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Background  Several biomarkers are used to measure iron deficiency (ID) during pregnancy, but the prevalence of ID and its association with adverse birth outcomes shows inconsistent results. The aim of this study was to examine the prevalence of ID in third trimester using multiple indicators of iron status and the relationship with birth outcomes in Chinese population.    Methods  We conducted a retrospective observational cohort study of 11,581 pregnant women between 2016 and 2017 in Changzhou City, Jiangsu Province, China. We obtained the data (maternal characteristics and birth outcomes) and the concentrations of ID biomarkers from our hospitalization information system and laboratory information system, respectively. Using serum ferritin (SF), serum transferrin (ST) and their ratio as criteria of ID, we investigated associations between birth outcomes and late pregnancy ID.    Results  The prevalence of ID in our study was 51.82% as defined by low SF (< 12 μg/L), 54.43% as defined by high ST (> 4 g/L) and 53.90% as defined by high ratio of ST/SF (Log 10 transform > 5.52). Maternal ST/SF ratio was associated with higher mean birth weight (97.04 g; 95% CI, 74.28, 119.81 for the highest vs. lowest quartile). Third trimester maternal ID, defined by ST/SF ratio, was associated with lower risks of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) infants, higher risks of macrosomia and large for gestational age (LGA) babies (for PTB: OR = 0.53, 95% CI, 0.36–0.77; for LBW: OR = 0.44, 95% CI, 0.31–0.62; for SGA: OR = 0.69, 95% CI, 0.57–0.83; for macrosomia: OR = 1.39, 95% CI, 1.13–1.70; for LGA: OR = 1.20, 95% CI, 1.04–1.39).    Conclusions  ID in the third-trimester of pregnancy are frequent in Chinese women. Our findings suggest that the ratio of ST/SF measured in late pregnancy could be useful as a significant predictor of unfavorable birth outcomes.    Electronic supplementary material  The online version of this article (10.1186/s12986-019-0360-9) contains supplementary material, which is available to authorized users.

Iron deficiency in late pregnancy and its associations with birth outcomes in Chinese pregnant women: a retrospective cohort study