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Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study.
BMC Public Health. 2019 Apr 11; 19(1):397.BP

Abstract

BACKGROUND

Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country.

METHODS

Within a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26-28 weeks' gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 μg/L (iron sufficiency), 15 to < 30 μg/L (modest iron depletion) and < 15 μg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion.

RESULTS

The median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9-30.6) μg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15-4.84), Malay (2.05; 1.30-3.24) and Indian (1.98; 1.14-3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13-2.38), multiparity (1.73; 1.23-2.44) and lack of iron-containing supplementation (3.37; 1.25-8.53) were associated with increased odds of modest and severe iron depletion.

CONCLUSIONS

Nearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy.

TRIAL REGISTRATION

NCT01174875 . Registered 1 July 2010 (retrospectively registered).

Authors+Show Affiliations

Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.Department of Haematology-Oncology, National University Cancer Institute, NUH Medical Centre, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK. National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK.Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore, 119228, Singapore. Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, H3G 2M1, Canada. Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, H3A 1A2, Canada.Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. claudia_chi@nuhs.edu.sg. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. claudia_chi@nuhs.edu.sg.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30975203

Citation

Loy, See Ling, et al. "Iron Status and Risk Factors of Iron Deficiency Among Pregnant Women in Singapore: a Cross-sectional Study." BMC Public Health, vol. 19, no. 1, 2019, p. 397.
Loy SL, Lim LM, Chan SY, et al. Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. BMC Public Health. 2019;19(1):397.
Loy, S. L., Lim, L. M., Chan, S. Y., Tan, P. T., Chee, Y. L., Quah, P. L., Chan, J. K. Y., Tan, K. H., Yap, F., Godfrey, K. M., Shek, L. P., Chong, M. F., Kramer, M. S., Chong, Y. S., & Chi, C. (2019). Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. BMC Public Health, 19(1), 397. https://doi.org/10.1186/s12889-019-6736-y
Loy SL, et al. Iron Status and Risk Factors of Iron Deficiency Among Pregnant Women in Singapore: a Cross-sectional Study. BMC Public Health. 2019 Apr 11;19(1):397. PubMed PMID: 30975203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. AU - Loy,See Ling, AU - Lim,Li Min, AU - Chan,Shiao-Yng, AU - Tan,Pei Ting, AU - Chee,Yen Lin, AU - Quah,Phaik Ling, AU - Chan,Jerry Kok Yen, AU - Tan,Kok Hian, AU - Yap,Fabian, AU - Godfrey,Keith M, AU - Shek,Lynette Pei-Chi, AU - Chong,Mary Foong-Fong, AU - Kramer,Michael S, AU - Chong,Yap-Seng, AU - Chi,Claudia, Y1 - 2019/04/11/ PY - 2018/11/12/received PY - 2019/04/02/accepted PY - 2019/4/13/entrez PY - 2019/4/13/pubmed PY - 2019/6/14/medline KW - Anaemia KW - Ferritin KW - Iron status KW - Pregnancy KW - Risk factor KW - Singapore KW - Soluble transferrin receptor SP - 397 EP - 397 JF - BMC public health JO - BMC Public Health VL - 19 IS - 1 N2 - BACKGROUND: Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country. METHODS: Within a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26-28 weeks' gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 μg/L (iron sufficiency), 15 to < 30 μg/L (modest iron depletion) and < 15 μg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion. RESULTS: The median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9-30.6) μg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15-4.84), Malay (2.05; 1.30-3.24) and Indian (1.98; 1.14-3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13-2.38), multiparity (1.73; 1.23-2.44) and lack of iron-containing supplementation (3.37; 1.25-8.53) were associated with increased odds of modest and severe iron depletion. CONCLUSIONS: Nearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy. TRIAL REGISTRATION: NCT01174875 . Registered 1 July 2010 (retrospectively registered). SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/30975203/Iron_status_and_risk_factors_of_iron_deficiency_among_pregnant_women_in_Singapore:_a_cross_sectional_study_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6736-y DB - PRIME DP - Unbound Medicine ER -