Iron Absorption and Transfer to the Fetus During Pregnancy in Normal Weight and Overweight/Obese Women and the Effects on Infants Iron Status (PIANO)

April 21, 2021 updated by: Isabelle Herter-Aeberli, Swiss Federal Institute of Technology

Maternal Iron Absorption and Utilization and Iron Transfer to the Fetus During Pregnancy in Normal Weight and Overweight/Obese Women and the Effects on Infant Iron Status

Overweight and obesity causes low-grade systemic inflammation, which sharply increases risk for iron deficiency. Studies in our laboratory have shown that this is mainly the result of reduced dietary iron absorption because of increased hepcidin concentrations. During pregnancy, women have a large increase in iron needs because of the expansion of maternal blood volume and fetal needs. Iron deficiency anemia in infancy can impair cognitive development. Whether maternal adiposity impairs absorption and transfer of iron to the fetus, and thereby increases risk of iron deficiency in the mother and the infant is unclear.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

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Intervention / Treatment

Intervention / Treatment

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Detailed Description

In obese subjects, hepcidin concentrations are increased and iron absorption is believed to be reduced, leading to iron deficiency over time. How all this will influence iron supply of the fetus in obese pregnancy has not been well investigated to date. Even if maternal and fetal iron uptakes are regulated separately, it is unclear to what extent maternal subclinical inflammation might influence this process. A small study by Dao et al. indicated that maternal-fetal iron transfer was impaired in obese pregnant women, possibly due to hepcidin up-regulation. In this study, both maternal BMI as well as hepcidin were negatively correlated with cord blood iron status. Maternal hepcidin and c-reactive protein were significantly higher and cord blood iron was significantly lower in the obese compared to the normal weight. Hepcidin was shown to have an effect on iron transfer across the placenta in the study by Young et al.: the transfer was increased in women with undetectable hepcidin at delivery compared to those with higher levels. As of now, clear associations between maternal BMI or maternal hepcidin concentration and fetal iron status were not shown.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
83

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Switzerland
      • Zurich, Switzerland, 8092
        • Human Nutrition Laboratory ETH Zurich

Participation Criteria

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Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 45 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Pregnant women with either normal pre-pregnancy BMI (BMI 18.5 - 24.9kg/kg2) or with overweight or obesity (BMI > 27.5kg/m2) before pregnancy (assessed based on data reported by the women at their first visit at the hospital)
  • 18 to 45 years old
  • singleton pregnancy
  • week of pregnancy 14±3

Exclusion Criteria:

  • underlying malabsorption disease
  • chronic illness, which influences iron absorption
  • inflammatory status other than obesity
  • medical problems known to affect iron homeostasis
  • smoking during pregnancy
  • no regular use of medication, which influences iron absorption

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Basic Science
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Isotopically labeled test meal week of pregnancy 20
Other: Stable iron isotope 57 (57Fe) labeled iron solution
test meal labeled with 12 mg 57Fe
Experimental: Isotopically labeled test meal week of pregnancy 30
Other: Stable iron isotope 58 (58Fe) labeled iron solution
test meal labeled with 12 mg 58Fe

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Fractional iron absorption
Time Frame: week 20 of pregnancy
The fractional iron absorption from the first test meal will be calculated based on the shift of the iron isotopic ratios in the collected blood samples 14 days after administration of the isotopically labeled meal.
week 20 of pregnancy
iron transfer from the mother to the fetus in cord blood/infant
Time Frame: delivery
To determine the amount of iron transferred from the mother to the fetus
delivery
Fractional iron absorption
Time Frame: week 30 of pregnancy
The fractional iron absorption from the second test meal will be calculated based on the shift of the iron isotopic ratios in the collected blood samples 14 days after administration of the isotopically labeled meal.
week 30 of pregnancy
infants iron status
Time Frame: over the first six months of life
infants iron status
over the first six months of life

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in plasma ferritin
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in plasma ferritin
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in Hepcidin
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in Hepcidin
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in transferrin receptor
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in transferrin receptor
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in hemoglobin
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in hemoglobin
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in c-reactive protein
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in c-reactive protein
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in interleukin-6
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in interleukin-6
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Chage in alpha-1-acid glycoprotein
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Chage in alpha-1-acid glycoprotein
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in retinol binding protein
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in retinol binding protein
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in riboflavin
Time Frame: weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Change in riboflavin
weeks of pregnancy 12, 18, 20, 28, 30, 36; 3 and 6 months after delivery
Assessment of children's iron needs within their first 2 years of life using an isotope dilution technique
Time Frame: Follow-up blood samples at 3, 6, 12, 18, 24 months after birth
Assessment of children's iron needs within their first 2 years of life
Follow-up blood samples at 3, 6, 12, 18, 24 months after birth
Assessment of recovery of mother's iron Status after pregnancy using an isotope dilution technique
Time Frame: Follow-up blood samples at 3, 6, 12, 18, 24 months after delivery
Assessment of recovery of mother's iron Status after pregnancy
Follow-up blood samples at 3, 6, 12, 18, 24 months after delivery
infants iron status
Time Frame: over the first 24 months of life
infants iron status
over the first 24 months of life

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Swiss Federal Institute of Technology

Publications and helpful links

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General Publications

Study record dates

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Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 1, 2016

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 1, 2019

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2020

Study Registration Dates

First Submitted

First Submitted

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January 8, 2016

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 18, 2016

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 21, 2016

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
April 23, 2021

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 21, 2021

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
April 1, 2021

More Information

Terms related to this study

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Other Study ID Numbers

Other Study ID Numbers

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  • PIANO

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