Thursday, May 19, 2016
Micronutrients improve birth outcome of pregnant women with iron deficiency anaemia
Maternal micronutrient deficiency is common in pregnancy, and this may result in low birth weight and foetal growth restriction. A clinical study has revealed the impact of iron and micronutrient supplementation on erythropoietin (EPO) and cortisol levels in pregnant mothers.
The study, published in the journal Maternal & Child Nutrition, was a double-blind, randomised controlled trial conducted among pregnant women (n=737) at Sarlahi, Nepal between 1998 - 2001. Parul Christian, the lead author from the Department of International Health at Johns Hopkins Bloomberg School of Public Health, and her team provided the subjects with vitamin A alone (Control), or with folic acid (FA), FA + iron, FA + iron + zinc, and a multiple micronutrient supplement.
Maternal blood samples were collected in the first and third trimesters, and subjected to biochemical tests for the analysis of EPO and cortisol levels. EPO levels in groups supplemented with iron alone and FA alone were similar but lower compared to the control group.
Cortisol levels were lower in the micronutrient-supplemented group compared to the control group. Cortisol levels demonstrated a positive correlation with EPO and soluble transferrin receptor in the non-iron group. The association between EPO and iron status indicators was the strongest in groups that did not receive iron.
The study also indicated that EPO levels during the third trimester were associated with increased birth weight. However, cortisol levels were negatively associated with the duration of gestation and a higher risk of preterm birth.
The study findings may be explained by the occurrence of iron deficiency anaemia during pregnancy, which stimulates erythropoietin production; this in turn leads to increased synthesis of cortisol. Excess of cortisol contributes to low birth weight, intrauterine growth restriction, and preterm birth.
The study suggests that supplementation of iron and other micronutrients has a positive influence on birth outcomes by ameliorating the mediators of maternal stress and reduced erythropoiesis.
News Source: Christian P, Nanayakkara‐Bind A, Schulze K, Wu L, LeClerq SC, Khatry SK. Antenatal micronutrient supplementation and third trimester cortisol and erythropoietin concentrations. Maternal & child nutrition. 2016 Jan 1;12(1):64-73.