European Journal of Nutrition

, Volume 52, Issue 6, pp 1631–1639 | Cite as

Predictors of haemoconcentration at delivery: association with low birth weight

  • N. Aranda
  • B. Ribot
  • F. Viteri
  • P. Cavallé
  • V. Arija
Original Contribution

Abstract

Propose

To assess the factors associated with risk of haemoconcentration at delivery, such as initial haemoglobin levels and alterations in the HFE gene, and its effect on low birth weight in pregnant women supplemented with moderate doses of iron.

Methods

Case–control study nested in a longitudinal study conducted on 217 healthy pregnant women taking moderate iron supplementation and their newborns. Women were classified according to the risk of haemoconcentration at delivery, defined as Hb > 130 g/L. Each subject’s obstetric and clinical history, smoking habit, and iron biochemical parameters (haemoglobin (Hb), serum ferritin and transferrin saturation) were recorded at 1st, 2nd and 3rd trimester and at delivery. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were also measured.

Results

The average of iron supplementation of all the women was 43.9 mg/dia (geometric mean, 95 % CI: 43.6–44.1). Higher levels of Hb at early gestation and the presence of HFE mutations were associated with greater risk of haemoconcentration at delivery, adjusted odds ratios of 1.14 (95 % CI: 1.05–1.25) and 5.35 (95 % CI: 1.6–17.8). Haemoconcentration at delivery was associated with a greater risk of low birth weight, adjusted odd ratio of 11.48 (95 % CI: 1.13–116.6).

Conclusions

Moderate daily doses of supplementary iron may be harmful for foetal growth in women with alterations in HFE gene and who started pregnancy with good haemoglobin levels. Overall, this suggests the importance of determining a woman’s iron status early in her pregnancy in order to establish a more appropriate pattern of supplementation.

Keywords

Pregnancy Haemoconcentration Iron status Iron supplementation HFE mutations Low birth weight 

References

  1. 1.
    Bothwell TH (2000) Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 72:257S–263SGoogle Scholar
  2. 2.
    Hallberg L (2001) Perspectives on nutritional iron deficiency. Annu Rev Nutr 21:1–21CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (1998) Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep 47:1–29Google Scholar
  4. 4.
    Ministerio de Sanidad y consumo (2006) Guía para la prevención de defectos congénitos. Ministerio de Sanidad y Consumo, MadridGoogle Scholar
  5. 5.
    Stoltzfus R, Dreyfuss M (1998) Guidelines for the use of iron supplements to prevent and treat iron deficiency anaemia. INACG. ILSI Press, Washington, DCGoogle Scholar
  6. 6.
    WHO (2006) Iron and folate supplementation. Standards for maternal and neonatal care. Integrated Management of Pregnancy and Childbirth (IMPAC). World Health Organization, Geneva, pp 1–6Google Scholar
  7. 7.
    Aranda N, Ribot B, Garcia E, Viteri F, Arija V (2011) Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight. Early Hum Dev 87:791–797CrossRefGoogle Scholar
  8. 8.
    Casanueva E, Viteri F, Mares-Galindo M, Meza-Camacho C, Loria A, Schnaas L, Valdés-Ramos R (2006) Weekly iron as a safe alternative to daily supplementation for nonanemic pregnant women. Arch Med Res 37:674–682CrossRefGoogle Scholar
  9. 9.
    Papadopoulou E, Stratakis N, Roumeliotaki T, Sarri K, Merlo DF, Kogevinas M, Chatzi L (2012) The effect of high doses of folic acid and iron supplementation in early-to-mid pregnancy on prematurity and fetal growth retardation: the mother-child cohort study in Crete, Greece (Rhea study). Eur J Nutr. doi:10.1007/s00394-012-0339z Google Scholar
  10. 10.
    Peña-Rosas J, Viteri F (2009) Effects and safety of preventive oral iron or iron plus folic acid supplementation for women during pregnancy. Cochrane database of systematic reviewsGoogle Scholar
  11. 11.
    Casanueva E, Viteri F (2003) Iron and oxidative stress in pregnancy. J Nutr 133:1700S–1708SGoogle Scholar
  12. 12.
    Emamghorashi F, Heidari T (2004) Iron status of babies born to iron-deficient anaemic mothers in an Iranian hospital. East Mediterr Health J 10:808–814Google Scholar
  13. 13.
    Milman N (2006) Iron and pregnancy a delicate balance. Ann Hematol 85:559–565CrossRefGoogle Scholar
  14. 14.
    Milman N, Bergholt T, Eriksen L, Byg K, Graudal N, Pedersen P, Hertz J (2005) Iron prophylaxis during pregnancy—how much iron is needed? A randomized dose- response study of 20–80 mg ferrous iron daily in pregnant women. Acta Obstet Gynecol Scand 84:238–247Google Scholar
  15. 15.
    Milman N, Byg K, Bergholt T, Eriksen L, Hvas AM (2006) Body iron and individual iron prophylaxis in pregnancy—should the iron dose be adjusted according to serum ferritin? Ann Hematol 85:567–573CrossRefGoogle Scholar
  16. 16.
    Scanlon KS, Yip R, Schieve LA, Cogswell ME (2000) High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol 96:741–748CrossRefGoogle Scholar
  17. 17.
    Scholl TO (2005) Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr 81:1218S–1222SGoogle Scholar
  18. 18.
    Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E (2007) A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. BJOG 114:1311CrossRefGoogle Scholar
  19. 19.
    Aranda N, Viteri F, Montserrat C, Arija V (2010) Effects of C282Y, H63D, and S65C HFE gene mutations, diet, and life-style factors on iron status in a general Mediterranean population from Tarragona, Spain. Ann Hematol 89:767–773CrossRefGoogle Scholar
  20. 20.
    Feder JN, Gnirke A, Thomas W, Tsuchihashi Z, Ruddy DA, Basava A, Dormishian F, Domingo R, Ellis MC, Fullan A et al (1996) A novel MHC class I-like gene is mutated in patients with hereditary haemochromatosis. Nat Genet 13:399–408CrossRefGoogle Scholar
  21. 21.
    Feder JN, Tsuchihashi Z, Irrinki A, Lee V, Mapa F, Lee VK, Mapa FA, Morikang E, Prass CE, Starnes SM, Wolff RK, Parkkila S et al (1997) The hemochromatosis founder mutation in HLA-H disrupts beta2-microglobulin interaction and cell surface expression. J Biol Chem 272:14025–14028CrossRefGoogle Scholar
  22. 22.
    Aranda N, Viteri F, Fernandez-Ballart J, Murphy M, Arija V (2007) Frequency of the hemochromatosis gene (HFE) 282C→Y, 63H→D, and 65S→C mutations in a general Mediterranean population from Tarragona, Spain. Ann Hematol 86:17–21CrossRefGoogle Scholar
  23. 23.
    Chen X, Scholl TO, Stein TP (2006) Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: the Camden study. Diabetes Care 29:1077–1082CrossRefGoogle Scholar
  24. 24.
    Hollingshead AB (2011) Four factor index of social status. Yale J Sociol 8:21–52Google Scholar
  25. 25.
    Gómez F, Simó JM, Camps J, Clivillé X, Bertran N, Ferré N, Bofill C, Joven J (2000) Evaluation of a particle-enhanced turbidimetric immunoassay for the measurement of ferritin: application to patients participating in an autologous blood transfusion program. Clin Biochem 33:191–196CrossRefGoogle Scholar
  26. 26.
    Fairbanks VF, Klee GG (1999) Biochemical aspects of haematology. In: Burtis CA, Ashwood ER (eds) Tietz textbook of clinical chemistry, 3rd edn. WB Saunders, Philadelphia, pp 1698–1705Google Scholar
  27. 27.
    WHO (2001) Iron deficiency anemia assessment prevention and control: a guide for program managers. World Health Organization, GenevaGoogle Scholar
  28. 28.
    Jouanolle AM, Fergelot P, Gandon G, Yaouanq J, Le Gall JY, David V (1997) A candidate gene for hemochromatosis: frequency of the C282Y and H63D mutations. Hum Genet 100:544–547CrossRefGoogle Scholar
  29. 29.
    Mura C, Raguenes O, Férec C (1999) HFE mutations analysis in 711 hemochromatosis probands: evidence for S65C implication in mild form of hemochromatosis. Blood 93:2502–2505Google Scholar
  30. 30.
    WHO (1993) International statistical classification of diseases and related health problems. 10th revision. World Health Organization, GenevaGoogle Scholar
  31. 31.
    Carrillo SM, Pérez Guillén A, Hernández Hernández RA, Herrera Mogollón HA (2010) Anthropometric nutritional evaluation of the pregnant women and its relation with the product of the gestation. Nutr Hosp 25:832–837Google Scholar
  32. 32.
    Reinold C, Dalenius K, Smith B, Brindley P, Grummer-Strawn L (2011) Pregnancy nutrition surveillance 2009 report. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, USGoogle Scholar
  33. 33.
    Río I, Castelló A, Jané M, Prats R, Barona C, Más R, Rebagliato M, Zurriaga O, Bolúmar F (2010) Reproductive and perinatal health indicators in immigrant and Spanish-born women in Catalonia and Valencia (2005–2006). Gac Sanit 24:123–127CrossRefGoogle Scholar
  34. 34.
    Pueyo V, Güerri N, Oros D, Valle S, Tuquet H, González I, Ferrer C, Pablo L (2011) Effects of smoking during pregnancy on the optic nerve neurodevelopment. Early Hum Dev 87:331–334CrossRefGoogle Scholar
  35. 35.
    Favier M, Hininger-Favier I (2004) Is systematic iron supplementation justified during pregnancy? Gynecol Obstet Fertil 32:245–250CrossRefGoogle Scholar
  36. 36.
    Rioux F, LeBlanc C (2007) Iron supplementation during pregnancy: what are the risks and benefits of current practices? Appl Physiol Nutr Metab 32:282–288CrossRefGoogle Scholar
  37. 37.
    Steer P, Alam M, Wadsworth J, Welch A, Alam MA (1995) Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ 310:489–491CrossRefGoogle Scholar
  38. 38.
    Walsh T, O’Broin S, Cooley S, Donnelly J, Kennedy J, Harrison R, McMahon C, Geary M (2011) Laboratory assessment of iron status in pregnancy. Clin Chem Lab Med 49:1225–1230CrossRefGoogle Scholar
  39. 39.
    Zimmermann MB (2008) Methods to assess iron and iodine status. Br J Nutr 99(Suppl 3):S2–S9Google Scholar
  40. 40.
    Muñoz M, García-Erce JA, Remacha AF (2011) Disorders of iron metabolism. Part II: iron deficiency and iron overload. J Clin Pathol 64:287–296CrossRefGoogle Scholar
  41. 41.
    Rambod M, Kovesdy C, Kalantar-Zadeh K (2008) Combined high serum ferritin and low iron saturation in hemodialysis patients: the role of inflammation. Clin J Am Soc Nephrol 3:1691–1701CrossRefGoogle Scholar
  42. 42.
    Von Tempelhoff GF, Heilmann L, Rudig L, Pollow K, Hommel G, Koscielny J (2008) Mean maternal second-trimester hemoglobin concentration and outcome of pregnancy: a population-based study. Clin Appl Thromb Hemost 14:19–28CrossRefGoogle Scholar
  43. 43.
    Palma S, Perez-Iglesias R, Prieto D, Pardo R, Llorca J, Delgado-Rodriguez M (2008) Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case-control study. J Epidemiol Commun Health 62:120–124CrossRefGoogle Scholar
  44. 44.
    Ramakrishnan U, Grant FK, Goldenberg T, Bui V, Imdad A, Bhutta ZA (2012) Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: a systematic review. Paediatr Perinat Epidemiol 26:153–167CrossRefGoogle Scholar
  45. 45.
    Maringhini S, Corrado C, Maringhini G, Cusumano R, Azzolina V, Leone F (2010) Early origin of adult renal disease. J Matern Fetal Neonatal Med 23:84–86CrossRefGoogle Scholar
  46. 46.
    Taylor HG, Filipek PA, Juranek J, Bangert B, Minich N, Hack M (2011) Brain volumes in adolescents with very low birth weight: effects on brain structure and associations with neuropsychological outcomes. Dev Neuropsychol 36:96–117CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • N. Aranda
    • 1
  • B. Ribot
    • 1
  • F. Viteri
    • 2
  • P. Cavallé
    • 3
  • V. Arija
    • 1
    • 4
  1. 1.Institut d’Investigació Sanitària Pere Virgili (IISPV), Unitat de Salut Pública i Nutrició, Universitat Rovira i VirgiliReusSpain
  2. 2.Nutritional Sciences and ToxicologyUniversity of California, Berkeley, and Children’s Hospital Oakland Research Institute (CHORI)OaklandUSA
  3. 3.Ginecology and Obstetrics UnitHospital Universitari de Sant Joan. Grup SAGESSAReusSpain
  4. 4.Institut d’Investigació en Atenció Primària, Jordi Gol i GorinaCatalunyaSpain

Personalised recommendations