International Journal of Epidemiology, Vol 28, 461-468, Copyright © 1999 by International Epidemiological Association
J Kilbride, TG Baker, LA Parapia, SA Khoury, SW Shuqaidef and D Jerwood
BACKGROUND: A high prevalence of 50-65% iron-deficiency anaemia in mothers
and infants in Jordan was reported by the United Nations Relief and Works
Agency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay
cognitive and psychomotor development with long-term consequences. While
socioeconomic deprivation and inadequate nutrition are known underlying
factors, it is unclear whether iron endowment at birth is compromised when
mothers are anaemic, further jeopardizing iron status during infancy. A
prospective case-control study of infants from birth to one year was
conducted in a lower middle-class urban setting in Amman, Jordan. The study
objective was to examine the relationship between maternal anaemia and
iron-deficiency anaemia during infancy. METHOD: A sample of 107 anaemic (Hb
< 11 g/dl) and 125 non-anaemic mothers was selected at 37 weeks'
gestation and matched for age and parity, and infant data at birth
obtained. The infants were reviewed at 3, 6, 9 and 12 months, to assess
growth, current nutrition, infection rates and iron status. The main
outcome measure was the incidence of iron-deficiency anaemia in the two
groups of infants, defined in the study as Hb < 11 g/dl and either
plasma ferritin < 12 mcg/l or zinc protoporphyrin > 35 mcg/dl.
RESULTS: Iron endowment in cord blood samples appeared similar between the
two groups. The incidence of iron-deficiency anaemia was very high in these
infants, at 72% by research criteria, (51% if Hb < 10.5 g/dl), but
significantly higher in the infants born to anaemic mothers at all stages
of the year, with overall incidence of 81% (n = 91), compared to 65% in
controls (n = 112). This was not explained by differences in environmental
risk factors. Anaemic mothers had not recovered adequate iron status at 6
months' postpartum, with implications for future pregnancy iron demands.
CONCLUSIONS: Anaemia during pregnancy compromises the health of mothers in
traditional cultures, where women tend to have several children close
together after marriage, with an inadequate interval to replenish
nutritional stores. Their infants also appear to be at increased risk of
developing iron-deficiency anaemia, undetected at birth.
ARTICLES
Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan
Department of Biomedical Sciences, University of Bradford, UK.
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