Association of increased maternal ferritin levels with gestational diabetes and intra-uterine growth retardation
1st Department of Neonatology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Diabetes & Metabolism
(Impact Factor: 3.27).
02/2010; 36(1):58-63. DOI: 10.1016/j.diabet.2009.06.010
The objectives of the present study were to determine whether or not increased serum ferritin in women with premature labour is associated with gestational diabetes mellitus (GDM) and intra-uterine growth retardation (IUGR) and, if so, whether or not such increased levels reflect excess maternal iron stores, and have an effect on neonatal iron status and outcome.
This prospective, single-hospital, observational study involved 63 mothers and their 90 preterm neonates. Full blood counts as well as serum ferritin, soluble transferrin receptor (sTfR) and erythropoietin concentrations were compared across the three study groups based on maternal ferritin levels at the time of delivery. Perinatal history, neonatal morbidity and early outcomes were also assessed.
High maternal ferritin levels were significantly associated with higher rates of GDM and IUGR. However, there was no correlation between maternal ferritin and sTfR levels or between maternal and neonatal iron status.
Elevated maternal ferritin is not a reflection of excess iron stores, but is related to an increased risk of GDM or IUGR. Also, maternal ferritin levels are not associated with either neonatal iron status or neonatal outcomes.
Available from: Riitta Luoto
- "High haemoglobin (Hb) level in early pregnancy has been positively (Lao et al. 2002) and low Hb level negatively (Lao & Ho 2004) associated with the risk of GDM, although not in all studies (Chen et al. 2006). Higher levels of serum ferritin, transferrin and some other markers of iron stores have been found among women with GDM compared with women without GDM (Lao et al. 2001; Chen et al. 2006; Afkhami-Ardekani & Rashidi 2009; Soubasi et al. 2010; Derbent et al. 2013). Serum ferritin level is also elevated in inflammatory states and therefore may not necessarily indicate increased body iron stores (Williams et al. 2002; Mainous et al. 2004). "
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ABSTRACT: Observational studies suggest that high iron intake during pregnancy is associated with the risk of gestational diabetes. As such studies are prone to bias, we re-analysed data from a randomised controlled trial of iron supplementation to see whether it supports the risk found in observational studies. The trial was conducted in primary health care setting in five municipalities in Finland in 1985-1986. The participants were 2944 women (95% of pregnant women in the area) who were randomly allocated either to (1) the selective iron group (elemental iron 50 mg twice a day only if diagnosed as anaemic, continuing until their haemoglobin increased to 110 g L(-1) ) or (2) the routine iron group (elemental iron 100 mg day(-1) throughout the pregnancy regardless of haemoglobin level). The numbers of women in the analyses were 1358 and 1336, respectively. The main outcome measure was a composite variable including any glucose intolerance-related outcome (e.g. glucosuria, gestational diabetes, large-for-gestational-age child) in mothers' or children's patient records during pregnancy and post-partum. There were no statistically significant differences in the incidence of the primary outcome between the selective iron and the routine iron groups (13.0 vs. 11.0%, P = 0.12). The most common outcome was large-for-gestational-age calculated from children's hospital data (8.3 vs. 8.2%, P = 0.95). The results were mainly similar when stratified by the mothers' baseline haemoglobin level, body mass index or gestational weight gain. Routine iron supplementation throughout pregnancy did not increase the risk of glucose intolerance during pregnancy. The results need to be confirmed in future trials.
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ABSTRACT: Blood tests for investigating maternal wellbeing is the 10th series of 'Midwifery basics' and is targeted at both student and practising midwives who wish to update. The series aims to raise awareness of the needs of women during their childbearing experience. This first article will provide an overview of the blood screening tests concerned with differential diagnosis of anaemia in pregnancy so that midwives are able to identify those women who 'actually' need iron therapy and those who require further specialist input from either an obstetrician and/or a haematologist. The reader is encouraged, through directed exercises, to seek further information.
Available from: Martha Lappas
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ABSTRACT: Normal human pregnancy is considered a state of enhanced oxidative stress. In pregnancy, it plays important roles in embryo development, implantation, placental development and function, fetal development, and labor. However, pathologic pregnancies, including gestational diabetes mellitus (GDM), are associated with a heightened level of oxidative stress, owing to both overproduction of free radicals and/or a defect in the antioxidant defenses. This has important implications on the mother, placental function, and fetal well-being. Animal models of diabetes have confirmed the important role of oxidative stress in the etiology of congenital malformations; the relative immaturity of the antioxidant system facilitates the exposure of embryos and fetuses to the damaging effects of oxidative stress. Of note, there are only a few clinical studies evaluating the potential beneficial effects of antioxidants in GDM. Thus, whether or not increased antioxidant intake can reduce the complications of GDM in both mother and fetus needs to be explored. This review provides an overview and updated data on our current understanding of the complications associated with oxidative changes in GDM.
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