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Inadequate iron stores in early term neonates

Journal of Perinatology volume 38, pages 1017–1021 (2018)Cite this article

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Abstract

Objective

To characterize neonatal iron stores depending on gestational age (GA) at term.

Study design

Participants were 751 mother–newborn pairs from the placebo arm of a randomized clinical trial of prenatal iron-folate supplementation in China. We compared mean cord serum ferritin (SF) by weeks GA and, following the general linear model, assessed whether maternal iron deficiency (ID) influenced relations between GA and cord SF.

Results

Controlling for covariates, cord SF increased between 37 and 41 weeks (ps < 0.05–0.01). Cord SF was lower in infants of ID vs. non-ID mothers (geometric mean 96.3 [95% CI: 91.3–101.6] µg/L vs. 115.9 [95% CI: 105.0–127.8] µg/L, effect size = 0.33 SD, p = 0.0012). There was no significant increase with GA among infants of ID mothers. For non-ID mothers, cord-blood SF increased sharply with GA until 38 5/7 weeks, after which it plateaued.

Conclusions

The findings emphasize that neonates at 37–38 weeks, although considered term, are not fully mature.

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Acknowledgements

This analysis was based on a RCT supported by Vifor Pharma Limited (Switzerland). Measures of maternal and newborn iron status were supported by a grant from US National Institutes of Health (R01 HD052069), which included funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Dietary Supplements. Iron supplements and placebo were prepared by Lee’s Pharmaceutical Holdings Limited (Hong Kong) and provided at cost. We thank Drs. Gengli Zhao and Min Zhou for overall direction of the pregnancy RCT, Drs. Zhixiang Zhang and Twila Tardif for their leadership roles in coordinating and supervising the project, Dr. Xintian Lu for input about iron status measures and supervision of Ying Hua, Dr. Michael Georgieff for critical comments and constructive suggestions on the manuscript, and Ms. Katy Clark for help preparing the manuscript. We also appreciate the dedicated efforts of project doctors and nurses at Sanhe Maternal and Child Health Center.

Funding

This analysis was based on a randomized clinical trial supported by Vifor Pharma Limited (Switzerland). Measures of maternal and newborn iron status were supported by a grant from US National Institutes of Health (R01 HD052069), which included funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Dietary Supplements. The study sponsors had no role in the study design, collection, analysis, and interpretation of data, writing of the report, or decision to submit for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Iron supplements and placebo were prepared by Lee’s Pharmaceutical Holdings Limited (Hong Kong) and provided at cost. This clinical trial was registered at ClinicalTrials.gov, NCT02221752.

Author contribution

YH conceived the research question, performed initial data analysis, wrote the first draft, and approved the final version. NK conceived the analytic approach, performed final data analysis, revised the manuscript, and approved the final version. YJ established and performed laboratory iron studies, participated in conceiving the study, revised the manuscript, and approved the final version. XL assisted in organizing the pregnancy study, including cord blood iron collection, participated in conceiving the research question, revised the manuscript, and approved the final version. GX designed and supervised laboratory iron studies, participated in conceiving the analysis, revised the manuscript, and approved the final version. BR participated in conceiving the research question, performed data analysis, revised the manuscript, and approved the final version. ML helped conceptualize the pregnancy trial, organized and supervised the pregnancy and infant components, critically reviewed the manuscript, and approved the final version. BL conceptualized the pregnancy trial, organized and supervised the pregnancy and infant components, critically reviewed and revised the manuscript, and approved the final version.

Author information

Author notes

  1. These authors contributed equally: Dr. Hua and Dr. Kaciroti.

Authors and Affiliations

  1. Peking University First Hospital, Beijing, China

    Ying Hua, Yaping Jiang, Xing Li, Guobin Xu & Ming Li

  2. Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA

    Niko Kaciroti, Blair Richards & Betsy Lozoff

  3. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA

    Betsy Lozoff

Authors
  1. Ying Hua
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  2. Niko Kaciroti
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  3. Yaping Jiang
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  4. Xing Li
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  5. Guobin Xu
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  6. Blair Richards
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  7. Ming Li
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  8. Betsy Lozoff
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Corresponding authors

Correspondence to Ming Li or Betsy Lozoff.

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The authors declare that they have no conflict of interest.

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Hua, Y., Kaciroti, N., Jiang, Y. et al. Inadequate iron stores in early term neonates. J Perinatol 38, 1017–1021 (2018). https://doi.org/10.1038/s41372-018-0140-9

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  • DOI: https://doi.org/10.1038/s41372-018-0140-9

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