scholarly journals Iron Status from Early Through Late Pregnancy and Neonatal Anthropometric Measures: Friend or Foe?

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1003-1003
Author(s):  
Anisa Holloman ◽  
Jing Wu ◽  
Mengying Li ◽  
Shristi Rawal ◽  
Ellen Francis ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Gestational Age ◽  
Chronic Conditions ◽  
Iron Status ◽  
Late Pregnancy ◽  
Increased Risk ◽  
Maternal Iron ◽  
In Pregnancy

Abstract Objectives Although iron status in pregnancy is an important factor for fetal growth, associations between maternal iron status and neonatal size are highly conflicting. Further, studies with longitudinal measures of iron status in pregnancy are scarce. This study investigated maternal iron status from early through late pregnancy using comprehensive measures of iron biomarkers (ferritin, hepcidin, soluble transferrin receptor [sTfR], and sTfR: ferritin ratio) in relation to neonatal size. Methods This study included 321 pregnant women without major chronic conditions before pregnancy who were enrolled in the NICHD Fetal Growth Study- Singletons (n = 2802). Plasma iron biomarkers (i.e., ferritin, sTfR, hepcidin) were measured at 4 visits (10–14, 15–26, 23–31, and 33–39 gestational weeks [GW]). We used linear and Poisson regression models adjusted for covariates including pre-pregnancy BMI and C-reactive protein to estimate the association of tertiles (T) of iron biomarkers and clinically defined iron status with neonatal anthropometry, such as birthweight (BW), risk of large and small-for-gestational age (LGA, SGA) and macrosomia. Results Iron deficiency (i.e., ferritin <12 ug/L) at 10–14 GW was related to increased risk of macrosomia and LGA; adjusted RR (95% confidence interval (CI)) were 3.64 (1.45, 9.17), and 14.2 (5.49, 36.4), respectively. At 15–26 GW, iron deficiency was also related to increased risk of LGA with a RR of 3.58 (1.13, 11.4). In contrast, at 33–39 GW, iron deficiency was related to lower risk of macrosomia with a RR of 0.06 (0.01, 0.36). The CIs were wide, largely due to small sample size of macrosomia cases. In addition, at 10–14 GW, lower iron status (indicated by higher sTfR levels) was related to greater BW; highest vs. lowest T mean BW was 3385 g vs. 3251 g with an adjusted p-value for difference <0.05. Conclusions Our findings among U.S. pregnant women without major chronic conditions before pregnancy suggest that the relation of maternal iron status to neonatal size may vary by gestational age and lower iron status in early pregnancy is generally related to heavier neonates. Funding Sources Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH).

scholarly journals Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2221
Author(s):  
Hugo G. Quezada-Pinedo ◽  
Florian Cassel ◽  
Liesbeth Duijts ◽  
Martina U. Muckenthaler ◽  
Max Gassmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Child Health ◽  
Methodological Quality ◽  
Iron Status ◽  
Meta Analysis ◽  
Child Health Outcomes ◽  
Maternal Iron ◽  
In Pregnancy

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.

Maternal iron deficiency alters trophoblast differentiation and placental development in rat pregnancy

Endocrinology ◽  
2021 ◽  
Author(s):  
Hannah Roberts ◽  
Andrew G Woodman ◽  
Kelly J Baines ◽  
Mariyan J Jeyarajah ◽  
Stephane L Bourque ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Fetal Growth ◽  
Growth And Development ◽  
Iron Homeostasis ◽  
Junctional Zone ◽  
Altered Expression ◽  
Expression Of Genes ◽  
Iron Deficient ◽  
Increased Risk ◽  
Maternal Iron

Abstract Iron deficiency occurs when iron demands chronically exceed intake, and is prevalent in pregnant women. Iron deficiency during pregnancy poses major risks for the baby, including fetal growth restriction and long-term health complications. The placenta serves as the interface between a pregnant mother and her baby, and ensures adequate nutrient provisions for the fetus. Thus, maternal iron deficiency may impact fetal growth and development by altering placental function. We used a rat model of diet-induced iron deficiency to investigate changes in placental growth and development. Pregnant Sprague-Dawley rats were fed either a low-iron or iron-replete diet starting two weeks before mating. Compared to controls, both maternal and fetal hemoglobin were reduced in dams fed low-iron diets. Iron deficiency decreased fetal liver and body weight, but not brain, heart or kidney weight. Placental weight was increased in iron deficiency, due primarily to expansion of the placental junctional zone. The stimulatory effect of iron deficiency on junctional zone development was recapitulated in vitro, as exposure of rat trophoblast stem cells to the iron chelator deferoxamine increased differentiation toward junctional zone trophoblast subtypes. Gene expression analysis revealed 464 transcripts changed at least 1.5-fold (P<0.05) in placentas from iron-deficient dams, including altered expression of genes associated with oxygen transport and lipoprotein metabolism. Expression of genes associated with iron homeostasis was unchanged despite differences in levels of their encoded proteins. Our findings reveal robust changes in placentation during maternal iron deficiency, which could contribute to the increased risk of fetal distress in these pregnancies.

scholarly journals Prevalence of Iron Deficiency in Pregnancy: A Single Centre Canadian Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4896-4896
Author(s):  
Grace Tang ◽  
Andrea Lausman ◽  
Jessica Petrucci ◽  
Jameel Abdulrehman ◽  
Rosane Nisenbaum ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Iron Status ◽  
Tertiary Care ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Iron Deficient ◽  
In Pregnancy

Abstract Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in both developing and developed countries (WHO, 2001; Mei et al., 2011). Women of child bearing age are at the highest risk, but this risk increases even more during pregnancy. The expansion of blood volume, growth of the fetus and placenta increase demand for iron to approximately 5.0mg/day by the third trimester (Met et al., 2011). Common symptoms of ID during pregnancy include fatigue, shortness of breath, and difficulty concentrating (WHO, 2001). Poor prenatal iron status is associated with diminished cognitive performance, language ability, and motor functions in the child (Tamura et al, 2002). For the mother, it is associated with risk of blood transfusion and post-partum depression. Despite international recommendations and guidelines on the management of ID in pregnancy, it remains a problem of epidemic proportions and is often unrecognized and left untreated. To increase awareness of ID, a quality improvement project, IRON Deficiency project in Pregnancy: Maternal Iron Optimization (IRON MOM) was implemented January 1st, 2017 at St. Michael's Hospital (SMH), in Toronto, Canada. Phase 1 of the project involved adapting lab requisitions and workflow in the obstetrics clinic to incorporate routine measurement of ferritin in week 12, 16 and 28 of pregnancy. As part of the IRON MOM, laboratory requisitions were modified to include ferritin as part of routine screening for all pregnant women. Objective The primary objective of this study was to assess the prevalence of ID in pregnant women consistently screened for ID after the implementation of the IRON MOM quality improvement project at a tertiary hospital in Toronto, Canada. Methods Administrative laboratory data was collected from the electronic medical record system at SMH, Toronto, Canada between January 1 and December 31, 2017. Suboptimal iron stores was defined as serum ferritin between 30-50μg/L. ID was defined as serum ferritin between 15-29μg/L, and severe ID was defined as <15μg/L. Significant anemia was defined as hemoglobin levels <100 g/L. Descriptive statistics were used to calculate proportions. SAS version 9.4 was used to perform the analyses. Results In 2017, 2400 ferritin tests were completed on pregnant women at our institution. A total of 76.8% (1844/2400) of tests demonstrated iron deficiency with a ferritin <30μg/L. Of those, 30.2% (726/2400) had ferritin between 15-29μg/L, and 46.6% (1118/2400) were severely iron deficient with a ferritin <15μg/L (Figure 1). 3282 hemoglobin checks, at delivery, occurred in this same one-year period and 10.5% (345/3282) were significantly anemic (<100 g/L). Of those, 6.2% (204/3282) had hemoglobin levels between 90-99g/L, 2.6% (85/3282) had hemoglobin levels between 80-89g/L, and 1.7% (56/3282) had hemoglobin levels <80g/L. Conclusion We found an extremely high prevalence of ID in our pregnant patient population. This confirms that ID remains an underappreciated problem, even at a tertiary care centre. Our findings highlight a tremendous gap in awareness, which demands strategies to improve knowledge translation. Future directions include the simplification and digitization of IRON MOM to empower pregnant patients to advocate for their care. Figure 1. Figure 1. Disclosures Lausman: Ferring: Other: gave a talk.

scholarly journals Insulin-stimulated adiponectin secretion in pregnancy is mediated by inhibition of adiponectin ubiquitination and degradation and is impaired in obesity

2021 ◽  
Author(s):  
Irving L. M. H. Aye ◽  
Fredrick J. Rosario ◽  
Anita Kramer ◽  
Oddrun Kristiansen ◽  
Trond M. Michelsen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Adipose Tissue ◽  
Gestational Diabetes ◽  
Er Stress ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Molecular Mechanisms ◽  
Placental Function ◽  
Increased Risk ◽  
In Pregnancy

ABSTRACTIn pregnancy, adiponectin serves as an endocrine link between maternal adipose tissue, placental function and fetal growth, with low adiponectin promoting placental function and fetal growth. Circulating adiponectin levels are decreased in obese pregnant women and in gestational diabetes, which is believed to contribute to the insulin resistance and increased risk of fetal overgrowth associated with these conditions. However, the molecular mechanisms governing adiponectin secretion from maternal adipose tissues in pregnancy are poorly understood. Using visceral adipose tissue from lean and obese pregnant mice, we show that obesity in pregnancy is associated with adipose tissue inflammation, ER stress, insulin resistance, increased adiponectin ubiquitination and decreased total abundance of adiponectin. Moreover, adiponectin ubiquitination was increased in visceral fat of obese pregnant women as compared to lean pregnant women. We further observed that insulin prevents, whereas ER stress and inflammation promote, adiponectin ubiquitination and degradation in differentiated 3T3-L1 adipocytes. We have identified key molecular pathways regulating adiponectin secretion in pregnancy. This information will help us better understand the mechanisms controlling maternal insulin resistance and fetal growth in pregnancy and may provide a foundation for the development of strategies aimed at improving adiponectin production in pregnant women with obesity or gestational diabetes.

scholarly journals Investigating the Links between Lower Iron Status in Pregnancy and Respiratory Disease in Offspring Using Murine Models

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4461
Author(s):  
Henry M. Gomez ◽  
Amber L. Pillar ◽  
Alexandra C. Brown ◽  
Richard Y. Kim ◽  
Md Khadem Ali ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Lung Function ◽  
Respiratory Disease ◽  
Iron Status ◽  
Severe Disease ◽  
Experimental Models ◽  
Murine Models ◽  
Iron Supplements ◽  
Increased Risk ◽  
In Pregnancy

Maternal iron deficiency occurs in 40–50% of all pregnancies and is associated with an increased risk of respiratory disease and asthma in children. We used murine models to examine the effects of lower iron status during pregnancy on lung function, inflammation and structure, as well as its contribution to increased severity of asthma in the offspring. A low iron diet during pregnancy impairs lung function, increases airway inflammation, and alters lung structure in the absence and presence of experimental asthma. A low iron diet during pregnancy further increases these major disease features in offspring with experimental asthma. Importantly, a low iron diet increases neutrophilic inflammation, which is indicative of more severe disease, in asthma. Together, our data demonstrate that lower dietary iron and systemic deficiency during pregnancy can lead to physiological, immunological and anatomical changes in the lungs and airways of offspring that predispose to greater susceptibility to respiratory disease. These findings suggest that correcting iron deficiency in pregnancy using iron supplements may play an important role in preventing or reducing the severity of respiratory disease in offspring. They also highlight the utility of experimental models for understanding how iron status in pregnancy affects disease outcomes in offspring and provide a means for testing the efficacy of different iron supplements for preventing disease.

Factors influencing foetal growth in pregnancy complicated by diabetes

2017 ◽  
Vol 4 (6) ◽  
pp. 2136
Author(s):  
Sathish Kumar S. ◽  
Anandhi A. ◽  
Luke Ravi Chelliah ◽  
Karthick A. R.
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Gestational Age ◽  
Growth Pattern ◽  
Abdominal Circumference ◽  
Large For Gestational Age ◽  
Maternal Weight ◽  
In Pregnancy

Background: Gestational diabetes mellitus represents a metabolically altered fetal environment due to an increased maternal supply of carbohydrates. It leads to fetal hyperinsulinemia and stimulates insulin-sensitive tissue, predominantly of the abdomen, resulting in increased fetal growth and delivering large-for-gestational-age newborns. Implications of fetal hyperinsulinemia reach far beyond delivery. Children of mothers with diabetes in pregnancy are predisposed to develop obesity and glucose intolerance through a non-genetic “fuel-mediated” mechanism. The objective of the present study was to study the “fetal growth pattern at different periods of pregnancy complicated by diabetes” and to identify the factors that influence the fetal growth pattern in pregnancy complicated by diabetesMethods: 69 pregnant women with diabetes and 34 pregnant women without diabetes were included in the study by random sampling. Maternal parameters such as age, parity, height, weight at registration, and weight gain during pregnancy, BMI at the time of registration of pregnancy and at the time of delivery, detailed diabetic profile and management including meal plan, insulin administration and dosage were recorded. The fetuses were monitored for Biparietal diameter, abdomen circumference, femur length by 2 ultrasound examinations, one at 18-22 weeks and another at 28-32 weeks were performed. Soon after delivery, sex, gestational age, birth weight, length, head circumference and chest circumference of the newborn were recorded and infants were classified as LGA/SGA/AGA.Results: Maternal age, parity, BMI at the time of delivery and maternal weight gain had significant influence on the birth weight. The abdominal circumference of the fetus detected at 18-20 and 28-32 ultrasound scans had a very significant correlation with neonatal mean birth weight percentile. Conclusions: Not all babies born to diabetic mothers are macrosomic. SGA babies were not uncommon in pregnancies with diabetes especially in those who did not have significant micro vasculopathy. Maternal nutrition plays a significant key role in determining birth weight of babies even in pregnancies complicated by diabetes.

scholarly journals Iron Deficiency Project in Pregnancy: Maternal Iron Optimization (IRON MOM)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4893-4893
Author(s):  
Jameel Abdulrehman ◽  
Grace Tang ◽  
Rosane Nisenbaum ◽  
Jessica Petrucci ◽  
Katerina Pavenski ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Clinical Pathways ◽  
Reproductive Age ◽  
Psychomotor Development ◽  
Long Term Effects ◽  
Post Intervention ◽  
One Year ◽  
Maternal Iron ◽  
In Pregnancy

Abstract Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in the world and is found predominantly in women of reproductive age. The prevalence of ID is even higher in pregnancy, as maternal iron requirements increase to accommodate the expansion of maternal red blood cell (RBC) mass, development of the placenta and fetus, and the loss of blood associated with labor and delivery. When ID leads to anemia (IDA), it is associated with preterm delivery, cesarian delivery, RBC transfusions, low birth weight, five minute Apgar score < 7, neonatal intensive care unit admission and long term effects on mental and psychomotor development in the child. Although ID in pregnancy is simple to diagnose and treat, it often goes undiagnosed and untreated, due to low awareness of its implications and multiple competing priorities. Objectives Our primary objective was to increase awareness of ID in pregnant women, measured by a process metric which compared the monthly rate of ferritin testing pre- versus post-initiative. Our secondary objective was to decrease the incidence of IDA in pregnant women, measured by comparing the proportion of women to ever have an antepartum hemoglobin (HB) ≥ 100g/L pre- versus post- initiative. Methods Using a multidisciplinary and sequential quality improvement approach, we developed the IRON MOM toolkit for use at our institution, St. Michael's Hospital (SMH), Toronto, Canada. The toolkit included educational resources for clinicians and patients, clinical pathways to guide management of ID in pregnancy, adjusted laboratory requisitions and providing standardized iron prescriptions in the prenatal clinic. The initiative was formally reviewed by institutional authorities and was deemed to neither require Research Ethics Board approval nor written informed consent from participants. Data was collected from the electronic patient record to compare pre-intervention data (January 1, 2012 to December 31, 2016) to post-intervention data (January 1, 2017 to December 31, 2017). SAS software was used for statistical analysis. The monthly ferritin rates were calculated by dividing the number of ferritin tests by the number of outpatient HB tests, at each month and year and multiplying by 100. For the proportion of women to have ever had an antepartum HB ≥100g/L, as some women may have been in both the pre and post intervention groups, generalized estimating equations were used, with binomial distribution and logit link, to test for differences between pre and post periods. Results IRON MOM was launched at SMH on January 1, 2017. The pre-intervention five year period included 1292 outpatient ferritin tests, and 16,603 antepartum HB values belonging to 15,019 women and the post-intervention one year period included 2400 outpatient ferritin tests and 3282 antepartum HB values belonging to 3280 women. The monthly rate of ferritin testing increased dramatically post-initiative, 81.0 (Standard Deviation [SD] 6.3) compared to 8.4 (SD 4.4) pre-initiative. Please see figure 1 for details. There was a statistically significant increase in the proportion of women to have ever had an antepartum HB ≥ 100g/L, 89.5% (2936/3280) (95% confidence interval (CI) 88.3% to 90.4%) in the post-initiative, compared to 87.8% (13184/15,019)(95%CI 87.2% to 88.3%) in the pre-initiative period (p<0.01). Conclusions The IRON MOM toolkit successfully increased awareness of ID in pregnant women. The implementation of educational materials and simple process changes dramatically increased the rate of ferritin testing by almost 10x. Although there were statistically significant increases in the proportion of women with antepartum HB greater than 100g/L, post-IRON MOM, these changes were clinically insignificant. This was expected as this assessment was limited to one year (52 weeks) post intervention, and a full term pregnancy is 40 weeks. Therefore, only the women giving birth in the last 12 weeks of the year would have participated in the initiative throughout their entire pregnancy. We conclude that the practical changes involved in the IRON MOM tool kit have the potential for clinically meaningful impact. Future directions include simplification and digitization of the tool kit, which aim to maximize adherence to the protocols and further empower the pregnant patient. Disclosures Lausman: Ferring: Other: gave a talk.

scholarly journals Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

2021 ◽  
pp. 1753495X2110125
Author(s):  
Jonathan S Zipursky ◽  
Deva Thiruchelvam ◽  
Donald A Redelmeier
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Pregnant Women ◽  
Odds Ratio ◽  
Population Based ◽  
Relative Increase ◽  
Organic Disease ◽  
Increased Risk ◽  
Clinical Clue ◽  
In Pregnancy

Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

scholarly journals Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

2021 ◽  
Vol 38 (05) ◽  
pp. 515-522
Author(s):  
Marissa Berry ◽  
Amanda Wang ◽  
Shannon M. Clark ◽  
Hassan M. Harirah ◽  
Sangeeta Jain ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Disease Severity ◽  
Gestational Age ◽  
Laboratory Data ◽  
Population Characteristics ◽  
Neonatal Outcomes ◽  
P Value ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes

Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. Key Points

scholarly journals Prenatal Iron Deficiency and Replete Iron Status Are Associated with Adverse Birth Outcomes, but Associations Differ in Ghana and Malawi

2019 ◽  
Vol 149 (3) ◽  
pp. 513-521 ◽  
Author(s):  
Brietta M Oaks ◽  
Josh M Jorgensen ◽  
Lacey M Baldiviez ◽  
Seth Adu-Afarwuah ◽  
Ken Maleta ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Birth Outcomes ◽  
Regression Models ◽  
Iron Status ◽  
Secondary Data ◽  
Hemoglobin Concentration ◽  
Late Pregnancy ◽  
Zinc Protoporphyrin ◽  
Adverse Birth Outcomes ◽  
Soluble Transferrin Receptor

ABSTRACTBackgroundPrevious literature suggests a U-shaped relation between hemoglobin concentration and adverse birth outcomes. There is less evidence on associations between iron status and birth outcomes.ObjectiveOur objective was to determine the associations of maternal hemoglobin concentration and iron status with birth outcomes.MethodsWe conducted a secondary data analysis of data from 2 cohorts of pregnant women receiving iron-containing nutritional supplements (20–60 mg ferrous sulfate) in Ghana (n = 1137) and Malawi (n = 1243). Hemoglobin concentration and 2 markers of iron status [zinc protoporphyrin and soluble transferrin receptor (sTfR)] were measured at ≤20 weeks and 36 weeks of gestation. We used linear and Poisson regression models and birth outcomes included preterm birth (PTB), newborn stunting, low birth weight (LBW), and small-for-gestational-age.ResultsPrevalence of iron deficiency (sTfR >6.0 mg/L) at enrollment was 9% in Ghana and 20% in Malawi. In early pregnancy, iron deficiency was associated with PTB (9% compared with 17%, adjusted RR: 1.63; 95% CI: 1.14, 2.33) and stunting (15% compared with 23%, adjusted RR: 1.44; 95% CI: 1.09, 1.94) in Malawi but not Ghana, and was not associated with LBW in either country; replete iron status (sTfR <10th percentile) was associated with stunting (9% compared with 15%, adjusted RR: 1.71; 95% CI: 1.06, 2.77) in Ghana, but not PTB or LBW, and was not associated with any birth outcomes in Malawi. In late pregnancy, iron deficiency was not related to birth outcomes in either country and iron-replete status was associated with higher risk of LBW (8% compared with 16%, adjusted RR: 1.90; 95% CI: 1.17, 3.09) and stunting (6% compared with 13%, adjusted RR: 2.14; 95% CI: 1.21, 3.77) in Ghana, but was not associated with birth outcomes in Malawi.ConclusionsThe associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. These trials were registered at clinicaltrials.gov as NCT00970866 (Ghana) and NCT01239693 (Malawi).

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