Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment

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Abstract

Background

To our knowledge, no studies have addressed whether maternal anemia of inflammation (AI) affects newborn iron status, and few have addressed risk factors for specific etiologies of maternal anemia.

Objective

The study aims were to evaluate 1) the contribution of AI and iron deficiency anemia (IDA) to newborn iron endowment, 2) hepcidin as a biomarker to distinguish AI from IDA among pregnant women, and 3) risk factors for specific etiologies of maternal anemia.

Methods

We measured hematologic biomarkers in maternal blood at 12 and 32 wk of gestation and in cord blood from a randomized trial of praziquantel in 358 pregnant women with Schistosoma japonicum in The Philippines. IDA was defined as anemia with serum ferritin <30 ng/mL and non-IDA (NIDA), largely due to AI, as anemia with ferritin ≥30 ng/mL. We identified cutoffs for biomarkers to distinguish IDA from NIDA by using area under the curve (AUC) analyses and examined the impact of different causes of anemia on newborn iron status (primary outcome) by using multivariate regression modeling.

Results

Of the 358 mothers, 38% (n = 136) had IDA and 9% (n = 32) had NIDA at 32 wk of gestation. At 32 wk of gestation, serum hepcidin performed better than soluble transferrin receptor (sTfR) in identifying women with NIDA compared with the rest of the cohort (AUCs: 0.75 and 0.70, respectively) and in identifying women with NIDA among women with anemia (0.73 and 0.72, respectively). The cutoff that optimally distinguished women with NIDA from women with IDA in our cohort was 6.1 µg/L. Maternal IDA, but not NIDA, was associated with significantly lower newborn ferritin (114.4 ng/mL compared with 148.4 µg/L; P = 0.042).

Conclusion

Hepcidin performed better than sTfR in identifying pregnant women with NIDA, but its cost may limit its use. Maternal IDA, but not NIDA, is associated with decreased newborn iron stores, emphasizing the need to identify this cause and provide iron therapy. This trial was registered at www.clinicaltrials.gov as NCT00486863.

Keywords

iron-deficiency anemia
non–iron deficiency anemia
anemia of inflammation
pregnancy
Schistosoma japonicum
biomarker
hepcidin
sTfR

Abbreviations used

AI
anemia of inflammation
CBC
complete blood count
CRP
C-reactive protein
epg
eggs per gram
IDA
iron-deficiency anemia
LMIC
low- and middle-income country
MCV
mean corpuscular volume
NIDA
non–iron deficiency anemia
RTR
Remedios Trinidad Romualdez
sTfR
soluble transferrin receptor
ZPP
zinc protoporphyrin

Cited by (0)

The randomized controlled trial (“S. japonicum and Pregnancy Outcomes: An RCT”) was supported by the NIH/National Institute of Allergy and Infectious Diseases (NIH/NIAID; U01AI066050), with relevant data for this article collected through newborn day of life 28; the NIH/NIAID (R21AI107520; “S. japonicum, Anemia, and Iron Transport in Human Pregnancy”) supported extended biomarkers to define the etiology of anemia among pregnant women and their offspring.

AIA, SP, and KR contributed equally to this work as the first author and are listed in alphabetical order of last names.