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Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes

European Journal of Clinical Nutrition volume 70, pages 358–363 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

There are several biomarkers for measuring iron deficiency (ID) in pregnancy, but the prevalence of ID and its association with inflammation and adverse pregnancy outcomes is inconclusive. The aim of this work was to describe the prevalence and determinants of first trimester ID and associations with pregnancy and birth outcomes.

Subjects/Methods:

A record-linkage cohort study of archived serum samples of women attending first trimester screening and birth and hospital data to ascertain maternal characteristics and pregnancy outcomes. Sera were analysed for iron stores (ferritin; μg/l), lack of iron in the tissues (soluble transferrin receptor (sTfR); nmol/l) and inflammatory (C-reactive protein (CRP); mg/dl) biomarkers. Total body iron (TBI) was calculated from serum ferritin (SF) and sTfR concentrations. Multivariate logistic regression analysed risk factors and pregnancy outcomes associated with ID using the definitions: SF<12 μg/l, TfR⩾21.0 nmol/l, and TBI<0 mg/kg.

Results:

Of the 4420 women, the prevalence of ID based on ferritin, sTfR and TBI was 19.6, 15.3 and 15.7%, respectively. Risk factors of ID varied depending on which iron parameter was used and included maternal age <25 years, multiparity, socioeconomic disadvantage, high maternal body weight and inflammation. ID, defined by SF and TBI but not TfR, was associated with reduced risk of gestational diabetes mellitus (GDM). ID defined using TBI only was associated with increased risk of large-for-gestation-age (LGA) infants.

Conclusions:

Nearly one in five Australian women begin pregnancy with ID. Further investigation of excess maternal weight and inflammation in the relationships between ID and GDM and LGA infants is needed.

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Article 16 February 2023

Evdokia Dimitriadis, Daniel L. Rolnik, … Ellen Menkhorst

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Acknowledgements

We thank the New South Wales PaLMS Pathology service and Ministry of Health for provision of population data and the NSW Centre for Health Record Linkage for record linkage. This work was funded by a National Health and Medical Research Council (NHMRC) Project Grant (no. 632653). Funding for Amina Khambalia is by an Australian NHMRC Centers for Research Excellence (APP1001066), to Natasha Nassar by an NHMRC Career Development Fellowship (no. APP1067066) and to Christine Roberts by an NHMRC Senior Research Fellowship (no. APP1021025). Clare Collins is supported by a Faculty of Health and Medicine Strategic Research Fellowship at the University of Newcastle.

Author contributions

AZK, NN, CLR, JM and VT conceived and designed the study; NN, CLR, JM and VT acquired data; AZK was responsible for the integrity of data and statistical analysis; AZK drafted the manuscript; and all authors approved the manuscript and critically reviewed the manuscript for important intellectual content.

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Authors and Affiliations

  1. Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia

    A Z Khambalia, C L Roberts, J M Morris, V Tasevski & N Nassar

  2. School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia

    C E Collins

  3. Division of Perinatal Research, Kolling Institute, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, Australia

    K L Powell

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  1. A Z Khambalia
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Correspondence to A Z Khambalia.

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Khambalia, A., Collins, C., Roberts, C. et al. Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes. Eur J Clin Nutr 70, 358–363 (2016). https://doi.org/10.1038/ejcn.2015.157

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