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Timing, duration, and severity of iron deficiency in early development and motor outcomes at 9 months

European Journal of Clinical Nutrition volume 72, pages 332–341 (2018)Cite this article

Subjects

Abstract

Background/objectives

Poorer motor development is reported in infants with iron deficiency (ID). The role of timing, duration and severity is unclear. We assessed relations between ID timing, duration, and severity and gross motor scores, neurological integrity, and motor behavior quality at 9 months.

Subjects/methods

Iron status was determined at birth and 9 months in otherwise healthy term Chinese infants. The 9-month motor evaluation included the Peabody Developmental Motor Scale (PDMS-2), Infant Neurological International Battery (INFANIB), and motor quality factor. Motor outcomes were analyzed by ID timing (fetal–neonatal, infancy), duration, and severity. For severity, we also considered maternal iron status.

Results

The data were available for 1194 infants. Iron status was classified as fetal–neonatal and infancy ID (n = 253), fetal–neonatal ID (n = 256), infancy ID (n = 288), and not ID (n = 397). Compared with not ID, infants with fetal–neonatal or infancy ID had lower locomotion scores (effect size ds = 0.19, 0.18) and those with ID in both periods (longer duration) had lower locomotion and overall PDMS-2 gross motor scores (ds = 0.20, 0.18); ID groups did not differ. More severe ID in late pregnancy was associated with lower INFANIB Vestibular function (p = 0.01), and total score (p = 0.03). More severe ID in infancy was associated with lower scores for locomotion (p = 0.03), overall gross motor (p = 0.05).

Conclusions

Fetal–neonatal and/or infancy ID was associated with lower overall gross motor development and locomotion test scores at 9 months. Associations with ID severity varied by ID timing: more severe ID in late pregnancy, poorer neurological integrity; more severe ID in infancy, poorer gross motor development.

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Acknowledgements

This work was funded by a grant from the 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, provided support for the infancy study and laboratory measures of iron status for mothers and infants, Betsy Lozoff, Principal Investigator. Vifor Pharma, Ltd. provided financial support for the pregnancy study. São Paulo Research Foundation – FAPESP/Brazil (2014/00018-0) and Methodist University of Piracicaba – UNIMEP/Brazil provided financial support for Denise CC Santos. The content is solely the responsibility of the authors and does not necessarily represent the official views of funding sources. Authors had full control of primary data and did not have an agreement with the funders that limited their ability to complete the research as planned.

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Author notes

    Authors and Affiliations

    1. Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, 48109-5406, USA

      Denise C. C. Santos, Rosa M. Angulo-Barroso, Julie Sturza, Blair Richards & Betsy Lozoff

    2. Human Movement Sciences Graduate Program, Methodist University of Piracicaba, Piracicaba, SP, Brazil

      Denise C. C. Santos

    3. Department of Kinesiology, California State University, Northridge, CA, 91330-8287, USA

      Rosa M. Angulo-Barroso

    4. Department of Pediatrics, Peking University First Hospital, Beijing, China

      Ming Li & Yang Bian

    5. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, 48109-5718, USA

      Betsy Lozoff

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    1. Denise C. C. Santos
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    Correspondence to Rosa M. Angulo-Barroso.

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    Conflict of interest

    Betsy Lozoff was an unpaid speaker at 2 seminars supported by Lee’s Pharmaceutical Holdings Limited. The topic was iron deficiency and child development (Shanghai, 11 April 2010, and Beijing, 15 May 2011). The company covered hotel accommodations and, for the 2011 seminar, internal airfare between Hangzhou and Beijing. The authors declare that they have no other competing interests.

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    Denise C. C. Santos, Rosa M. Angulo-Barroso and Ming Li contributed equally to this work.

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    Santos, D.C.C., Angulo-Barroso, R.M., Li, M. et al. Timing, duration, and severity of iron deficiency in early development and motor outcomes at 9 months. Eur J Clin Nutr 72, 332–341 (2018). https://doi.org/10.1038/s41430-017-0015-8

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