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Baseline iron and low-grade inflammation modulate the effectiveness of iron supplementation: evidence from follow-up of pregnant Sri Lankan women

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Abstract

Purpose

We evaluated the effectiveness of iron supplementation in relation to baseline iron and inflammatory status of pregnant women and their offspring in Sri Lanka.

Methods

Apparently healthy women aged 18–36 years at < 12 weeks of gestation prior to receiving any supplementation were randomly recruited at the antenatal clinics. They received 60 mg of elemental iron in combined iron–folic acid pills from 12 weeks of gestation until delivery via the National Maternal Supplementation Programme. Serum ferritins (SF), hemoglobin and high-sensitive C-reactive protein (hs-CRP) were assessed. The women were grouped as iron sufficient-inflammation (+), iron sufficient-inflammation (−), iron deficient-inflammation (+) and iron deficient-inflammation (−) based on their baseline iron stores and low-grade inflammation (hs-CRP > 5 < 10 mg/L) at baseline and late pregnancy.

Results

Despite supplementation, SF in the iron sufficient-inflammation (+) women reduced significantly (p = 0.037) to deficiency state (SF < 30 µg/L) at mid-pregnancy. Whereas no significant changes were noted in the SF in iron sufficient-inflammation (−) women (p > 0.05). They maintained their stores at sufficient state until delivery. The cord SF was higher (p < 0.001) in iron sufficient-inflammation (−) than the inflammation (+) women. 96.4% of the iron deficient women remained deficient until delivery regardless of their inflammatory state. Low-grade inflammation was higher (p < 0.001) in women with baseline BMI > 25 kg/m2. Whereas inflammation at late pregnancy was higher (p < 0.001) in women who gained weight in excess of the recommended, regardless of their baseline BMI.

Conclusion

Iron status prior to supplementation and low-grade inflammation associated with BMI > 25 kg/m2 and excess weight gain during pregnancy appear to modulate the effectiveness of iron supplementation.

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Acknowledgements

We acknowledge all the participants and the staffs of antenatal clinics and De-Soysa Maternity Hospital, Colombo, Sri Lanka. This study was supported by National Science Foundation (NSF) Grant no. RG/2011/HS/14 for sample collection, National Research Council (NRC) Grant no. 15-36 during manuscript preparation and National Research Scholarship—NSF/SCH/2019/03 by providing a student stipend.

Author information

Authors and Affiliations

  1. Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo, P.O. Box-271, Colombo 8, Sri Lanka

    Miruna Sudharshani Kalaimani Rabindrakumar & Tharanga Thoradeniya

  2. Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    V. Pujitha Wickramasinghe

  3. Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Carukshi Arambepola

  4. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Hemantha Senanayake

  5. Department of Chemistry, University of Peradeniya, Peradeniya, Sri Lanka

    Veranja Karunaratne

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  1. Miruna Sudharshani Kalaimani Rabindrakumar
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Contributions

MSKR: Participated in conceptualizing and designing the study, conducted the research; was involved in sample and data collection, hands-on conduct of the experiments, data interpretation, performed statistical analysis and drafted the original manuscript; PW: contributed to developing the concept, revised the manuscript critically for important intellectual content; CA: contributed to designing of the study, confirmed statistical analysis and critically reviewed the manuscript and edited; HS and VK: critically reviewed the proposal for important intellectual content, modified the concept and copyedited the manuscript; TT: designed the research, developed overall research plan, confirmed laboratory and data analysis, intensively reviewed intellectual content and provided input for the manuscript. All authors have given approval for the final version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Tharanga Thoradeniya.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study received approval from the Ethics Review Committee of the Faculty of Medicine, University of Colombo, Sri Lanka (EC-15-006) and was conducted in accordance with the Helsinki Declaration of 1964 and its later amendments.

Informed consent

Informed written consent was obtained from all women at recruitment.

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Rabindrakumar, M.S.K., Wickramasinghe, V.P., Arambepola, C. et al. Baseline iron and low-grade inflammation modulate the effectiveness of iron supplementation: evidence from follow-up of pregnant Sri Lankan women. Eur J Nutr 60, 1101–1109 (2021). https://doi.org/10.1007/s00394-020-02320-2

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  • DOI: https://doi.org/10.1007/s00394-020-02320-2

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