Mothers using iron supplements during pregnancy and lactation could help prevent anemia in newborns and infants in rural Nepal

Iron supplementation during pregnancy may result in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.

Around 293 million young children and 468 million non-pregnant women suffer from anemia due to iron deficiency (ID), which makes iron one of the most common micronutrient deficiencies in the world. Common causes of ID include inadequate intake of iron, infection and blood loss. In developing countries, impairment of mucosal absorption of iron may lead to the high rates of ID. When ID occurs in women of reproductive age, it is associated with reduced physical activity and impaired cognitive performance as well as causing irreversible intergenerational effects. During pregnancy, ID anemia (IDA) increases the risk of adverse pregnancy and perinatal outcomes. The use of iron and folic acid supplementation, changes in dietary patterns and urbanization have changed the contributions of ID to anemia in low and middle income countries. The aim of the present study was to analyze the prevalence and predictors of anemia and ID in breastfed infants and the relationship between maternal and infant iron status, specifically in Bhaktapur, Nepal.

500 lactating women and 474 of their infants (less than 1 year of age) from Bhaktapur, Nepal were selected in a cross-sectional survey. Anemia and iron-deficient erythropoiesis was determined by analyzing blood samples for hemoglobin, ferritin, total iron-binding capacity and transferrin receptors. As the study participants lived in a high altitude above sea level (1400m), cut-off values for the definition of anemia were adjusted according to the Centers for Disease Control guidelines.

Results showed that the mean hemoglobin among infants was 10.7 g/dl and more than two-thirds of infants older than 6 months of age (72%) were anemic. Among infants less than 6 months of age, the prevalence of anemia was 49%. Only 2 infants had severe anemia. The mean hemoglobin concentration was 13.1 g/dl and 20% of the women were found to be anemic using the altitude-specific cutoff value of Hb < 12.3 g/dl. Only 5% of the women and 175 of the infants ≤ 6 months were considered to be iron deficient when plasma ferritin was assessed with a cutoff of < 15 and < 20 µg/l, respectively. About 30% of infants > 6 months of age were iron deficient (plasma ferritin < 12 µg/l). The prevalence of ID was 18%, 30% and 71% among mothers, infants ≤ 6 months and infants > 6 months of age, respectively (plasma ferritin < 30 µg/l). Results also showed that each 1-month increase in infant age was linked with a decline in plasma ferritin concentration of 8.2 µg/l. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations.

The prevalence of ID and anemia among infants in the study population was high. The contribution of ID to the total anemia prevalence was low, suggesting that anemia may have other causes in this community. The use of iron supplementation among pregnant and lactating women was high and the observation that high maternal plasma ferritin was linked with lower risk of anemia among infants suggests that iron supplementation in pregnancy may result in a low prevalence of postpartum anemia in rural Nepal and in other South-East Asian countries.

References

  1. Chandyo, R.K., et al., The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal. Eur J Clin Nutr, 2015.