Iron status in Nigerian mothers and their newborns.

An evaluation of iron status was carried out on 364 Nigerian pregnant women from Niamey at delivery and in cord blood from their newborns. Anemia, defined as a low hematocrit value, was observed in 46% of pregnant women. Iron deficiency, recognized by a combination of, at least, 2 abnormal values in the 3 independent indicators measured (serum ferritin level, erythrocyte protoporphyrin concentration and transferrin saturation) was present in 47.8% of pregnant women. Anemia was associated with iron deficiency in 60.1% of cases in anemic mothers. A correlation between maternal and newborn iron indicators was found. This study points out the necessity for developing strategies in Sahelian countries to combat iron deficiency during pregnancy by specific measures in combination with more general interventions.     

Nutritional anaemia in pregnant Beninese women: consequences on the haematological profile of the newborn

An assessment of iron and folic acid status, blood thick film and haemoglobin (Hb) electrophoresis was performed on 126 pregnant women (and their newborn infants) and in ninety-five menstruating women in Cotonou (Benin). Anaemia (according to the World Health Organization (1972] was observed in 55% of pregnant women and in 39% of menstruating women. Fe-deficiency was defined as a low serum ferritin concentration (12 micrograms/l or less), combined with a low transferrin saturation (less than 16%) or a high erythrocyte protoporphyrin level (more than 3 micrograms/g Hb), or both. A moderate elevation in the serum ferritin concentration (between 13 and 50 micrograms/l), associated with a low transferrin saturation or a high erythrocyte protoporphyrin level, or both, indicated Fe-deficiency in an inflammatory context. Fe-deficiency was present in 73% of pregnant women and in 41% of menstruating women. Folate deficiency (defined as erythrocyte folate below 160 micrograms/l) was observed in 45% of pregnant women. In pregnant women, anaemia was associated with Fe-deficiency in 83% of cases and with folate deficiency in 48% of cases. Haemoglobinopathies were mainly heterozygous and did not seem to contribute significantly to anaemia. Intensity of malaria was not related to Hb level, but Plasmodium falciparum was found in 99% of subjects. Hb concentration and mean corpuscular volume were significantly lower in babies born of Fe-deficient mothers than in babies born of Fe-sufficient mothers. Hb concentration in newborn infants was positively correlated with maternal serum ferritin.     

Iron status in hypogammaglobulinaemia.

Iron, transferrin and ferritin were measured in serum samples from 16 patients with primary hypogammaglobulinaemia. Transferrin saturation was low in 12 patients (75%) and serum ferritin was low in 9 patients (56.25%). Both parameters were low, confirming the state of iron deficiency, in 6 patients (37.5%). These figures are highly significant (P less than 0.01) when compared with the prevalence of iron deficiency in the general population. Eight patients were maintained on intravenous immunoglobulin infusions and the rest on intramuscular immunoglobulin injections, their mean serum IgG being 4.4 g/l and 2.6 g/l respectively. There was no difference in the prevalence of iron deficiency between the two groups.     

Relationship between the iron status of pregnant women and their newborns

OBJECTIVE: To determine the relationship between iron nutritional status of pregnant women and their newborns using a combination of hematological and biochemical parameters for the diagnosis of iron deficiency. METHODS: A cross-sectional study was conducted in Jundiaí, Southeastern Brazil, in 2000. Venous blood samples collected from 95 pregnant women and from their umbilical cord and used for the determination of complete blood count, serum iron, total iron-binding capacity, serum ferritin, zinc protoporphyrin, and transferrin saturation. Women were classified into three groups: anemic, iron deficient and non-iron deficient. Statistical analysis included the Tukey-HSD test, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: Among pregnant women, 19% were anemic (97.9% mildly anemic and 2.1% moderately anemic) and 30.5% were iron deficient. No significant difference was seen in mean values of any parameter studied between newborns in the three groups (p>0.05). Multiple linear regression analysis showed weak association between neonatal and maternal parameters. CONCLUSIONS: The iron nutritional status of pregnant women with iron deficiency or mild anemia does not seem to have a significant impact on the iron levels of their children.     

孕期铁营养状况与胎儿铁贮备的探讨

作者纵向追踪观察80名健康初孕妇女,于不同孕期抽取静脉血并留取部分脐血进行8项有关铁营养指标的测定,并了解孕期膳食摄入情况。观察到:随孕龄的增加,孕妇铁贮备显著降低,故铁缺乏症的检出率有增高的趋势;孕期总铁摄入量与孕期母血多项指标的变化幅度、孕期铁缺乏症的程度与脐血铁蛋白均存在密切关系;母血血清铁与脐血铁蛋白呈正相关。提示在孕期及时调整膳食结构、投予铁剂或铁强化食品是防治孕妇铁缺乏的重要措施。     

Iron status in a general practice and its relationship to morbidity.

1. An epidemiological study of iron status in general practice has been undertaken. An age-sex register was established and a 10% stratified random sample (194 males and 220 females) of the patients above the age of 15 years was studied. A full blood count, serum Fe concentration, transferrin saturation and serum ferritin concentration were measured and correlated with clinical features associated with Fe deficiency. 2. The geometric mean for serum ferritin for males was 77 micrograms/l (20-196 micrograms/l) and for females 37 micrograms/l (8--177 micrograms/l). A low serum ferritin (male less than 30 micrograms/l, female less than 20 micrograms/l) in the absence of anaemia was found in fifteen males and thirty-five females. In this group forty patients had clinical features which are aetiologically associated with Fe deficiency. The incidence of similar features in a control group of thirty-three patients was seven. 3. It is suggested that this is indirect evidence that serum ferritin concentration is the most sensitive monitor of Fe status enabling the detection of pre-anaemic Fe deficiency.     

Maternal and neonatal iron status in Ivory Coast

Despite the high prevalence of neonatal anemia in C?te d'Ivoire, complete blood counts and iron studies have not been adequately explored. The authors studied complete blood counts (from peripheral blood mononuclear cells), hemoglobin electrophoresis results, and serum iron, ferritin and transferrin levels in 40 newborns and their mothers. The neonatal results (mean +/- SD) were: hemoglobin: 14.96 +/- 2.24 g/dl; serum iron: 16.88 +/- 7.29 micromol/l; total iron-binding capacity (TIBC): 39.88 +/- 14.85 micromol/l; transferrin: 2 +/- 0.65 g/l; ferritin: 116.20 +/- 105.25 microg/l; and hemoglobin electrophoresis: 22.5% of infants showed some hemoglobinopathy (FAC, FAS, FSA(2)). Maternal serum iron levels were positively correlated with the newborns' TIBC (r = 0.362, p<0.05), maternal ferritin with neonatal transferrin (r = 0.374, p<0.05), maternal transferrin coefficient of saturation (CS) with neonatal TIBC (r = 0.554, p<0.01). These results suggest a high prevalence of iron deficiency in mothers and a consequent potential risk of iron deficiency in their newborns in the absence of iron supplementation.     

Influence of inflammation on laboratory indicators of iron deficiency in the elderly

Hemoglobin, serum iron, transferrin, erythrocyte protoporphyrin and serum ferritin concentrations were measured in 151 elderly institutionalized women. One hundred-fifteen subjects presented an inflammatory process identified by at least one abnormal value for serum concentration of orosomucoid, C-reactive Protein and sedimentation rate. Thirty-six subjects did not present any biological evidence of inflammatory process. Anemia (according to WHO references) was present in 4 (11%) women without and in 37 (32%) women with inflammation. Hemoglobin and serum iron were negatively correlated with the different markers of inflammation, while erythrocyte protoporphyrin and serum ferritin were positively correlated with them. Total iron-binding capacity may be considered as the iron parameter the least affected by the inflammatory process. In women without inflammation, iron deficiency was defined as a combination of low transferrin saturation and a high erythrocyte protoporphyrin concentration. In women with inflammation, iron deficiency was defined as the same association combined with a high total iron-binding capacity. According to these definitions, iron deficiency was present in 11% of elderly women without inflammation and in 16% with biochemical evidence of an inflammatory process, respectively.     

Iron stores in pregnant Nigerians and their infants at term

Serum ferritin and blood haemoglobin were evaluated as indices of iron status in 65 pregnant Nigerians and in the cord blood of their full-term infants. All the mothers had taken iron and folate supplementation throughout pregnancy. The mean gravidity was 3.3 +/- 2.0. The mean cord ferritin concentration of 135.9 micrograms/l (77.6-238.2 micrograms/l) was 3.6 times the maternal level of 38.1 micrograms/l (17.3-83.8 micrograms/l). Parity had no effect on the haemoglobin or serum ferritin concentrations of the mothers or those of their babies. Maternal haemoglobin or serum ferritin concentrations correlated significantly (P less than 0.01) with cord levels, in babies with mothers of parity greater than or equal to 5. Infants of mothers with low iron stores (less than 20 micrograms/l) had significantly lower serum ferritin concentrations than infants of iron-replete mothers, which suggests variation in amounts of iron received during intrauterine growth. In order to ensure adequate iron stores in newborn infants, continual use of supplementary oral iron should be encouraged in pregnant Nigerians.     

Prevalence of iron depletion and anemia in top-level basketball players

Iron depletion, with or without anemia, may have a negative effect on physical and mental performance. Even with current recognition of the problem, its incidence among athletes remains high. Most studies describe iron status in endurance athletes. This study examined the prevalence of iron depletion and anemia among male and female top-level basketball players. Adolescents and adults (N = 103) from 8 national basketball teams were screened for anemia and iron stores status, which included a complete blood count and levels of plasma ferritin, transferrin, and serum iron. Iron depletion, defined by a ferritin level below 20 microg/L, was found among 22% of study participants (15% in males vs. 35% in females, p = .019). Anemia was found among 25% of athletes (18% in males vs. 38% in females, p = .028). Iron deficiency anemia, defined by the presence of anemia, ferritin levels below 12 microg/L, and transferrin saturation below 16%, was found among 7% of players (3% in males vs. 14% in females, p = .043). In summary, a high prevalence of iron depletion, anemia, and iron deficiency anemia was found among basketball players of both genders. We recommend screening ballgame players for blood count and iron store status, and providing nutritional counseling and iron supplementation when necessary.     

Iron status and its association with pregnancy outcome in Korean pregnant women

OBJECTIVE: The purpose of this study was to assess the prevalence of iron deficiency anemia among Korean pregnant women and to assess the association between maternal hemoglobin (Hb) level and pregnancy outcome. DESIGN: A longitudinal study. SETTING: Ewha Womans University Hospital, Seoul, Korea. SUBJECTS: A total of 248 normal pregnant women of 24-28 weeks gestation and 190 babies born to the pregnant subjects. METHODS: Maternal anthropometry, blood parameters and pregnancy outcomes were measured. RESULTS: Mean Hb, serum iron concentration, transferrin saturation and total iron binding capacity of the subjects were 11.4 g/dl, 89.4 microg/dl, 18.7% and 484.6 microg/dl, respectively, and 30.2% of the subjects were anemic judged by Hb concentration of <10.5 g/dl. When subjects were classified into tertile groups based on Hb levels, the lowest tertile (HbT1) group had significantly lower concentrations of cord serum iron and albumin than those in the highest tertile (HbT3) group. Newborn infants from the HbT1 group had significantly higher rates of preterm delivery, low birth weight and low Apgar scores than those in other groups. Logistic regression analysis showed that maternal serum albumin and Hb level were the most important predictive variables for low birth weight.Conclusions:A substantial proportion of Korean pregnant women were at risk of anemia. Infants born to women with a low Hb level showed a lower birth weight, height and Apgar scores.     

Relationship between serum ferritin, erythrocyte protoporphyrin and transferrin saturation in Mauritanian free living children

Serum ferritin, serum iron, total iron-binding capacity (TIBC) and erythrocyte protoporphyrin were measured in a group of 69 children (6.4 +/- 3.6 years) living in a rural area of Mauritania. The predictive value of low serum ferritin was calculated for each iron parameter. A serum ferritin value above 12 micrograms/l was present in 50.2% of children with abnormal serum iron, in 59.0% of those with abnormal TIBC, in 60.3% of those with abnormal transferrin saturation and in 60.0% of those with abnormal erythrocyte protoporphyrin. The percentages varied from 88.0 to 94.8% for a predictive value of serum ferritin of less than 50 micrograms/l. Nearly 35% of children had biochemical evidence of iron deficiency, i.e. 2 abnormal independent iron parameters or more, including serum ferritin of less than 12 micrograms/l. Nearly 32% had probable iron deficiency, i.e. 2 abnormal independent iron parameters, with a serum ferritin value between 13 and 50 micrograms/l.     

A traditional beverage prevents iron deficiency in African women of child bearing age.

OBJECTIVE: To determine if a traditional item in the diet might be useful in preventing iron deficiency in African women of child-bearing age. DESIGN: In a prospective study, the iron status of women who did and did not drink traditional beer high in iron and folic acid, was compared. Iron status was determined by a combination of haemoglobin, serum ferritin and transferrin saturation. SETTING: The study was conducted amongst rural villagers in the Murehwa and Zaka districts of Zimbabwe and in Mpumalanga Province, South Africa. SUBJECTS: 112 women aged between 12 and 50 y from a population of 425 rural people participating in on-going family genetic studies. RESULTS: Women who consumed traditional beer had significantly higher serum ferritin concentrations and transferrin saturations compared to non-drinkers (P = 0.0001 and 0.03 respectively). Iron deficiency anaemia was not present in drinkers but the prevalence in non-drinkers was 13%. Forty seven percent of the non-drinkers and only 14% of the drinkers had evidence of iron deficiency (P = 0.002). Six (21%) of the drinkers and none of the non-drinkers had evidence of iron overload (transferrin saturation > 55% and serum ferritin > 400 ug/l). CONCLUSION: We conclude that the consumption of traditional beer, rich in iron, protects women against iron deficiency. While the use of an alcoholic beverage is not ideal, our findings suggest that indigenous cultural practices might be successfully employed or adapted for promoting iron nutrition.     

Iron status in a group of Norwegian menstruating women

Serum ferritin was determined in 170 healthy Norwegian women (18-48 years; median age 36 years) including 23 blood donors. In women with serum ferritin less than or equal to 20 micrograms/l haemoglobin, serum iron and total iron binding capacity were determined. Women using oral contraceptives were excluded. Information was collected on use of contraceptive techniques, habits of iron prophylaxis, and duration of menses. About 40 per cent of the participants used the intra-uterine device. Geometric mean serum ferritin was 26.9 micrograms/l with a prevalence of 21.8 per cent with exhausted iron stores (serum ferritin less than 17 micrograms/l) among the non-donors. In the group with low to empty iron stores (serum ferritin less than or equal to 20 micrograms/l) 13 per cent had anaemia (Hb less than 120 g/l). This may correspond to 4.1 per cent among all the non-donors. The blood donors had a geometric mean serum ferritin of 20.4 micrograms/l and 30 per cent with empty stores. Our study shows that in the group of non-donors there was a tendency to higher prevalence of low or empty iron stores among IUD-users and premenopausal women. In addition to these groups the blood donors are at risk of iron deficiency.     

Iron status of the Taiwanese elderly: the prevalence of iron deficiency and elevated iron stores

Iron status, prevalence of iron deficiency and elevated iron stores, and the effect of gastrointestinal ulceration on iron status in free-living Taiwanese elderly persons were all assessed in a nationally representative, cross-sectional nutrition survey--the Elderly NAHSIT. The survey included blood measurements of iron indices. Data were collected from 1202 elderly men and 1152 elderly women aged 65 years and older. Multiple iron measures, including serum ferritin (SF), transferrin saturation (Tsat), and hemoglobin were used to evaluate the prevalence of iron deficient erythropoiesis (ID) and iron deficiency anemia (IDA). Despite no routine practice of iron fortification in Taiwan, elderly subjects had a low prevalence of ID and IDA. The prevalence of ID was 2.3% in men and 1.4% in women. The prevalence of IDA was 2.5% in men and 2.0% in women. In contrast, 15.7% of men and 9.8% of women had elevated iron stores as diagnosed by SF>300 microg/L. Subjects with a history of gastrointestinal ulceration had significantly lower serum ferritin than those without ulcers, but the prevalence of anemia, ID and IDA was unaffected. In conclusion, elderly people in Taiwan are an iron-replete population with a high prevalence of elevated iron stores and a low prevalence of iron deficiency.     

母亲和足月儿脐带血铁营养状态的关系

检查了45对母婴临产前后母血和脐带血之各项铁参数,发现脐血铁营养状态明显优于母血,母血和脐血各参数间无明显相关。脐血各参数不因母血之血清铁蛋白水平的高低而有显著差异。研究结果表明,无论母体铁营养状态如何,胎儿都能自母体获得足够的铁以供生长发育所需,这就有可能导致孕妇的铁缺乏状态,因此需要加强妊娠时期铁缺乏症的防治。     

A national survey of iron and folate status in pregnant women in Switzerland.

Women often do not meet the increased iron and folate needs of pregnancy. Maternal iron-deficiency anemia is associated with poor maternal and infant outcomes, including preterm delivery and low birth weight. Poor folate status increases risk for maternal anemia, spontaneous abortion, and congenital defects. Because of this, supplemental iron and folate are often recommended during pregnancy. There are few data on iron and folate status in pregnant women in Switzerland. We measured iron and folate status in a national sample of Swiss pregnant women, estimated the prevalence of anemia, and determined if supplement use is associated with iron and/or folate status in this group. A 3-stage probability to size cluster sampling method was used to obtain a representative national sample of pregnant women (n = 381) in the second and third trimester. We measured hemoglobin, hematocrit, mean corpuscular volume, and serum folate and ferritin concentrations. Serum transferrin receptor concentration was determined in anemic subjects. The use of iron and folate supplements was evaluated by questionnaire. Mean hemoglobin (+/- SD) in the sample was 123 g/L (+/- 1.0). The prevalence of anemia was 6%. Of the 21 anemic women, 11 were iron-deficient, giving an iron-deficiency anemia prevalence of 3%. Nineteen percent of women had low serum ferritin concentrations (< 12 micrograms/L) and 4% had low serum folate concentration (< 2.5 micrograms/L). Supplements containing iron were taken by 65% of women, and 63% were taking folate-containing supplements. Women in the second and third trimester taking folate-containing supplements had significantly higher serum folate concentrations compared to those not taking a folate supplement (p < 0.001). In the third trimester, women taking iron-containing supplements had significantly higher serum ferritin concentrations compared to those not taking an iron-containing supplement (p < 0.01). Our findings indicate that iron and folate status appears to be adequate in the majority of pregnant women in Switzerland, and that use of iron and folate supplements may have a positive impact on status.     

Evaluation of the frequency of anaemia and iron-deficiency anaemia in a group of Algerian menstruating women by a mixed distribution analysis: contribution of folate deficiency and inflammatory processes in the determination of anaemia

Frequency of anaemia was estimated by two methods for 254 menstruating women living in South-eastern Algeria. One method defines the frequency of anaemia as the percentage of women with haemoglobin concentrations below the cut-off point defined by WHO (12 g/dl). The second method defines the frequency of anaemia as the percentage of women whose haemoglobin values are shifted downwards relative to a Gaussian distribution of haemoglobin of nonanaemic women. The conventional cut-off point probably tends to overestimate the true frequency of anaemia: 7% of women with haemoglobin concentration less than 12 g/dl were not found as anaemic using the cumulative frequency method. The contribution of iron deficiency folate deficiency and inflammatory process was estimated using the cumulative frequency distribution after excluding respectively women with biological evidence of iron deficiency (serum ferritin of 12 micrograms/l or less, transferrin saturation less than 15% and/or MCV less than 80 fl), of folate deficiency (red blood cell folates less than 100 micrograms/l) and of inflammatory process (C. Reactive Protein more than 12 mg/l, orosomucoid more than 1.4 g/l or white cell counts of more than 10,000/mm3). According to this method iron deficiency represented the most important cause of anaemia in the context of our sample: iron deficiency contributed to 77% of anaemia. Folate deficiency and inflammatory processes do not in themselves appear to contribute to anaemia.     

Assessment of iron status using plasma transferrin receptor in pregnant women with and without human immunodeficiency virus infection in Malawi

BACKGROUND: Although anemia is highly prevalent during pregnancy and is common during human immunodeficiency virus (HIV) infection, anemia and iron status have not been well characterized in HIV-infected pregnant women. OBJECTIVE: To gain insight into iron status in HIV-infected pregnant women using plasma transferrin receptor and related indicators of anemia. STUDY DESIGN: Plasma transferrin receptor, ferritin, alpha1-acid glycoprotein, C-reactive protein and hemoglobin concentrations were measured in pregnant women, gestational age 18-28 weeks, seen in an urban antenatal clinic in Blantyre, Malawi. RESULTS: The prevalence of anemia among 662 HIV-positive and 190 HIV-negative pregnant women was 73.1% and 50.0%, respectively (P<0.0001). Among HIV-positive and HIV-negative women, median plasma transferrin receptor concentrations were 24.4 and 24.1 nmol/l (P=0.5), respectively, and median plasma ferritin concentrations were 17.8 and 20.8 microg/l (P<0.05), respectively. There was a large overlap in plasma transferrin receptor concentrations among women with and without anemia. Using the combination of hemoglobin and ferritin as a standard, the sensitivity and specificity of plasma transferrin receptor in diagnosing iron deficiency anemia was estimated at 45.9% and 68.1%, respectively. CONCLUSION: The use of plasma transferrin receptor concentrations as an indicator of iron deficiency anemia may be limited in pregnant women with chronic inflammation and infection.     

The impact of malarial infection and diet on the anaemia status of rural pregnant Malawian women

OBJECTIVE: To investigate haematological and biochemical iron indices in relation to malaria, gravida, and dietary iron status in rural pregnant Malawian women. DESIGN: In this self-selected sample, haemoglobin, haematocrit, red cell indices, serum ferritin, serum iron, serum transferrin, and serum transferrin receptor (TfR) were measured. Infection was assessed by a malaria slide, serum C-reactive protein, and white blood cell count. Dietary iron variables were measured by three 24-h interactive recalls. SETTING AND SUBJECTS: 152 rural pregnant women recruited at 24 weeks gestation while attending a rural antenatal clinic in Southern Malawi; 36% were primagravid; 43% were gravida 2-4; 26% were gravida >5. RESULTS: Of the women, 69% (n=105) were anaemic (haemoglobin <110 g/l); 37% (n=39) had anaemia and malarial parasitaemia on the test day; 17% (n=26) with malaria were also classified with iron deficiency (ID) anaemia (based on serum ferritin < or = 50 microg/l and Hb <110 g/l) while an additional seven with malaria were classified with ID without anaemia. In malarial-free subjects, 32% were classified with IDA (serum ferritin <12 microg/l and Hb <110 g/l) and 17% with ID (serum ferritin <12 microg/l; Hb > or = 110 g/l). Serum TfR concentrations were elevated in anaemic women (P<0.01). In non-malarial parasitaemic subjects, serum TfR correlated negatively with haemoglobin (r=-0.313; P<0.001) but not serum ferritin. Of the women, 49% were at risk for inadequate iron intakes. Most dietary iron was non-haem; plant foods provided 89%; flesh foods (mainly fish) only 9%. Malarial parasitaemia and intakes of available iron impacted significantly on iron status. CONCLUSION: Anaemia prevalence from all causes was high (that is, 69%); three factors were implicated: malaria, and deficiencies of iron and possibly folate, induced partly by an inadequate dietary supply and/or secondary to malarial parasitaemia. Sponsorship: International Development Research Centre (IDRC) of Canada. Opportunities for Micronutrient Interventions (OMNI) Project. Natural Sciences and Engineering Research Council of Canada.