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Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes among Iron-Deficient Tanzanian Women.
J Nutr. 2016 06; 146(6):1162-71.JN

Abstract

BACKGROUND

Iron deficiency is a highly prevalent micronutrient abnormality and the most common cause of anemia globally, worsening the burden of adverse pregnancy and child outcomes.

OBJECTIVE

We sought to evaluate the response of hematologic biomarkers to iron supplementation and to examine the predictors of the response to iron supplementation among iron-deficient pregnant women.

METHODS

We identified 600 iron-deficient (serum ferritin ≤12 μg/L) pregnant women, aged 18-45 y, presenting to 2 antenatal clinics in Dar es Salaam, Tanzania using rapid ferritin screening tests, and prospectively followed them through delivery and postpartum. All women received 60 mg Fe and 0.25 mg folate daily from enrollment until delivery. Proportions meeting the thresholds representing deficient hematologic status including hemoglobin <110 g/L, ferritin ≤12 μg/L, serum soluble transferrin receptor (sTfR) >4.4 mg/L, zinc protoporphyrin (ZPP) >70 mmol/L, or hepcidin ≤13.3 μg/L at baseline and delivery were assessed. The prospective change in biomarker concentration and the influence of baseline hematologic status on the change in biomarker concentrations were assessed. Regression models were estimated to assess the relation of change in biomarker concentrations and pregnancy outcomes.

RESULTS

There was significant improvement in maternal biomarker concentrations between baseline and delivery, with increases in the concentrations of hemoglobin (mean difference: 15.2 g/L; 95% CI: 13.2, 17.2 g/L), serum ferritin (51.6 μg/L; 95% CI: 49.5, 58.8 μg/L), and serum hepcidin (14.0 μg/L; 95% CI: 12.4, 15.6 μg/L) and decreases in sTfR (-1.7 mg/L; 95% CI: -2.0, -1.3 mg/L) and ZPP (-17.8 mmol/L; 95% CI: -32.1, 3.5 mmol/L). The proportions of participants with low hemoglobin, ferritin, and hepcidin were 73%, 93%, and 99%, respectively, at baseline and 34%, 12%, and 46%, respectively, at delivery. The improvements in biomarker concentrations were significantly greater among participants with poor hematologic status at baseline - up to 12.1 g/L and 14.5 μg/L for hemoglobin and ferritin concentrations, respectively. For every 10-g/L increase in hemoglobin concentration, there was a 24% reduced risk of perinatal mortality (RR = 0.76; 95% CI: 0.59, 0.99) and a 23% reduced risk of early infant mortality (RR = 0.77; 95% CI: 0.60, 0.99). The risk of anemia at delivery despite supplementation was predicted by baseline anemia (RR = 2.11; 95% CI: 1.39, 3.18) and improvements in ferritin concentration were more likely to be observed in participants who took iron supplements for up to 90 d (RR = 1.41; 95% CI: 1.13, 1.76).

CONCLUSION

Iron supplementation decreases the risk of maternal anemia and increases the likelihood of infant survival among iron-deficient Tanzanian pregnant women. Interventions to promote increased duration and adherence to iron supplements may also provide greater health benefits.

Authors+Show Affiliations

Departments of Global Health and Population, iabioye@hsph.harvard.edu.Departments of Microbiology and Immunology and.Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and.Departments of Global Health and Population, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.Departments of Global Health and Population.Departments of Global Health and Population.Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and.Departments of Global Health and Population.Departments of Global Health and Population.Departments of Global Health and Population, Nutrition.Nutrition, Epidemiology, and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA;Departments of Global Health and Population, Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.Departments of Global Health and Population, Nutrition, Epidemiology, and.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27121530

Citation

Abioye, Ajibola I., et al. "Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes Among Iron-Deficient Tanzanian Women." The Journal of Nutrition, vol. 146, no. 6, 2016, pp. 1162-71.
Abioye AI, Aboud S, Premji Z, et al. Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes among Iron-Deficient Tanzanian Women. J Nutr. 2016;146(6):1162-71.
Abioye, A. I., Aboud, S., Premji, Z., Etheredge, A. J., Gunaratna, N. S., Sudfeld, C. R., Mongi, R., Meloney, L., Darling, A. M., Noor, R. A., Spiegelman, D., Duggan, C., & Fawzi, W. (2016). Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes among Iron-Deficient Tanzanian Women. The Journal of Nutrition, 146(6), 1162-71. https://doi.org/10.3945/jn.115.225482
Abioye AI, et al. Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes Among Iron-Deficient Tanzanian Women. J Nutr. 2016;146(6):1162-71. PubMed PMID: 27121530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes among Iron-Deficient Tanzanian Women. AU - Abioye,Ajibola I, AU - Aboud,Said, AU - Premji,Zulfiqar, AU - Etheredge,Analee J, AU - Gunaratna,Nilupa S, AU - Sudfeld,Christopher R, AU - Mongi,Robert, AU - Meloney,Laura, AU - Darling,Anne Marie, AU - Noor,Ramadhani A, AU - Spiegelman,Donna, AU - Duggan,Christopher, AU - Fawzi,Wafaie, Y1 - 2016/04/27/ PY - 2015/10/15/received PY - 2016/03/15/accepted PY - 2016/4/29/entrez PY - 2016/4/29/pubmed PY - 2017/6/29/medline KW - anemia KW - biological markers KW - dietary supplement KW - iron deficiency KW - pregnancy outcomes SP - 1162 EP - 71 JF - The Journal of nutrition JO - J Nutr VL - 146 IS - 6 N2 - BACKGROUND: Iron deficiency is a highly prevalent micronutrient abnormality and the most common cause of anemia globally, worsening the burden of adverse pregnancy and child outcomes. OBJECTIVE: We sought to evaluate the response of hematologic biomarkers to iron supplementation and to examine the predictors of the response to iron supplementation among iron-deficient pregnant women. METHODS: We identified 600 iron-deficient (serum ferritin ≤12 μg/L) pregnant women, aged 18-45 y, presenting to 2 antenatal clinics in Dar es Salaam, Tanzania using rapid ferritin screening tests, and prospectively followed them through delivery and postpartum. All women received 60 mg Fe and 0.25 mg folate daily from enrollment until delivery. Proportions meeting the thresholds representing deficient hematologic status including hemoglobin <110 g/L, ferritin ≤12 μg/L, serum soluble transferrin receptor (sTfR) >4.4 mg/L, zinc protoporphyrin (ZPP) >70 mmol/L, or hepcidin ≤13.3 μg/L at baseline and delivery were assessed. The prospective change in biomarker concentration and the influence of baseline hematologic status on the change in biomarker concentrations were assessed. Regression models were estimated to assess the relation of change in biomarker concentrations and pregnancy outcomes. RESULTS: There was significant improvement in maternal biomarker concentrations between baseline and delivery, with increases in the concentrations of hemoglobin (mean difference: 15.2 g/L; 95% CI: 13.2, 17.2 g/L), serum ferritin (51.6 μg/L; 95% CI: 49.5, 58.8 μg/L), and serum hepcidin (14.0 μg/L; 95% CI: 12.4, 15.6 μg/L) and decreases in sTfR (-1.7 mg/L; 95% CI: -2.0, -1.3 mg/L) and ZPP (-17.8 mmol/L; 95% CI: -32.1, 3.5 mmol/L). The proportions of participants with low hemoglobin, ferritin, and hepcidin were 73%, 93%, and 99%, respectively, at baseline and 34%, 12%, and 46%, respectively, at delivery. The improvements in biomarker concentrations were significantly greater among participants with poor hematologic status at baseline - up to 12.1 g/L and 14.5 μg/L for hemoglobin and ferritin concentrations, respectively. For every 10-g/L increase in hemoglobin concentration, there was a 24% reduced risk of perinatal mortality (RR = 0.76; 95% CI: 0.59, 0.99) and a 23% reduced risk of early infant mortality (RR = 0.77; 95% CI: 0.60, 0.99). The risk of anemia at delivery despite supplementation was predicted by baseline anemia (RR = 2.11; 95% CI: 1.39, 3.18) and improvements in ferritin concentration were more likely to be observed in participants who took iron supplements for up to 90 d (RR = 1.41; 95% CI: 1.13, 1.76). CONCLUSION: Iron supplementation decreases the risk of maternal anemia and increases the likelihood of infant survival among iron-deficient Tanzanian pregnant women. Interventions to promote increased duration and adherence to iron supplements may also provide greater health benefits. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/27121530/Iron_Supplementation_Affects_Hematologic_Biomarker_Concentrations_and_Pregnancy_Outcomes_among_Iron_Deficient_Tanzanian_Women_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.3945/jn.115.225482 DB - PRIME DP - Unbound Medicine ER -