Friday, August 19, 2016
Cord blood hepcidin as a promising biomarker to predict key child health outcomes
Hepcidin is an iron regulatory and inflammatory protein. Greater cord blood hepcidin concentrations are associated with maternal inflammation, placental malaria, and higher maternal haemoglobin concentrations. An editorial published in The American Journal of Tropical Medicine and Hygiene discusses the association between iron and malaria dynamics in pregnancy and early childhood.
Higher cord blood hepcidin concentration predicts a significantly increased risk of anaemia but a reduced risk of malaria and all-cause mortality during childhood. Hepatic production of hepcidin has been shown to be influenced by slowed erythropoietic rate, dietary iron sufficiency, and inflammation. However, in malaria-endemic areas, inflammation has a significant influence on the cord blood hepcidin concentrations.
Although restricted maternal systemic iron availability and consequent limited iron transfer to the foetus in malaria-exposed pregnant mothers may protect the offspring from malarial morbidity during early childhood, it may set the stage for iron deficiency in these children. In a birth cohort, functional iron deficiency may manifest as high concentrations of hepcidin, ferritin, and C-reactive protein coexisting with low haemoglobin concentration. This would reflect a state in which body iron is unavailable for red blood cells and the developing brain. In such a case, administering iron supplements may not be helpful since high hepcidin concentrations would restrict dietary iron absorption. Hence, caution should be exercised while administering iron supplements during early childhood in malaria-endemic areas.
The lack of iron supplementation programs in malaria-endemic areas may protect children from malaria and save lives but at the cost of injury to the developing brain in survivors. Well-designed randomised clinical trials with short-term morbidity and long-term neurodevelopment outcomes are required to examine the effects of intermittent preventive treatment of malaria and subsequent iron supplementation in children with low cord blood hepcidin concentration.
News source - Cusick SE, John CC. Iron, inflammation, and malaria in the pregnant woman and her child: saving lives, saving brains. The American Journal of Tropical Medicine and Hygiene. 2016. pii: 16-0533. [Epub ahead of print].