ABSTRACT:The influence of maternal stress during pregnancy on the postpartum iron status and immune maturation of infants was investigated in a nonhuman primate model. Forty infant rhesus monkeys were generated from two types of disturbed pregnancies, early or late gestation stress, and compared with 24 undisturbed controls. Prenatal stress increased the prevalence and magnitude of iron deficiency (ID) as the infants' growth-related demands for iron exceeded dietary intake from breast milk. At 4 -6 mo of age, the emergence of ID significantly accentuated an effect of prenatal stress on natural killer cell activity, an important component of innate immunity. These findings indicate that maternal stress, especially early in pregnancy, should be added to the list of risk factors that warrant closer scrutiny of hematological profiles in fast-growing babies. (Pediatr Res 61: 520-524, 2007) I D is a major nutritional problem affecting 1-2 billion people worldwide (1). The anemia caused by ID is very common in women due to the hematological demands of menstruation and pregnancy and is particularly prevalent in young infants, who also have high iron needs (2,3). To meet the iron requirements of a rapidly growing baby, many mammalian species, including humans, have evolved a two-stage transmission process, providing significant amounts of iron before birth via placental transfer, and the remainder postpartum through breast milk. As a consequence, if iron stores in the form of Hb and ferritin are low at birth, dietary iron intake from milk will often prove to be inadequate by 2-4 mo of age (4). These babies are then at greater risk for developing the "early anemia of childhood," which typically becomes evident at 4 -8 mo of age (5).Although the use of fortified formulas has reduced the prevalence of ID, it continues to impact 3-4% of 1 y olds in the United States and up to 8 -17% of infants in high-risk populations (6 -8). ID is also more likely to occur in babies provided only breast milk past the first year of age or in families that rely on bottle-feeding with cow's milk for economic or cultural reasons (9).Considerable evidence points to prenatal factors as predisposing and significant contributors to the development of ID (10). Because the bulk of maternal iron is transferred in the last month of pregnancy, babies born premature have low stores, and their iron needs are more likely to exceed the capacity of dietary intake (11). Similarly, small-forgestational age neonates and growth-restricted twins and triplets, who then undergo a compensatory growth spurt, are at higher risk (12,13). Recently, it was discovered that babies gestated by women who had developed pregnancy-induced diabetes or hypertension are also predisposed to ID (14,15). Rodent models suggest further that high alcohol consumption during pregnancy can compromise iron regulation in the offspring (16). Information about the importance of these prenatal factors has not been widely disseminated to pediatricians, and thus some high-risk babies may be ID fo...