Iron deficiency and child and maternal health1–4
Laura E Murray-Kolb and John L Beard
Background: Iron deficiency is most commonly found in women of
reproductive age and infants worldwide, but the influence of mater-
nal iron deficiency on infant development is underexplored.
Objective: The objective was to examine the relation between ma-
ternal iron status and mother-child interactions in a randomized,
double-blind, intervention trial conducted in South Africa.
Design: Women were recruited into the study from a health clinic at
6–8 wk postpartum and were classified as either iron-deficient ane-
mic (IDA) or iron-sufficient after blood analysis. IDA mothers re-
ceived iron supplements of 125 mg FeSO4(IDA-Fe; n ¼ 34) or
placebo (IDA-PL; n ¼ 30) daily from 10 wk to 9 mo postpartum.
The control group (n ¼ 31) consisted of iron-sufficient mothers.
Free-play mother-child interaction sessions were videotaped in the
clinic at 10 wk (n ¼ 80) and 9 mo (n ¼ 66) postpartum and coded
per the Emotional Availability Scales (4 maternal scales: sensitivity,
structuring, nonintrusiveness, and nonhostility; 2 infant scales: re-
sponsiveness and involvement).
Results: At 10 wk, scores for maternal sensitivity and child respon-
siveness were significantly greater in the control group than in the
IDA groups (P ¼ 0.028 and 0.009, respectively). At 9 mo, the
control and IDA-Fe groups no longer differed. These 2 groups
scored significantly better on the maternal sensitivity, structuring,
and nonhostility scales and on the child responsiveness scale than
did the IDA-PL group (P ¼ 0.007–0.032), whose iron status re-
Conclusion: These data indicate that maternal iron deficiency neg-
atively affects mother-child interactions and that iron supplementa-
tion protects against these negative effects.
Am J Clin Nutr
Iron deficiency is the most prevalent single nutrient deficiency
in the world (1) and is recognized by the World Health Organi-
zation as 1 of the 10 greatest global health risks in existence today
(2). Anemia affects the lives of .2 billion people worldwide and
twice as many are iron-deficient (2). Worldwide, 50% of women
of reproductive age are iron-deficient, with estimates as high as
80% in pregnant women from developing countries. Recovery of
iron stores in the postpartum period is often delayed in women
who experienced iron deficiency anemia during pregnancy.
The consequences of iron deficiency include reduced physical
work capacity, poor immune function, and changes in cognition,
emotions, and behavior. The bulk of the research has been
conducted in infants and young children, and most studies have
reported altered mental and motor development in iron-deficient-
anemic children (3–5). Research in infants also suggests that
iron-deficient infants are less attentive and more wary, clingy,
and hesitant than are their non-iron-deficient counterparts (5).
Whereas most research has focused on young children, altered
cognition and behavior have been investigated in iron-deficient
women of reproductive age (6–11). Behavioral symptoms as-
sociated with iron deficiency in adults include irritability, apa-
thy, fatigue, depressive symptoms, and hypoactivity. Although
data are beginning to emerge on the relation between iron status,
cognition, and behavior in women of reproductive age, there is
a relative lack of information regarding the influence of maternal
iron deficiency during the postpartum period on infant de-
velopment. Modifications in a mother’s emotional and cognitive
functioning may alter mother-child interactions, which, in turn,
may affect infant behavior and development. Two reports on the
outcomes of this study in a settlement community outside of
Cape Town, South Africa, have been published (11, 12). The
current study used the Emotional Availability Scales (EAS) to
reexamine mother-child interactions. We decided to reevaluate
mother-child interactions with the EAS for several reasons.
Unlike most other scales, the EAS is geared specifically toward
research. It has 3 underlying assumptions that ensure that the
mother and child are treated as a dyad rather than as 2 in-
dividuals acting independently, that the child’s developmental
level is considered, and that the context is considered when
evaluating the interaction. We believe that these 3 concepts are
crucial when evaluating the relation between a nutrient de-
ficiency and mother-child interactions. Additionally, given the
differences in affect between the iron-deficient–anemic and
control mothers in this study (11), we hypothesized that the iron-
deficient-anemic mothers would be less emotionally available to
their infants than would be the control mothers. The EAS con-
sists of 6 dimensions of emotional regulation in the dyad; 4 of
1From the Center for Human Nutrition, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD (LEM-K), and the Department of Nutri-
tional Sciences, Pennsylvania State University, University Park, PA (JLB).
2Presented at the symposium ‘‘Maternal and Child Mental Health: Role of
Nutrition,’’ held at Experimental Biology 2008, San Diego, CA, 8 April
3Supported by the International Life Sciences Institute (JLB) and the
Children Youth and Family Consortium (LEM-K).
4Reprints not available. Address correspondence to JL Beard, 110 Chand-
lee Laboratory, Department of Nutritional Sciences, The Pennsylvania State
University, University Park, PA, 16802. E-mail: firstname.lastname@example.org.
First published online January 21, 2009; doi: 10.3945/ajcn.2008.26692D.
Am J Clin Nutr 2009;89(suppl):946S–50S. Printed in USA. ? 2009 American Society for Nutrition