Infant Development

Despite the concept that the fetus is an effective parasite for iron, the previously discussed information indicates that fetal development is compromised when maternal iron status is compromised (Table 16.4). One dimension now receiving attention vis-à-vis iron status is neurodevelopment of the infant [40]. In an important study several years ago, Tamura et al. [41] noted a relationship between newborn cord ferritin levels and cognition and behavior at 5 years of age. The children were compared by their cord blood ferritin in the two median ferritin quartiles: Those in the lowest quartile scored lower on a number of tests including language ability, fine motor skills, and tractability. Since cord blood ferritin is correlated with maternal iron status, these data suggest that poor iron status at birth is related to later infant development. The intervention study of Presozio et al. [42] reached a similar conclusion regarding the benefit of iron supplementation in pregnancy on infant scores in tests of motor and mental development at 12 months of age. More recently, a study in South Africa [43, 44] showed that infants of iron-deficient anemic mothers had lower developmental scores, assessed with the Griffith scale at 9 months of age, than had infants of mothers who were not anemic. All

Table 16.4

Studies of Maternal Anemia and Fetal Outcomes

Table 16.4

Studies of Maternal Anemia and Fetal Outcomes

Hb range (g/l),

Minimal

optimal birth

Minimal

infant

Study and authors

weight

prematurity

mortality

Notes

National Collaborative

105-125

115-125

95-105

Variable dates of samplings

Perinatal Project

National Collaborative

85-95

105-115

85-95

Variable dates of samplings

Perinatal Project

African-Americans

United Kingdom

86-95

96-105

N/a

Variable dates of samplings

Cardiff Birth Studies

104-132

104-132

Regardless of samples <13 weeks,13-19 weeks, or >20 weeks gestation

Chinese mothers

110-119

110-119

Before 8th week of gestation

American mothers

110-119

Control for length of gestation

infants in this study were of full gestational age and weight, thus intrauterine growth failure and severe maternal anemia (<85 g/l) were excluded. These anemic mothers had increased amounts of depression and altered mother-child interactions compared with iron-supplemented mothers. Indeed, maternal postpartum depression related to Hb concentration in the months after delivery of the infant may contribute to changes in infant development. While it is an area of maternal nutrition not frequently considered, it is important to consider that maternal functioning in the postpartum period can be heavily influenced by her nutritional status [43], and Chap. 19, "Postpartum Depression and the Role of Nutritional Factors". This in turn, has a strong influence on infant development. This is not to suggest that iron supplementation will lead to smarter children. A recent study showed that very modest iron supplementation (20 mg/day) of mothers in New Zealand had no effect on the IQ of the infants at 4 years of age despite a reduction in prevalence of IDA from 11 to 1% during pregnancy [45]. The authors did show that behaviors of the infants were affected by the iron intervention in pregnancy, but they could not separate direct biological effects of the iron on fetal growth and development from the indirect effect that would be expected through the improved iron status of the mother during and after the pregnancy. Mother-child interactions can be quite sensitive to the nutritional status of the infant and the mother.

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