A systematic review and meta-analysis of the correlation between maternal and neonatal iron status and haematologic indices

Sanni, Omolara; Chambers, Thane; Li, Jia Hang; Rowe, Stewart; Woodman, Andrew G.; Ospina, María; Bourque, Stéphane

doi:10.1016/j.eclinm.2020.100555

Cited by 15 publications

(16 citation statements)

References 80 publications

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“…A large systematic review on iron supplementation found an effect on maternal hemoglobin but not on child outcomes at birth [ 2 ]. Another review found a poor correlation between maternal and neonatal hemoglobin just after birth [ 19 ]. An overview of the longer-term consequences of maternal iron status on child health is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Consequently, fetal Hb status is typically estimated based on maternal Hb levels, with the implicit assumption that the two indices are correlated. Our recent study found that indices of maternal iron status (e.g., serum ferritin) correlate poorly with fetal levels [ 18 ], and the relationship between maternal and fetal Hb is also variable [ 18 ], in some cases showing moderate to strong correlation [ 19 , 20 , 21 , 22 ] and others none [ 23 , 24 ]. Since anemia, per se, drives placental compensation rather than iron deficiency [ 11 ], the question arises as to whether maternal or fetal Hb status is a more important predictor of placental size.…”

Section: Introductionmentioning

confidence: 99%

Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study

Gragasin

Ospina

Serrano-Lomelin

et al. 2021

JCM

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Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a HemoCue Hb201+ system. Birth weight, placental weight, one- and five-minute APGAR scores, American Society of Anesthesiologists physical state classification, maternal age, and maternal height were also recorded. Relationships between maternal and cord blood hemoglobin levels with placental weight, birth weight, and birth weight to placental weight ratio were the main outcome measures. Results: A total of 182 subjects were included in the analysis. Regression analysis showed that cord blood hemoglobin, but not maternal hemoglobin, was inversely related with placental weight (β = −2.4, p = 0.001) and positively related with the birth weight to placental weight ratio (β = 0.015, p = 0.001 and p = 0.63, respectively). Conclusions: Our findings suggest that measuring cord blood hemoglobin levels, rather than maternal hemoglobin levels, may provide important diagnostic information about in utero fetal adaptation to suboptimal placental function and neonatal health.

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“…(19) A recent meta-analysis reported that maternal biomarkers of iron status correlated poorly with those in newborns. (19) However, others found that maternal ID or anemia, especially the severe type, adversely affected cord blood or infant iron status. (20)(21)(22)(23)(24) Further studies are needed to evaluate Accepted manuscript how prenatal maternal iron status affects newborn's ferritin level at birth.…”

Section: Introductionmentioning

confidence: 99%

“…Iron status at birth is therefore critical and impaired iron status may persist into early childhood. However, low maternal prenatal iron levels measured as serum ferritin have not been consistently linked with low cord blood serum ferritin (CBSF) concentrations (19) . A recent meta-analysis reported that maternal biomarkers of iron status correlated poorly with those in newborns (19) .…”

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confidence: 99%

“…However, low maternal prenatal iron levels measured as serum ferritin have not been consistently linked with low cord blood serum ferritin (CBSF) concentrations (19) . A recent meta-analysis reported that maternal biomarkers of iron status correlated poorly with those in newborns (19) . However, others found that maternal ID or anaemia, especially the severe type, adversely affected cord blood or infant iron status (20)(21)(22)(23)(24) .…”

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confidence: 99%

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Iron status of full-term infants in early infancy is not associated with maternal ferritin levels nor infant feeding practice

Chan

Tsun

et al. 2021

Br J Nutr

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Iron deficiency (ID) in early life is associated with morbidities. Most fetal iron required for infant growth is acquired in the third trimester from maternal iron store. However, how prenatal iron level affects ferritin level in early infancy remains controversial. This study aimed to examine the associations between maternal ferritin levels and cord blood serum ferritin (CBSF) and to compare the ferritin levels between different feeding practices in early infancy. Healthy Chinese mothers with uncomplicated pregnancy and their infants were followed up at 3 months post-delivery for questionnaire completion and infant blood collection. Infants who were predominantly breastfed and those who were predominantly formula fed were included in this analysis. Serum ferritin levels were measured in maternal blood samples collected upon delivery, cord blood and infant blood samples at 3 months of age. Ninety-seven mother-baby dyads were included. Maternal ID is common (56%) while the CBSF levels were significantly higher than maternal ferritin levels. Only 3 infants (3%) had ID at 3 months of age. There were no significant correlations between maternal ferritin levels with CBSF (r=0.168, p=0.108) nor with infant ferritin levels at 3 months of age (r=0.023, p=0.828). Infant ferritin levels at 3 months were significantly and independently associated with CBSF (p=0.007) and birth weight (p<0.001) after adjusting for maternal age, parity, maternal education, infant sex and feeding practice. In conclusion, maternal ID was common upon delivery. However, maternal ferritin levels were not significantly associated with CBSF concentrations nor infant ferritin concentrations at 3 months of age.

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A systematic review and meta-analysis of the correlation between maternal and neonatal iron status and haematologic indices

Cited by 15 publications

References 80 publications

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

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

Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study

Iron status of full-term infants in early infancy is not associated with maternal ferritin levels nor infant feeding practice

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