Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan

Background A high prevalence of 50-65% iron-deficiency anaemia in mothers a nd infants in Jordan was reported by the United Nations Relief and Works Ag ency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay co gnitive and psychomotor development with long-term consequences. While soci oeconomic deprivation and inadequate nutrition are known underlying factors , it is unclear whether iron endowment at birth is compromised when mothers are anaemic, further jeopardizing iron status during infancy. A prospectiv e case-control study of infants from birth to one year was conducted in a l ower middle-class urban setting in Amman, Jordan. The study objective was t o examine the relationship between maternal anaemia and iron-deficiency ana emia during infancy. Method A sample of 107 anaemic (Hb <11 g/dl) and 125 non-anaemic mothers wa s selected at 37 weeks' gestation and matched for age and parity, and infan t data at birth obtained. The infants were reviewed at 3, 6, 9 and 12 month s, to assess growth, current nutrition, infection rates and iron status. Th e main outcome measure was the incidence of iron-deficiency anaemia in the two groups of infants, defined in the study as Hb <11 g/dl and either plasm a ferritin <12 mcg/l or zinc protoporphyrin >35 mcg/dl. Results Iron endowment in cord blood samples appeared similar between the t wo groups. The incidence of iron-deficiency anaemia was very high in these infants, at 72% by research criteria, (51% if Hb <10.5 g/dl), but significa ntly higher in the infants born to anaemic mothers at all stages of the yea r, with overall incidence of 81% (n = 91), compared to 65% in controls (n = 112). This was not explained by differences in environmental risk factors. Anaemic mothers had not recovered adequate iron status at 6 months' postpa rtum, with implications for future pregnancy iron demands. Conclusions Anaemia during pregnancy compromises the health of mothers in t raditional cultures, where women tend to have several children close togeth er after marriage, with an inadequate interval to replenish nutritional sto res. Their infants also appear to be at increased risk of developing iron-d eficiency anaemia, undetected at birth.