I had iron supplementation during pregnancy; my child cannot suffer from IDA

Iron requirements in pregnancy

The iron requirement during pregnancy is increased gradually through gestation from 0.8 mg/day in the first trimester to 7.5 mg/day in the third trimester. During the entire gestation period, the average demand for absorbed iron is approximately 4.4 mg/day [Milman N, 2006].

Importance of Iron during pregnancy

During pregnancy, the absorbed iron is predominantly used to expand the woman’s erythrocyte mass, fulfil the foetus’s iron requirements and compensate for iron losses (i.e. blood losses) at delivery. To a large extent, the newborns’ iron content depends on their birth weight which is generally 200-270 mg for infants weighing between 2500-3500g respectively. Low-birth-weight infants (less than 2500 g) are born with fewer iron stores and are at high risk of deficiency after 2 months [Saddi and Shapira, 1970].

Impact of maternal iron status on adequate store of newborns

A study to assess the effect of maternal IDA on the iron store of newborns revealed that newborns of IDA mothers had significantly lower levels of serum ferritin (P = 0.017) than newborns of non-anaemic (NA) mothers. Though these newborns had reduced iron stores, the prevalence of anaemia among newborns of the two groups was not significantly different [Terefe et al., 2015; P = 0.593]. This is because visible difference that can be evidenced in the form of anaemia is not expected at such an early stage in life [Chaparro CM, 2008]. Therefore, maternal IDA may have an effect on the iron stores of newborns till the age of 6 months [Zetterstrom R, 2008; Ziegler et al., 2009]. Table 1 provides haematological profile and ferritin status of newborns by anaemia and iron status of their mothers.
However, beyond 6 months of age, iron content of breast milk/ mother's milk is not sufficient to meet infants’ requirements and complementary foods are required to bridge this gap, but common staples are low in iron. But infants need a relatively high iron intake because they are growing very rapidly and their iron stores have exhausted by the age of six months. Thus, infants need an external source of iron, which may be in form of iron rich/fortified complementary foods or iron supplements to fulfill their iron needs during first 2 years of life to avoid long term consequences.

What do the guidelines say?

Recent expert recommendations on iron fortification in infants suggested cow or goat milk protein or Soy protein based formulas with 2-4 mg/L of iron for 3-6 month old iron deficient infants and similar formulas with 4-8 mg/L iron content for 6-12 month old healthy infants [Kleinman RE, 2015].
The American Academy of Pediatrics (AAP) has concluded that universal screening for anaemia should be performed, with determination of haemoglobin concentration, at approximately one year of age. Universal screening should include an assessment of risk factors associated with iron deficiency, exclusive breastfeeding beyond 4 months of age and complementary foods [Baker and Greer, 2010]. Infant and Young Child Feeding Guidelines (IYCF) 2016, state that appropriate complementary foods after completion of 6 months is the most appropriate feeding strategy.
WHO recommends universal supplementation with 2 mg/kg/day of iron in children aged 6 to 23 months whose diet does not include foods fortified with iron or who live in regions (such as developing countries) where anaemia prevalence is higher than 40% [WHO, 2001].

 

 


Table 1: Haematological profile and ferritin status of newborns by anaemia and iron status of their mothers (n = 89).

Parameters

Group median (IQR)

P value

IDA (n=21)

NA (n=68)

Hb (gm/dL)

15.6
(14.8-16.4)

16.7
(15.5-17.6)

0.024*

Ferritin (ng/mL)

138.9
(105.0-211.7)

200.7
(151.4-265.3)

0.017*

Frequency (%) of anaemia

3 (14.3%)

5 (7.9%)

0.593**


Inference

To a large extent, the newborn’s iron status depends on the mother iron status during pregnancy. Infants born to mothers who have taken iron supplements during gestation have enough body iron reserves for 4-6 month period. This reserve depletes after 6 months of age thus iron rich/fortified complementary foods or iron supplements of adequate nutritional value becomes a need post 6 months of age.

Reference

  • Milman N. Iron and pregnancy--a delicate balance. Ann Hematol. 2006 Sep;85(9):559-65.
  • Saddi R, Shapira G. Iron requirements during growth. In: Hallberg L, Harwerth HG, Vanotti A (eds) Iron deficiency. Academic, London, 1970; 183–198.
  • Terefe B, Birhanu A, Nigussie P, Tsegaye A. Effect of maternal iron deficiency anemia on the iron store of newborns in ethiopia. Anemia. 2015;2015: 808204.
  • Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr. 2008 Dec;138(12):2529-33.
  • Zetterstrom R. Iron deficiency and iron deficiency anaemia during infancy and childhood. ActaPaediatr. 2004 Apr;93(4):436-9.
  • Ziegler EE, Nelson SE, Jeter JM. Iron supplementation of breastfed infants from an early age. Am J ClinNutr. 2009 Feb;89(2):525-32.
  • Kleinman RE. Expert recommendations on iron fortification in infants. The Journal of pediatrics. 2015 Oct 1;4(167):S48-9.
  • Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010 Nov 1;126(5):1040-50.
  • World Health Organization. Iron Deficiency Anaemia: Assessment, Prevention, and Control. World Health Organization, 2001.
  • Tiwari S, Bharadva K, Yadav B, Malik S, Gangal P, Banapurmath CR, Zaka-Ur-Rab Z, Deshmukh U, Visheshkumar -, Agrawal RK. Infant and Young Child Feeding Guidelines, 2016. Indian Pediatr. 2016 Aug 8;53(8):703-13.