means to reduce the occurrence of both PP and PA.
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Rezgale R, Pudule I, Cauce V, Klaramunta Antila K, Bule V, Lazdane G, Rezeberga D, Meija L. Iron Status in Pregnant Women in Latvia: An Epidemiological, Cross-Sectional, Multicenter Study According to WHO and UK Criteria. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070955. [PMID: 35888674 PMCID: PMC9321800 DOI: 10.3390/medicina58070955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: During pregnancy, iron deficiency anaemia is a common problem associated with health risks for both the mother and her foetus/infant. This study aimed to investigate the prevalence of iron deficiency, iron deficiency anaemia, and related dietary patterns in pregnant women in Latvia. Materials and Methods: This cross-sectional, multicentre study included pregnancy data from 974 women. The sample selection was based on the stratification principle (population of women of childbearing age in regions of Latvia). Maternal demographic details, anthropometric measurements, iron status, dietary patterns, and supplementation information were obtained from maternal files and during interviews held in eight outpatient departments of medical institutions and maternity departments. The prevalence was assessed. Chi-square tests and logistic regression were used to identify associations between iron deficiency and sociodemographic characteristics, dietary patterns, and iron supplement intake during pregnancy. The criterion used for the diagnosis of iron deficiency anaemia is a Hb level <110 g/L in the 1st and 3rd trimesters and <105 g/L during the 2nd trimester as recommended by the WHO. However, the UK guideline was used for borderline iron deficiency, which is an SF level <30 μg/L in all trimesters. Results: The observed prevalence of anaemia was 2.8% in the first trimester, 7.9% in the second trimester, and 27.0% in the third trimester. The prevalence of iron deficiency was 46.7% in the first trimester, 78.1% in the second trimester, and 91.7% in the third trimester. No associations with dietary patterns were found. Single women had 1.85 times the odds (95% CI 1.07 to 3.18) of being anaemic than married women. Conclusions: Iron deficiency affects a large proportion of pregnant women in Latvia in all trimesters, with iron deficiency anaemia affecting pregnant women in the third trimester. Monitoring and intervention should be performed in a timely and more targeted manner.
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Affiliation(s)
- Roberta Rezgale
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Iveta Pudule
- Centre for Disease Prevention and Control of Latvia, 22 Duntes Street, LV-1005 Rīga, Latvia;
| | - Vinita Cauce
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Kristine Klaramunta Antila
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Violeta Bule
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Riga East Clinical University Hospital, 2 Hipokrāta Street, LV-1038 Rīga, Latvia
| | - Gunta Lazdane
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
| | - Dace Rezeberga
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Riga Maternity Hospital, 45 Miera Street, LV-1013 Rīga, Latvia
| | - Laila Meija
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema Street, LV-1007 Rīga, Latvia; (R.R.); (V.C.); (K.K.A.); (V.B.); (G.L.); (D.R.)
- Pauls Stradins Clinical University Hospital, 13 Pilsoņu Street, LV-1002 Rīga, Latvia
- Correspondence: ; Tel.: +371-294-081-99
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Prevalence of postpartum anaemia and iron deficiency by serum ferritin, soluble transferrin receptor and total body iron, and associations with ethnicity and clinical factors: a Norwegian population-based cohort study. J Nutr Sci 2022; 11:e46. [PMID: 35754987 PMCID: PMC9201879 DOI: 10.1017/jns.2022.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Worldwide, there are limited data on the prevalence of postpartum anaemia and iron status. The aims of the present study were to assess the prevalence of anaemia and iron deficiency (ID) by three iron indicators 14 weeks postpartum, their relations to haemoglobin (Hb) and associations with ethnicity and clinical factors in a multi-ethnic population. We conducted a population-based cohort study of 573 women followed from early pregnancy. The prevalence of postpartum anaemia (Hb <12·0 g/dl) was 25 %. ID prevalence varied from 39 % by serum ferritin (SF <15 μg/l), to 19 % by soluble transferrin receptor (sTfR >4·4 mg/l) and 22 % by total body iron (TBI < 0 mg/kg). The mean Hb concentration was 12·8 g/dl in women with no ID, 12·6 g/dl in those with ID by SF only and 11·6 g/dl in those with ID by SF, sTfR and TBI. ID by sTfR and TBI defined by the current threshold values probably identified a more severe iron-deficient population compared with ID assessed by SF. Compared with Western Europeans, the prevalence of anaemia was at least the double in ethnic minorities (26–40 % v. 14 %; P < 0·01–0·05), and the prevalence of ID by sTfR and TBI, but not of ID by SF < 15 μg/l, was significantly higher in some minority groups. After adjustment for covariates, only South Asians had lower Hb and higher sTfR concentration. Insufficient iron intake, gestational anaemia or ID, and postpartum haemorrhage were associated with lower postpartum Hb concentration and poorer iron status.
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Quezada-Pinedo HG, Cassel F, Muckenthaler MU, Gassmann M, Huicho L, Reiss IK, Duijts L, Gaillard R, Vermeulen MJ. Ethnic differences in adverse iron status in early pregnancy: a cross-sectional population-based study. J Nutr Sci 2022; 11:e39. [PMID: 35720171 PMCID: PMC9161035 DOI: 10.1017/jns.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
We studied ethnic differences in terms of iron status during pregnancy between Dutch women and other ethnicities and explore to what extent these differences can be explained by environmental factors. This cross-sectional population-based study (2002-2006) was embedded in the Generation R study and included a total of 4737 pregnant women from seven ethnic groups (Dutch, Turkish, Moroccan, Cape Verdean, Surinamese-Hindustani, Surinamese-Creole and Antillean). Ethnicity was defined according to the Dutch classification of ethnic background. Ferritin, iron and transferrin were measured in early pregnancy. The overall prevalence of iron deficiency was 7 %, ranging from 4 % in both Dutch and Surinamese-Creoles, to 18 % in Turkish, Moroccan and Surinamese-Hindustani women. Iron overload was most prevalent in Surinamese-Creole (11 %) and Dutch (9 %) women. Socioeconomic factors accounted for 5-36 % of the differences. Income was the strongest socioeconomic factor in the Cape Verdean and Surinamese-Hindustani groups and parity for the Turkish and Moroccan groups. Lifestyle determinants accounted for 8-14 % of the differences. In all groups, the strongest lifestyle factor was folic acid use, being associated with higher iron status. In conclusion, in our population, both iron deficiency and iron overload were common in early pregnancy. Our data suggest that ethnic differences in terms of socioeconomic and lifestyle factors only partly drive the large ethnic differences in iron status. Our data support the development of more specific prevention programmes based on further exploration of socioeconomic inequities, modifiable risk and genetic factors in specific ethnic subgroups, as well as the need for individual screening of iron status before supplementation.
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Affiliation(s)
- Hugo G. Quezada-Pinedo
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Florian Cassel
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Martina U. Muckenthaler
- Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Molecular Medicine Partnership Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Irwin K. Reiss
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marijn J. Vermeulen
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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