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Maternal Anemia of Inflammation and Adverse Pregnancy and Neonatal Outcomes in India
Author(s) -
Finkelstein Julia L.,
Kurpad Anura V.,
Thomas Tinku,
Srinivasan Krishnamachari,
Duggan Christopher
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.668.3
Subject(s) - medicine , pregnancy , anemia , gestational age , ferritin , hemoglobin , birth weight , iron deficiency , body mass index , c reactive protein , obstetrics , soluble transferrin receptor , gastroenterology , inflammation , iron status , genetics , biology
Objective To examine the prevalence of anemia, iron deficiency, and anemia of inflammation (AI) during pregnancy and their associations with adverse pregnancy and neonatal outcomes in women in India. Methods A total of 366 women participating in a vitamin B 12 supplementation trial in India were monitored to assess hemoglobin (Hb), serum ferritin (SF), hepcidin, C‐reactive protein (CRP), and alpha‐1 acid glycoprotein (AGP) during pregnancy. All women received daily iron‐folic acid supplementation during pregnancy. Binomial and linear regression models were used to examine the associations of maternal hematological status and pregnancy and neonatal outcomes. Results 30% of mothers were anemic (Hb<11.0 g/dL), 48% were iron deficient (SF<15.0 μg/L), and 23% had iron deficiency anemia (IDA) at their first prenatal visit. The prevalence of inflammation (CRP>5 mg/L: 17%; AGP>1.0 g/L: 11%) and AI (Hb<11.0 g/dL, SF>15.0 μg/L, plus CRP>5 mg/L or AGP>1.0 g/L: 2%) was relatively low. Maternal hemoglobin concentrations were associated with significantly higher birth weight (p=0.02) and gestational age at delivery (p=0.001), lower risk of preterm delivery (<37 weeks; RR: 0.76 (95% CI: 0.63–0.91); p=0.003); and higher WAZ scores (p=0.02) and MUAC (p=0.002) in multivariate analyses, including gestational age at sample collection, vitamin B 12 intervention, maternal body mass index, socioeconomic status, and inflammation. Women who were anemic at enrollment had a two‐fold higher risk of low birth weight (<2,500 g; RR: 2.10 (95% CI: 1.18–3.74); p=0.01), preterm delivery (<37 weeks; RR: 2.67 (95% CI: 1.43–5.00); p=0.002), and underweight (WAZ<‐2; RR: 2.11 (95% CI: 1.13–3.93); p=0.02); and lower MUAC (p=0.03). IDA was associated with higher risk of low birth weight (RR: 1.99 (95% CI: 1.08–3.68); p=0.03) and preterm birth (RR: 3.48 (95% CI: 1.82–6.64); p=0.0002); and lower WAZ scores (p=0.02). Conclusions Anemia and iron deficiency were common early in pregnancy, and associated with increased risk of adverse pregnancy and neonatal outcomes. A comprehensive approach to prevent anemia and iron deficiency is needed in women of reproductive age to enhance pre‐pregnancy hematological status and improve maternal and child health outcomes. Support or Funding Information National Institutes of Health, Indian Council of Medical Research, Harvard University