Mother-infant Interactions and infant development are altered by maternal iron deficiency anemia
School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. Journal of Nutrition
(Impact Factor: 3.88).
The aim of this study was to determine whether iron deficiency anemia (IDA) in young South African mothers alters mother-infant interactions and the infant's development. The study was a prospective, randomized, controlled intervention trial with 3 groups of mothers: nonanemic controls and anemic mothers administered either placebo (25 mg ascorbic acid and 10 microg folate) or daily iron treatment (125 mg FeSO(4) plus ascorbate and folate). Mothers of full-term, normal birth weight infants (n = 81) were followed from 10 wk to 9 mo postpartum. Maternal iron status, socioeconomic level, mother-infant interaction [Parent/Caregiver Involvement Scale (PCIS scale)], and infant development (Griffiths scale) were assessed. At baseline, anemic mothers tended (P < 0.10) to be less responsive to, and more controlling of, their infants. Infants of anemic mothers were developmentally delayed at 10 wk in hand-eye movement and overall quotient. Despite normalization of maternal iron status with supplementation in some mothers, the developmental delays were not diminished at 9 mo. At 9 mo, anemic mothers were significantly more "negative" towards their babies, engaged less in goal setting, and were less "responsive" than control mothers. In contrast, the behavior of anemic mothers given iron treatment toward their children was similar to that of the control mothers on all 11 scales of the PCIS. In conclusion, IDA altered mother-child interactions at both 10 wk and 9 mo postpartum. Additionally, infants whose mothers were anemic in the early postpartum scored worse on developmental tests at 10 wk and 9 mo of age.
Available from: Johanna M A Pijnenborg
- "Approximately 21% of women in high-income countries experience postpartum anemia, a condition characterized by tiredness, maternal infections, depression, and impairments in mother–child interactions and infant development    . Treatment of postpartum anemia could, therefore, contribute to maternal health and infant development. "
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To evaluate the efficacy of adding folic acid to oral iron supplementation in postpartum women with anemia.
A randomized controlled trial was conducted in the Netherlands between April 8, 2008, and August 31, 2010. A total of 112 postpartum women with anemia (hemoglobin < 10.5 g/dL) were randomly allocated to receive 600 mg/day ferrous fumarate plus 1 mg/day folic acid (FFFA group) or 600/day ferrous fumarate alone (FF group) for 4 weeks. Primary outcome measures were hemoglobin and health status. Secondary outcome measures were fatigue, compliance, and adverse reactions.
No between-group differences were observed in hemoglobin and health status after treatment, and no differences were found in fatigue scores. Approximately 75% of all women reported having at least one symptom resulting from ferrous fumarate use. Constipation caused by ferrous fumarate was significantly associated with non-compliance (P = 0.014).
The addition of folic acid to iron supplementation is not beneficial in women with postpartum anemia, as it has no effect on hematologic or health status parameters. Clinical Trial Registration: CCMO website NL21797.028.08 and Netherlands Trial Register NTR2232.
Available from: Daisy A.A. Van Der Woude
- "This type of fatigue is not an isolated physical symptom, but involves lethargy, decreased mental alertness, physical weakness, and poor concentration . Uncorrected IDA may have a negative impact on maternal cognition, mood and behavior, and could thereby alter mother-child interactions  . Therefore, health status (HS), a multidimensional concept that incorporates the self-perceived functioning of physical, psychological, and social aspects of life , is regarded as reduced in women with postpartum anemia . "
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The incidence of postpartum anemia is high. Current therapy consists of iron supplementation or blood transfusions, based on the assumption that these treatments improve health status (HS) and reduce fatigue. The aim of this study was to compare HS and fatigue in postpartum women with and without anemia.
This prospective cohort study was performed in The Netherlands between April 2008 and August 2010 and involved 112 anemic (hemoglobin [Hb]<10.5g/dL) and 108 non-anemic (Hb≥10.5g/dL) women. The anemic women received oral iron supplementation. Within 48h and 5 weeks after delivery, HS was measured using the 36 item Short-Form Health Survey (SF-36) and fatigue was measured using the Checklist Individual Strength (CIS). ANOVA for repeated measures was used to compare HS and fatigue scores among groups and across time.
After adjustment for confounding variables, there were no differences in any of the HS and fatigue scores. HS and fatigue seem to be more influenced by a complicated delivery than by anemia. HS and fatigue scores significantly improved over time in all women.
HS and fatigue were not different among women with and without postpartum anemia.
Available from: Bernd Froessler
- "Women with iron deficiency are also at risk of adverse effects requiring medical interventions such as red blood transfusion , cardiovascular problems, reduced physical and cognitive performance, reduced immune function, tiredness and increased depressive episodes . Peri-partum maternal iron deficiency has also been associated with childhood developmental problems  and negative mother-infant interactions such as an increase in negative statements and decreased responsiveness . Progression from iron deficiency to iron deficiency anaemia (IDA) in pregnancy is common, due to the increased demand for iron during pregnancy, required to support maternal haemoglobin mass expansion, as well as the growing fetus and placenta . "
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ABSTRACT: Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester.
Prospective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.
Intravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients.
Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy.
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