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Maternal and pediatric nutrition

Hemoglobin and hepcidin have good validity and utility for diagnosing iron deficiency anemia among pregnant women

European Journal of Clinical Nutrition volume 74, pages 708–719 (2020)Cite this article

Subjects

Abstract

Background/Objectives

Screening and diagnosis of iron deficiency anemia (IDA) is cumbersome as it may require testing for hemoglobin, ferritin, and an inflammatory biomarker. The aim of this study was to compare the diagnostic capacity of hematologic biomarkers to detect IDA among pregnant women in Tanzania.

Subjects/Methods

We pooled data from an iron supplementation trial of 1500 iron-replete pregnant woman and a prospective cohort of 600 iron-deficient pregnant women. Receiver operating characteristic curves (ROC) for hematologic biomarkers were used to assess the sensitivity, specificity, and area under the curve (AUC) for iron deficiency (ID) and iron deficiency anemia (IDA), crude, or corrected for inflammation. Regression models assessed the relationship of baseline biomarker categories (gestational age <27 weeks) and IDA at delivery.

Results

Hemoglobin had the largest AUC for crude ID (0.96), while hepcidin had the largest AUC for corrected ID (0.80). The optimal hepcidin cutoff for the diagnosis of corrected IDA based on maximal sensitivity and specificity was ≤1.6 µg/L. An hepcidin cutoff of <4.3 µg/L had a sensitivity of 95% for regression-corrected ID. Among iron-replete women who did not receive iron, the association of baseline hemoglobin >110 g/L with IDA at delivery (RR = 0.73; 95% CI: 0.47, 1.13) was attenuated. Baseline hepcidin >1.6 µg/L was associated with reduced risk of anemia at delivery by 49% (95% CI: 27%, 45%).

Conclusions

Ascertaining hemoglobin and hepcidin levels may improve the targeting of iron supplementation programs in resource-limited countries, though hepcidin’s high costs may limit its use.

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Acknowledgements

We thank the study coordinators including Dr. Robert Mongi, Dr. Vera Juma (deceased), Laura Meloney, Jeremy Kane, Juliana Mghamba, Fee Msafiri, Mwanaidi Said, and Dr. Kristina Lugangira for their contributions to the study. We also thank Dr. Daniel Raiten for his valuable insights during the planning phase of the study.

Funding

This study was supported by a grant from the National Institute of Child Health and Human Development (NICHD U01 HD061232).CD was supported in part by K24DK104676.The NIH did not have any role in the design of the study, data collection, data analysis, data interpretation, or writing of this report.

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Authors and Affiliations

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Ajibola I. Abioye, Ramadhani A. Noor, Christopher Duggan & Wafaie Fawzi

  2. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Said Aboud

  3. Department of Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Zulfiqarali Premji

  4. Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, MA, USA

    Analee J. Etheredge & Christopher Duggan

  5. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Analee J. Etheredge, Christopher R. Sudfeld, Ramadhani A. Noor, Ellen Hertzmark, Christopher Duggan & Wafaie Fawzi

  6. Department of Public Health, Purdue University, Lafayette, IN, USA

    Nilupa S. Gunaratna

  7. Center on Methods for Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA

    Donna Spiegelman

  8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wafaie Fawzi

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  1. Ajibola I. Abioye
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Contributions

The paper was drafted by AIA and WF with contributions from all authors. WF, SA, and ZP designed the study. AE, NG, AIA, RN, SA, ZP, CD, and WF participated in field implementation. AIA, CS, EH, DS, and WF contributed to statistical analyses. All authors contributed to the development of and approved the final version of the manuscript. WF had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Ajibola I. Abioye.

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Abioye, A.I., Aboud, S., Premji, Z. et al. Hemoglobin and hepcidin have good validity and utility for diagnosing iron deficiency anemia among pregnant women. Eur J Clin Nutr 74, 708–719 (2020). https://doi.org/10.1038/s41430-019-0512-z

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