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The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia

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Abstract

Purpose

Whether anemia type modifies the risk of pregnancy and newborn outcomes and the effectiveness of iron supplementation is unclear. We examined the association of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) on the risks of these outcomes and the extent to which anemia type modifies the impact of prenatal iron supplementation.

Methods

This was a secondary analysis of a placebo-controlled trial of iron supplementation among 1450 HIV-negative women in Tanzania. Eligibility criteria included gestational age < 27 weeks, hemoglobin > 85 g/L, and ferritin > 12 µg/L. Individuals were categorized as non-anemia, IDA or NIDA using hemoglobin, ferritin and CRP. Analyses were conducted using regression models and likelihood ratio tests.

Results

Compared to the non-anemia group, delivery hemoglobin was lower by 15 g/L (95% CI 10.9, 19.3) in the baseline IDA group, and 7.3 g/L (95% CI 3.1, 11.5) in the baseline NIDA group. The RRs of anemia severity, iron deficiency, placental malaria, stillbirths, perinatal mortality, birthweight, and preterm birth were not different among women in the baseline NIDA group (vs. non-anemia) compared to the baseline IDA group (vs. non-anemia). The difference in the mean delivery hemoglobin for iron supplementation and placebo arms was 8 g/L (95% CI 6, 11) in the non-anemia group, 7 g/L (95% CI 2, 13) in the NIDA group, and 16 g/L (95% CI 10, 22) in the IDA group.

Conclusion

Iron supplementation is effective even among pregnant women with NIDA.

Trial registration

NCT01119612 (May 7, 2010).

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Abbreviations

ACD:

Anemia of chronic disease

AI:

Anemia of inflammation

AIDS:

Acquired Immune Deficiency Syndrome

ART:

Antiretroviral therapy

BMI:

Body Mass Index

CBC:

Complete blood count

CI:

Confidence Interval

CKD:

Chronic kidney disease

CRP:

C-reactive protein

ELISA:

Enzyme Linked Immunosorbent Assay

HAART:

Highly Active Antiretroviral Therapy

HAND:

HIV-associated neurocognitive disorder

HIV:

Human Immunodeficiency Virus

HR:

Hazard ratio

ID:

INTERGROWTH: International Fetal and Newborn Growth Consortium for the 21st Century

IDA:

Iron deficiency anemia

IQR:

Interquartile range

IRA:

Iron-restricted anemia

LMIC:

Low and Middle Income Countries

MRC:

Medical Research Council

NIDA:

Non-Iron Deficiency anemia

NTBI:

Non-transferrin bound iron

OR:

Odds ratio

PCR:

Polymerase chain reaction

PLWHIV:

People living with HIV

RCT:

Randomized controlled trial

RR:

Relative risk

SD:

Standard deviation

SE:

Standard error

SGA:

Small-for-gestational age

sTfR:

Soluble Transferrin receptor

TB:

Tuberculosis

TIBC:

Total Iron Binding Capacity

ZPP:

Zinc protoporphyrin

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Funding

This study was supported by a grant from the National Institute of Child Health and Human Development (NICHD U01 HD061232).CD was supported in part by K24DK104676 and 2P30 DK040561. The NIH did not have any role in the design of the study, data collection, data analysis, data interpretation, or writing of this report.

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Authors and Affiliations

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Ajibola Ibraheem Abioye, Christopher R. Sudfeld, Christopher P. Duggan & Wafaie W. Fawzi

  2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Michael D. Hughes

  3. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Christopher R. Sudfeld, Christopher P. Duggan & Wafaie W. Fawzi

  4. Department of Pathology, Aga Khan University, Nairobi, Kenya

    Zulfiqarali Premji

  5. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Said Aboud

  6. Department of Global Health, School of Public Health, Boston University, Boston, MA, USA

    Davidson H. Hamer

  7. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Davidson H. Hamer

  8. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

    Davidson H. Hamer

  9. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Drucilla J. Roberts

  10. Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA

    Christopher P. Duggan

  11. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

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  1. Ajibola Ibraheem Abioye
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  2. Michael D. Hughes
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Correspondence to Ajibola Ibraheem Abioye.

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Supplementary Information

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394_2022_3029_MOESM1_ESM.docx

Supplementary file1 Supplement 1. Anemia type with maternal and newborn outcomes among HIV-negative pregnant women in both arms of a recent randomized trial Dar es Salaam, Tanzania, 2010–2013 (N=1,479). Supplement 2. Association of anemia type and adverse maternal and newborn outcomes among HIV-negative women with singleton pregnancies in the placebo arm of a recent randomized trial in Dar es Salaam, Tanzania, 2010–2013. Supplement 3. Flow chart for the differential diagnosis of iron deficiency anemia and anemia of inflammation—using sTfR. Supplement 4. Association of anemia type and adverse maternal and newborn outcomes among HIV-negative pregnant women in the placebo arm of a recent randomized trial in Dar es Salaam, Tanzania, 2010–2013. Supplement 5. Effect modification of the effectiveness of iron supplementation on the risk of adverse maternal and child outcomes by anemia type among HIV-negative pregnant women in Dar es Salaam, Tanzania, 2010–2013 (DOCX 90 KB)

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Abioye, A.I., Hughes, M.D., Sudfeld, C.R. et al. The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia. Eur J Nutr 62, 987–1001 (2023). https://doi.org/10.1007/s00394-022-03029-0

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