Applied nutritional investigationEffects of anemia at different stages of gestation on infant outcomes
Introduction
Maternal anemia is a health issue worldwide. Despite most developing countries having national programs to combat anemia, the proportion of anemic pregnant women remains higher than developed countries (56% versus 16%) [1]. In general, the effects of anemia during pregnancy include poor gestational weight gain, complications during delivery, preterm delivery, maternal mortality, and morbidity [2]. Similarly, the effects of maternal anemia on infant outcomes include low birth weight, preterm birth, and irreversible or partially reversible neurobehavioral and cognitive deficits [3].
Emerging evidence indicates the timing of maternal anemia during pregnancy may have different implications for the infant [4]. A few human studies from developed countries that have investigated the impact of maternal nutrient intake, blood levels of micronutrients, and iron deficiency anemia (IDA) at different stages of gestation on brain development on newborns have shown mixed results [5], [6], [7]. In developed countries, pregnant women have good nutritional status and maternal anemia is predominantly because of iron deficiency (ID). The results from these studies are less relevant than they are to developing countries, in which women are undernourished and the majority have coexisting micronutrient deficiencies. Maternal anemia often develops because of concurrent deficiencies of iron, folic acid, and vitamin B12, especially when dietary intakes of animal sources of foods are limited [8]. In such settings, it is unclear whether maternal anemia at different trimesters of gestation affects brain and physical growth, as well as development of neonates or older infants.
The aim of the present study was to investigate the implications of anemia at 13 to 22 wk (i.e., second trimester) and 29 to 42 wk (i.e., third trimester) of gestation on the physical and neurobehavioral development of ∼3 wk old infants.
Section snippets
Materials and methods
The study investigated the iron and iodine deficiencies in pregnant Indian women in tribal villages of Ramtek block, Nagpur, Maharashtra State, India. We present data from this cohort of pregnant women recruited and first visited at 13 to 22 wk gestation (i.e., second trimester; n = 211), visited a second time at 29 to 42 wk gestation (i.e., third trimester; n = 178), and again when their infants reached ∼3 wk postpartum (n = 147). Details of data collection including study design, participant
Results
A total of 228 pregnant women consented, 5 women dropped out, 223 were recruited, and 178 completed the study. Of the 223 pregnant women recruited at the second trimester, 12 women were excluded from the analysis (positive sickle cell trait [n = 9], twin pregnancies [n = 2], and human immunodeficiency virus–positive [n = 1]), resulting in data available for 211 women (Table 1). The present cohort of women were young (mean SD: 23.0 [2.7] y), about a third had families with fewer than five
Discussion
The present study reports two important findings that add to the growing body of literature in the area of maternal anemia and infant outcomes. Firstly, infants born to women who were not anemic during early gestation had better physical growth at ∼3 wk postpartum than the infants of women who were anemic. Secondly, infants of women who were not anemic later in gestation had higher attention and social interaction abilities (measured via the degree of alertness and responses to animate and
Conclusions
The findings from the present study underpin the necessity of alleviating maternal anemia, both iron and non-iron deficiency anemia, to improve infant outcomes with regard to physical growth and behavior. Additionally, it is important that women use supplements that contain iron, folic acid, and vitamin B12 even before conception to ensure adequate micronutrient status during early stages of gestation. It may be prudent to promote the World Health Organization strategy to prevent anemia in
Acknowledgment
S.A.S., E.L.F., and C.D.T. designed and supervised the study, secured funding, and assisted in the interpretation of the data. K.C.M. conducted the research and, along with S.A.S., analyzed the data and prepared the manuscript. A.R.G. provided statistical advice and conducted the advanced statistical analysis. S.Z., A.S., and P.K.D. helped with obtaining ethical approval and liaised with district health professionals in Nagpur. None of the authors have any conflicts of interest. All other
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