Relationship between newborn and maternal iron status and haematological indices.

The haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin, haematocrit, serum iron and total iron binding capacity, and serum ferritin concentrations in umbilical cord blood samples taken from 96 appropriate-for-gestational age infants delivered at term were measured and compared to the respective maternal values measured at 36 weeks' gestation. All the values were higher in cord blood. Only maternal mean corpuscular volume and mean corpuscular haemoglobin were correlated with cord serum iron. Cord blood haematological indices were not correlated with either gestation at delivery or birth weight. However, newborn serum ferritin was positively correlated with gestation at delivery, while the maternal:newborn ferritin ratio was inversely correlated with gestation and birth weight. The results suggest that maternal haematological and iron indices are not predictive of the haemoglobin or iron status of the newborn, and that the fetus continues to take up iron from the mother until delivery.     

Iron studies in infants born to an iron overloaded mother with beta-thalassemia major: possible effects of maternal desferrioxamine therapy

A 30-year-old woman with transfusion-dependent, homozygous beta-thalassemia major and transfusional hemosiderosis had 2 successful pregnancies after ovulation induction and in vitro fertilization. Treatment with subcutaneous desferrioxamine (DF) was discontinued before the conception but restarted at 6 months of gestation. Elective cesarean section was performed at 35 weeks of pregnancy because of partial placenta previa. The infant was clinically normal. At the time of delivery, the maternal serum ferritin was 2000 ng/mL, serum iron/iron binding capacity (SI/TIBC) were 274/380 microg/dL, and % saturation 72%. Serum ferritin level in the infant was 42 ng/mL, SI/TIBC were 53/222 microg/dL, and % saturation 23%. During a twin pregnancy 2 years later, DF therapy was totally withheld. Elective cesarian section was performed at 36 weeks of gestation. Both twins were clinically normal. At delivery, the maternal serum ferritin was 1700 ng/mL, SI/TIBC 447/450 microg/dL, and % saturation 99%. Serum ferritins of the twins were 227 and 203 ng/mL, SI/TIBC were 30/182 and 27/203 microg/dL, and % saturations 16% and 13%. Despite elevated iron studies in the mother during both pregnancies, the SI/TIBC of the infants were quite low. In the first pregnancy in which DF was administered in last months of gestation, a low level of serum ferritin was present in the newborn that was even lower at 3 months of age. In the second pregnancy, high normal, levels of ferritin were present in both twin newborns. Despite comparable gestational ages, hemoglobin levels were lower in the first pregnancy than the second. These studies indicate that very high maternal levels of SI/TIBS and serum ferritin were not associated with increased fetal SI/TIBC, which were, in fact, quite low. Because of the different fetal ferritin levels in the 2 pregnancies, it is possible that treatment of the mother with DF in the last weeks of pregnancy may have resulted in depletion of fetal iron stores.     

Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents

Because chronic hypoxemia causes a redistribution of iron from serum and storage pools into an expanding erythrocyte mass, and because infants of diabetic mothers are often hypoxemic in utero and have a high prevalence of polycythemia at birth, we studied iron distribution in 43 term infants of diabetic mothers. Twenty-four infants were at an appropriate size for gestational age; 19 were large for gestational age. At birth, 28 infants (65%) had abnormal serum iron profiles; eight had decreased ferritin concentrations only (stage 1), nine had decreased ferritin and increased total iron-binding capacity values (stage 2), and 11 had these serum findings plus elevated free erythrocyte protoporphyrin concentrations (stage 3). The hypoglycemic infants who were large for gestational age (n = 14) had a higher prevalence of abnormal iron profiles than euglycemic infants who were appropriate in size for gestational age (n = 20; 93% vs 50%; p = 0.009). Progressively abnormal iron profiles were associated with higher glycosylated fetal hemoglobin values, greater degrees of macrosomia, increased hemoglobin and erythropoietin concentrations, and increased erythrocyte/storage iron ratios. Erythropoietin concentrations were inversely linearly correlated with serum iron values (n = 32, r = -0.54; p = 0.003). The combined erythrocyte and storage iron pools were significantly lower in infants with abnormal iron values whose mothers were diabetic, particularly in infants of women with confirmed diabetic vasculopathy. We speculate that these findings are likely due to (1) increased fetal iron utilization during compensatory hemoglobin synthesis in response to chronic hypoxemia and (2) reduced iron transfer during late gestation complicated by diabetes.     

Study of maternal influences on fetal iron status at term using cord blood transferrin receptors

AIMS: To determine effects of maternal iron depletion and smoking on iron status of term babies using serum transferrin receptors (STfR) and their ratio to ferritin (TfR-F index) in cord blood. METHODS: Iron, ferritin, STfR, and haemoglobin (Hb) concentration were measured and TfR-F index calculated in 67 cord /maternal blood pairs. Twenty six mothers were iron depleted (ferritin <10 microg/l) and 28 were smokers. RESULTS: Maternal iron depletion was associated with decreased cord ferritin (113 v 171 microg/l) and Hb (156 v 168 g/l) but no change in STfR or TfR-F index. Smoking was associated with increased cord Hb (168 v 157 g/l) and TfR-F index (4.1 v 3.4), and decreased ferritin (123 v 190 microg/l). Cord TfR-F index and Hb were positively correlated (r = 0.48). CONCLUSIONS: Maternal iron depletion is associated with reduced fetal iron stores but no change in free iron availability. Smoking is associated with increased fetal iron requirements for erythropoiesis.     

Iron nutritional status of preschool children

Low hemoglobin and low MCHC levels were indicative of high incidence of iron deficiency in preschool children. The extent of iron deficiency as assessed by serum ferritin and free erythrocyte protoporphyrin showed a different trend. While FEP levels were highly suggestive of extensive iron deficiency (in 40–45% of children below the age of 5 years), low serum ferritin was seen in only 16–20% of children. The discrepant finding of high serum ferritin, and high erythrocyte protoporphyrin despite low MCHC in the present study, possibly reflects iron deficiency status along with chronic infection resulting in hyperferritinemia and hyperprotoporphyrinemia. It may be also due to associated folate deficiency resulting in non utilization of iron leading to the elevated levels of protoporphyrin.     

Fetal Erythrocyte Lifespan

Harrison, K. L. (1979) Aust. Paediatr. J. , 15, 96–97. Fetal erythrocyte lifespan. The demonstration of fetal erythrocytes in the maternal circulation by the Kleihauer technique after feto-maternal macrotransfusion provides a means of measuring the lifespan of those cells produced at the time of the haemorrhage. Two cases of massive feto-maternal haemorrhage at 40 weeks gestation and one at 36 weeks gestation are used, together with a published case at 34 weeks gestation. to show that erythrocyte lifespan is quite short in fetal life and increases during the third trimester to be 80 to 90 days in a full term infant.     

Fetal iron status in maternal anemia

Hemoglobin, serum iron, transferrin saturation and ferritin were measured on paired maternal and cord blood samples in 54 anemic (hemoglobin < 110 g/L) and 22 non-anemic (hemoglobin ≥ 110 g/L) pregnant women at term gestation. The levels of hemoglobin, serum iron, transferrin saturation and ferritin were significantly low in the cord blood of anemic women, suggesting that iron supply to the fetus was reduced in maternal anemia. The linear relationships of these parameters with both maternal hemoglobin and maternal serum ferritin indicated that the fetus extracted iron in amounts proportional to the levels available in the mother. Infants of mothers with moderate and severe anemia had significantly lower cord serum ferritin levels and hence poor iron stores at birth. It is concluded that iron deficiency anemia during pregnancy adversely affects the iron endowment of the infant at birth.     

The effects of a lipid‐based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron,copper, and zinc in milk from HIV‐infected Malawian mothers and associations with maternal and infant biomarkers

We evaluated effects of antiretroviral (ARV) therapy and lipid‐based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV‐infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post‐partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant‐pairs in the Breastfeeding, Antiretrovirals, and Nutrition study. The participants received ARV, LNS, ARV and LNS, or no intervention from 0 to 28 weeks post‐partum. ARVs negatively affected copper and zinc milk concentrations, but only at 2 weeks, whereas LNS had no effect. Among all treatment groups, approximately 80–90% of copper and zinc and <50% of iron concentrations met the current adequate intake for infants at 2 weeks and only 1–19% at 24 weeks. Pregnancy haemoglobin was negatively correlated with milk iron at 2 and 6 weeks (r = ?.18, p < .02 for both). The associations of the milk minerals with each other were the strongest correlations observed (r = .11–.47, p < .05 for all); none were found with infant biomarkers. At 2 weeks, moderately anaemic women produced milk higher in iron when ferritin was higher or TfR lower. At 6 weeks, higher maternal α‐1‐acid glycoprotein and C‐reactive protein were associated with higher milk minerals in mildly anaemic women. Infant TfR was lower when milk mineral concentrations were higher at 6 weeks and when mothers were moderately anaemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal haemoglobin during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.     

Gender difference in cord serum ferritin concentrations.

We measured cord serum ferritin concentrations in a total of 255 infants (116 females and 139 males), and evaluated the association between these values and various neonatal as well as maternal characteristics. The mean ferritin concentration in females (166 +/- 110 microg/l) was significantly higher than that in male infants (123 +/- 77 microg/l). The gender differences in ferritin were significant within groups of infants with fetal growth restriction, those who weighed <3,000 g, those whose mothers were African Americans or <25 years old. Maternal serum ferritin concentrations at 36 weeks of gestation significantly correlated with cord serum ferritin of male infants (r = 0.32, p < 0.001), whereas the association was not significant for females (r = 0.09, p > 0.41). Although the mechanism of the gender difference is unknown, it may be important to consider the sex of neonates when evaluating their iron nutriture immediately after birth.     

Correlation of serum ferritin with other tests of iron status in sickle cell disease

The iron status of 42 patients with homozygous SS disease, none of whom was on chronic transfusion therapy, was investigated using tests for serum ferritin, serum iron, serum transferrin, transferrin saturation, and free erythrocyte protoporphyrin. Correlation coefficients were computed between ferritins and the other test results. The mean ferritin level of the group as a whole showed significant inverse linear correlation with the mean transferrin and free erythrocyte protoporphyrin values. The mean ferritin of the subgroup with normal ferritin levels correlated significantly only with the mean free erythrocyte protoporphyrin value. The mean ferritin of the subgroup with high ferritin levels correlated significantly only with the mean transferrin value. In these patients who had received only sporadic blood transfusions, there was poor correlation of ferritin levels with age and number of transfusions.     

The relationship between the percentage saturation of maternal and cord plasma transferrin and the maternal and cord blood free erythrocyte protoporphyrin:haem ratio

The relationship between the percentage saturation of maternal and cord plasma transferrin and the maternal and cord blood free erythrocyte protoporphyrin:haem ratio were investigated in 49 healthy mothers following an uncomplicated pregnancy, and in their full term newborn infants. The variables studied were plasma iron, plasma total iron-binding capacity, percentage saturation of plasma transferrin, free erythrocyte protoporphyrin:haem ratio and haematocrit value. The same variables were also investigated in a group of 60 healthy university students. Though the measurement of free erythrocyte protoporphyrin:haem ratio has broad application in public health studies, little information is available regarding the possible application and clinical use of this variable in the Nigerian population. The results obtained suggest that the free erythrocyte protoporphyrin:haem ratio of blood has a significant negative correlation with that of the percentage saturation of plasma transferrin of the sample. The maternal percentage saturation of plasma transferrin has a significant positive correlation with that of the corresponding fetal (cord) sample. There was no significant correlation between maternal and cord free erythrocyte protoporphyrin [FEP]:haem ratio.     

Influence of genetic and environmental factors on the level of IgE at birth

The effect of hereditary and environmental factors on the level of IgE at birlh was assessed in 1319 unselected infants. Cord igE was measured using a new enzyme-linked immunoassay. EIA Ultra® test. Information on family history of atopy and maternal smoking was obtained using a standard questionnaire. Data on length of gestation and birth weight were obtained from hospital records. Blood for maternal IgE was obtained from 1056 mothers within a week of delivery. Cord IgE levels were higher in infants with a history of atopy in the immediate family (p < 0.01). Male infants had a higher IgE than female (p < 0.01). Maternal IgE correlated positively with cord IgE (r = 0. 3, p < 0.001). There was no effect of length of gestation, birth weight, maternal smoking or month of birth on cord IgE values. It is concluded that the IgE level at birth is determined primarily by genetic factors. No significant effect of environmental factors was demonstrated in this study.     

Human placental IGF-I and IGF-II expression: correlating maternal and infant anthropometric variables and micronutrients at birth in the Pakistani population

Abstract Aim: To correlate infant birth weight with maternal and infant biometric data, including the expression of placental IGF-I and IGF-II at birth, and levels of serum zinc and ferritin. Methods: The data consisted of observations from 89 women from Karachi, Pakistan. Placental and cord blood samples were taken immediately following delivery and were subsequently divided into two groups, small and large for gestational age (SGA and LGA). Results: The mean birth weight was 2.79 kg; the prevalence of SGA being 13.4% (/=90th percentile). Placental IGF-I and IGF-II mRNA expression was greater in the LGA group (p < 0.05). Furthermore, a significant correlation was noted between infant birth weight and maternal anthropometric parameters (p < 0.01). Cord zinc levels were also significantly higher in the LGA group (p < 0.05). Conclusion: Maternal anthropometry, along with placental IGF-I and IGF-II mRNA levels, correlated significantly with infant birth weight suggesting the importance of these growth factors for birth weight outcomes. The higher zinc levels in the LGA group also suggest the importance of this micronutrient in foetal growth. Our results suggest that growth problems have a multifactorial aetiology arising from within the infant rather than due to maternal constraint alone.     

Influence of maternal diabetes mellitus on fetal iron status

OBJECTIVE: To determine the effects of maternal diabetes on fetal iron status using serum transferrin receptors (STfR) and their ratio to ferritin (TfR-F index) in cord blood. METHODS: Iron, ferritin, erythropoietin, STfR and haemoglobin concentration were measured and TfR-F index calculated in 97 maternal/cord blood pairs. Forty-nine women had type 1 diabetes (diagnosed before pregnancy) and these were compared with forty-eight non- diabetic controls. The women with type 1 diabetes were recruited consecutively from attendance at the joint antenatal endocrine clinic while the control group of women was recruited from consecutive attendance at the remaining antenatal clinics. RESULTS: The infants of the diabetic women had significantly lower levels of ferritin (47 vs 169 mug/l; p<0.01) and higher STfR (17.4 vs 12.9 mg/l; p<0.01) and TfR-F index (10.4 vs 5.8; p<0.01) than controls. They were also significantly more acidotic at birth (7.25 vs 7.30; p<0.01), were born at an earlier gestation (36.7 vs 39.7 weeks; p<0.01) and had higher z Scores for weight (0.53 vs 0.02; p = 0.016). CONCLUSIONS: Maternal diabetes causes depletion of fetal iron stores and is associated with higher fetal iron demands as indicated by higher STfR level and TfR-F index in cord blood.     

A prospective survey of serial maternal serum zinc levels and pregnancy outcome

Serum zinc levels were monitored serially in pregnant women. Compared with those of age-matched nonpregnant women, their serum zinc levels were significantly decreased in the first trimester (p less than 0.005) and further decreased in the second trimester (p less than 0.005) but then remained unchanged until delivery. Cord blood zinc levels and the ratio of cord blood to maternal serum zinc at delivery were significantly higher in preterm than term (greater than or equal to 37 weeks) infants (p less than 0.05, p less than 0.05). The maternal serum zinc level in the second trimester was not related to the birth weights of the infants. Mothers with serum zinc levels of less than 65 micrograms/dl in the last trimester showed a higher incidence of birth weights of less than the 50th percentile (p less than 0.005) and also of less than the 25th percentile (p less than 0.005) on term delivery. The incidences of birth weights of less than the 10th percentile on term delivery were similar for mothers with serum zinc levels of greater than or equal to 65 micrograms/dl. This observation suggested that a relatively lower birth weight may be associated with lower maternal serum zinc levels in the third trimester, but an additional factor (factors) is also involved in the outcome of low birth weight infants.     

Smoking during pregnancy--hematological observations in the newborn

Hematological values were measured in 28 newborn infants of mothers smoking 10-20 cigarettes daily during pregnancy, and in 25 infants of non-smokers. Higher hematocrit levels were found on the 1st day of life in infants of smoking mothers (60.8 +/- 5.0%, mean +/- S.D.) compared to controls (57.5 +/- 4.8%) (p less than 0.05). The hematocrit levels correlated positively with the maternal smoking level (r = 0.318, p less than 0.05) and the maternal serum thiocyanate concentrations at delivery (r = 0.389, p less than 0.01). Cord serum values for erythropoietin, serum-iron, transferrin and ferritin showed no statistically significant difference between the two groups. A significant inverse correlation was found between the hematocrit value on the 1st day of life and the cord serum ferritin concentration (r = -0.495, p less than 0.005). The present results suggest that maternal smoking stimulates fetal erythropoiesis, probably through a hypoxic effect on the fetus, dose related to the maternal smoking level. Increased erythropoiesis may cause increased iron incorporation into erythrocytes at expense of iron storage in the bone marrow and reticuloendothelial system.     

Cord blood transferrin receptors to assess fetal iron status.

OBJECTIVE: To study iron status at different gestational ages using cord blood serum transferrin receptors (STfRs). METHODS: STfRs, iron, ferritin, total iron binding capacity, haemoglobin, and reticulocytes were measured in 144 cord blood samples. The babies were divided into three groups according to gestation (26 very preterm (24-29 weeks); 50 preterm (30-36 weeks); 68 term (37-41 weeks)). RESULTS: Serum iron, ferritin, and total iron binding capacity were highest at term, whereas reticulocytes were highest in the very preterm. STfR levels were not influenced by gestation. Haemoglobin (r = 0.46; p < 0.0001) and reticulocytes (r = 0.42; p < 0.0001) were the only indices that independently correlated with STfR levels. CONCLUSIONS: STfR levels in cord blood are not directly influenced by gestation and probably reflect the iron requirements of the fetus for erythropoiesis.     

Relationship between infant birth weight </=2000 g and maternal zinc levels at Muhimbili National Hospital, Dar Es Salaam, Tanzania

The objective of this study was to determine the relationship between infant birth weight or=3000 g and their mothers formed the control group. There were 81 cases and 84 control infant-mother pairs. Maternal and infants venous blood samples were taken after delivery. Plasma zinc was analyzed using Atomic Absorption Spectrophotometer method. Data were analyzed using Epi-info version 6. Logistic regression was used to assess the contribution of other risk factor on infant birth weight. Date was converted to STATA format and logistic regression analysis was done using STATA program version 8. The results showed that there is significant relationship between infant birth weight and maternal zinc levels. Mothers with low zinc levels were two and half time more at risk of having an infant weighing 相似文献   

The role of erythrocyte protoporphyrin in the diagnosis of iron deficiency anemia of children

The values of erythrocyte protoporphyrin, ferritin and mean corpuscular volume (MCV) measurements in diagnosing iron deficiency anemia were investigated in 72 iron deficient and in 25 healthy control infants. Receiver operator curve, sensitivity and specificity of erythrocyte protoporphyrin, ferritin and mean corpuscular volume were compared between the study and control groups. In the study group mean corpuscular volume, hemoglobin and ferritin concentrations were significantly lower, and erythrocyte protoporphyrin was significantly higher when compared to the control group. In the iron deficient study group, erythrocyte protoporphyrin was the most sensitive test and ferritin was the most specific test, whereas ferritin was the most diagnostic test and mean corpuscular volume was the least diagnostic test. A significant correlation between erythrocyte protoporphyrin and hemoglobin values was determined. We conclude that erythrocyte protoporphyrin is a more sensitive but less specific test than ferritin, and it can be used as a first-line diagnostic test in the evaluation of iron deficiency and in diagnosing iron deficiency anemia in infants.     

Changes in the concentration of ferritin in the serum during fetal life in singletons and twins

Concentration of serum ferritin was analyzed in cord blood samples of 34 preterm and 24 full-term subjects, 10 fetuses which were aborted by laparotomy at 14-20 weeks of gestation, and 20 pairs of twins. The findings indicated that the fetal amount of storage iron gradually increases as the gestational age increases, it is similar in singletons and twins, within the pairs of twins, and slightly lower in some small-for-dates newborns. There was no correlation between fetal ferritin and maternal iron status. Our data suggest that the accumulation of fetal iron stores is not regulated by the fetus itself, or by maternal iron metabolism. Thus, we speculate that the placenta may have a role in this regulation.