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Nutrition during the early life cycle

Association of cesarean delivery on maternal request with neonatal iron stores at birth

European Journal of Clinical Nutrition volume 75, pages 1637–1644 (2021)Cite this article

Subjects

Abstract

Background

Cesarean has been suggested to decrease neonatal iron stores at birth. However, few studies have differentiated the effect induced by cesarean operation from that related to medical indications.

Objectives

We aimed to estimate the association of cesarean delivery on maternal request (CDMR), a subtype of cesarean without any medical indications, with a spectrum of indicators reflecting iron stores at birth.

Methods

This prospective cohort study involved 288 term singleton neonates born to women without any complications by CDMR or spontaneous vaginal delivery (SVD). Measured hematological iron-related indicators in cord blood included serum ferritin (SF), hemoglobin (Hb), red blood cell (RBC), and hematocrit (Hct). Blood flow volume (BFV) of cord vein when clamping was measured to reflect placental transfusion status during birth. Quantile regression was used to assess the association between delivery mode and the iron store indicators.

Results

CDMR (n = 154) versus SVD group (n = 134) had lower conditional median cord blood SF (–34.80; 95% CI –64.70, –4.90 μg/L; P = 0.02), Hb (–10.67; 95% CI –18.87, –2.47 g/L; P = 0.01), RBC (–0.30; 95% CI –0.48, –0.12 ×1012/L; P = 0.002), and Hct (–3.06; 95% CI –6.08, –0.04 %; P = 0.047). The BFV was higher in CDMR than SVD group at the 25th centile (0.51; 95% CI 0.19, 0.82 ml/cm3; P = 0.002), median (0.49; 95% CI 0.04, 0.95 ml/cm3; P = 0.03) and the 75th centile (0.54; 95% CI 0.06, 1.03 ml/cm3; P = 0.03).

Conclusions

The cesarean operation per se likely hampered placental transfusion from mother to neonate and decreased iron stores at birth.

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Fig. 1: Quantile level of cord blood iron-related outcomes for CDMR versus SVD.

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Acknowledgements

We would like to give special thanks to all the staff and participants of the study.

Funding

This work is supported by National Key Research and Development Program of China [2016YFC1000401 and 2016YFC1000406-1], National Natural Science Foundation of China [81801542 and 81701538].

Author information

Author notes

  1. These authors contributed equally: Zijun Liao, Yubo Zhou

Authors and Affiliations

  1. Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China

    Zijun Liao, Yubo Zhou, Hongtian Li & Jianmeng Liu

  2. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China

    Zijun Liao, Yubo Zhou, Hongtian Li & Jianmeng Liu

  3. Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China

    Zijun Liao

  4. Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, Inner Mongolia, China

    Aiju Liu

  5. Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia

    Rachel L. Peters

  6. Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia

    Rachel L. Peters

Authors
  1. Zijun Liao
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Contributions

JL conceived the study and supervised the study. YZ, HL and JL designed the study. YZ, HL, AL and JL conducted the study. ZL analyzed data. ZL and YZ wrote the manuscript. HL, AL, RLP and JL critically reviewed and revised the manuscript. JL had primary responsibility for final content. All the authors have reviewed and approved the final manuscript as submitted.

Corresponding author

Correspondence to Jianmeng Liu.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics

The Institutional Review Board of Peking University approved this study. The written informed consent was obtained from all participant mothers.

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Supplementary information

Figure S1 Process of collecting umbilical cord blood

Table S1 Maternal and neonatal characteristics of participants with and without available data of cord blood SF.

41430_2021_874_MOESM3_ESM.docx

Table S2 Maternal and neonatal characteristics of participants with and without available data of cord blood Hb, RBC, and Hct.

41430_2021_874_MOESM4_ESM.docx

Table S3 Maternal and neonatal characteristics of participants without available data of cord blood Hb, RBC, and Hct according to delivery mode.

Table S4 Correlation matrix of iron-related indicators in cord blood.

41430_2021_874_MOESM6_ESM.docx

Table S5 Adjusted quantile regression estimations (95% CI) of cord blood iron-related outcomes for CDMR compared with SVD, stratified by maternal SF.

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Liao, Z., Zhou, Y., Liu, A. et al. Association of cesarean delivery on maternal request with neonatal iron stores at birth. Eur J Clin Nutr 75, 1637–1644 (2021). https://doi.org/10.1038/s41430-021-00874-w

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