Elsevier

Archives of Medical Research

Volume 36, Issue 5, September–October 2005, Pages 598-602
Archives of Medical Research

Brief report
Sub-Optimal Fetal Iron Acquisition under a Maternal Environment

https://doi.org/10.1016/j.arcmed.2005.03.023Get rights and content

Iron deficiency acquired at an early age can lead to significant developmental alterations. To evaluate the need for an interventional trial, we determined the iron reserves of neonates born to a group of women from an urban disadvantaged group. The influence of maternal iron on newborn hemoglobin, birth weight, and height was also analyzed. Hemoglobin and serum ferritin (SF) concentrations were measured at delivery on 201 neonates and their mothers. Neonatal iron stores were considered deficient when the cord SF concentration was <12.0 μg/L, reduced if ≥12.0 but <30 μg/L, and replenished when ≥30 μg/L. The same cut-offs applied to maternal SF values. Cord SF in the study group was 81.2 ± 63 μg/L. Following the criteria adopted for this study, three groups of neonates were identified. I: 13 (6.5%) were born with deficient iron stores, II: 15 (7.5%) had reduced iron stores, and III: 173 (86%) had normal levels of storage iron. Cord SF concentrations were 7.1 ± 3.5, 19.9 ± 4.4 and 92 ± 60 μg/L, respectively. Cord hemoglobin did not differ among groups. Iron stores at birth were reduced when maternal stores were deficient, reflecting a limited fetal iron-acquisition capacity and the restrictive effect of gestational iron deficiency on the constitution of adequate fetal iron reserves. These findings support the need for an interventional trial on the study population. Hemoglobin, birth weight, and height did not correlate with fetal or maternal iron stores.

Introduction

Increasing evidence demonstrates that fetal iron acquisition through gestation is limited in the presence of maternal iron deficiency (ID) (1). Cord serum ferritin (cord SF) decreases after maternal serum ferritin (MSF) has fallen below 12 μg/L (2). Although iron stores (IS) at birth show considerable variation, they correlate with IS throughout the first year of life (3). Storage iron decreases progressively after birth 3, 4 due to the need to maintain a near constant mean hemoglobin (Hb) concentration of 125 g/L within a rapidly expanding blood volume, particularly between the ages of 4 and 12 months (5), when infants depend on the iron acquired from the mother before birth. Such a demand leaves the infant susceptible to ID. In these circumstances, less well-iron-endowed babies will be at a higher risk for the development of full ID later in infancy (3).

The present investigation was undertaken to determine the effect of maternal ID on the IS of neonates born to a group of low-income women with a high likelihood to be iron deficient, in order to evaluate the need for an interventional trial on the study population. Maternal findings have been reported elsewhere (6), and data pertinent to this study have been incorporated when necessary to provide the adequate context for the findings in their neonates.

Section snippets

Patients and Methods

The study was conducted at the “José E. Gonzalez” University Hospital in the city of Monterrey, Mexico (534 m above sea level). After obtaining maternal informed consent, cord hemoglobin (cord Hb) and cord SF concentrations were measured in cord blood drawn at birth in 201 consecutive healthy full-term neonates. Delayed cord clamping at delivery was not routinely practiced. All of the newborns were the product of a single, uncomplicated pregnancy. The mothers' last menstruation date, echography

Results

The mean cord SF concentration in the group of 201 neonates was 81.0 ± 63 μg/L; mean MSF was 7.0 ± 6.4 μg/L. For purposes of this study, newborns were classified into three groups depending on their cord SF concentration (Table 1). Neonatal ID (group I), defined by a cord SF value <12.0 μg/L, was documented in 13 neonates (6.5%), whose cord SF concentration was 7.1 ± 3.5 μg/L.

The group of neonates born with reduced iron reserves (group II) included 15 babies (7.5%) with a mean cord SF value of

Discussion

Our results suggest that neonatal iron stores in the study group were influenced by maternal storage iron levels. This was reflected in a difference of 30 μg/L on mean cord SF in favor of neonates born to women with a MSF ≥12.0 μg/L and 21.0 μg/L in favor of babies born to mothers who consistently ingested iron supplements, underscoring the importance of improving maternal iron supplementation programs as a first line intervention to increase newborn stores of iron, following established

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