Maternal serum ferritin concentration is positively associated with newborn iron stores in women with low ferritin status in late pregnancy

Jie Shao, Jingan Lou, Raghavendra Rao, Michael K Georgieff, Niko Kaciroti, Barbara T Felt, Zheng-Yan Zhao, Betsy Lozoff, Jie Shao, Jingan Lou, Raghavendra Rao, Michael K Georgieff, Niko Kaciroti, Barbara T Felt, Zheng-Yan Zhao, Betsy Lozoff

Abstract

Iron deficiency (ID) is common in pregnant women and infants, particularly in developing countries. The relation between maternal and neonatal iron status remains unclear. This study considered the issue in a large sample of mother-newborn pairs in rural southeastern China. Hemoglobin (Hb) and serum ferritin (SF) were measured in 3702 pregnant women at ≥37 wk gestation and in cord blood of their infants born at term (37-42 wk gestation). Maternal anemia (Hb <110 g/L) was present in 27.5% and associated with maternal SF <20 μg/L in 86.9%. Only 5.6% of neonates were anemic (Hb <130 g/L) and 9.5% had cord-blood SF <75 μg/L. There were low-order correlations between maternal and newborn iron measures (r = 0.07-0.10 for both Hb and SF; P ≤ 0.0001 due to the large number). We excluded 430 neonates with suggestion of inflammation [cord SF >370 μg/L, n = 208 and/or C-reactive protein (CRP) >5 mg/L, n = 233]. Piecewise linear regression analyses identified a threshold for maternal SF at which cord-blood SF was affected. For maternal SF below the threshold of 13.6 μg/L (β = 2.4; P = 0.001), cord SF was 0.17 SD lower than in neonates whose mothers had SF above the threshold (167 ± 75 vs. 179 ± 80 μg/L). The study confirmed that ID anemia remains common during pregnancy in rural southeastern China. Despite widespread maternal ID, however, iron nutrition seemed to meet fetal needs except when mothers were very iron deficient. The impact of somewhat lower cord SF on iron status later in infancy warrants further study.

Conflict of interest statement

Author disclosures: J. Shao, J. Lou, R. Rao, M. K. Georgieff, N. Kaciroti, B. T. Felt, Z. Y. Zhao, and B. Lozoff, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The effect of maternal SF on cord-blood SF in healthy term infants. A threshold (or inflection point, x0) was identified using piecewise linear regression analyses. Dashed vertical line at maternal SF concentration of 13.6 μg/L indicates the threshold. Maternal SF related to cord-blood SF for maternal SF below this threshold (β = 2.4; P = 0.001) but not above, n = 3247 pairs. Data for mother-newborn pairs with suggestion of neonatal inflammation and 2 pairs with maternal SF >250 μg/L were excluded, because the model did not converge when these outliers were included. SF, serum ferritin.

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