Iron status, serum folate and B-12 values in pregnancy and postpartum: Report from a study in Jordan

Background: A high prevalence of anemia has been reported in Jordan affecti ng women of childbearing age and infants/preschool children. This paper con siders maternal iron, folate and B-12 status, with possible implications fo r both maternal and infant health. Patients and Methods: A case-control study of infants born to anemic (Hb < 11 g/dL) (n=107) and non-anemic mothers (n=125) from birth to one year, was conducted in a lower middle-class urban setting in Amman, Jordan. Maternal hematology included full blood count (FBC), plasma ferritin, transferrin s aturation, serum folate and B12 at term, and FBC and ferritin at 6 months p ostpartum. Serum B12 was reassessed at 6 and 12 months postpartum if antena tal values were low. Infant FBC and ferritin were assessed in cord blood an d at 3, 6, 9 and 12 months, and zinc protoporphyrin (ZPP) from 6 months. Results: Anemic mothers (mean [SD] Hb 9.9 [0.7] g/dL) had significantly low er antenatal values for Hb, MCV, MCH, transferrin saturation, plasma ferrit in and serum folate than non-anemic mothers (mean Hb 12.2 [0.9] g/dL), whic h persisted at 6 months postpartum. Antenatal B12 values were low (< 200 pg /mL) in 67% of samples (26% < 100 pg/mL), evenly distributed between the gr oups, and, therefore, not related to maternal anemia. Low values persisted in 27% (n=127) and in 61% (n=31), respectively, at 6 and 12 months postpart um. Iron-deficiency anemia (Hb < 11 g/dL and either ferritin < 12 mcg/L or ZPP > 35 mcg/dL) affected 72% of infants, with significantly higher inciden ce in those born to anemic mothers. Ambiguous hematology in 11% of infants may have reflected other nutritional deficiencies, including vitamin B12, w here mothers had depleted values. Conclusion: Iron, folate and B12 status should be monitored during pregnanc y/lactation in developing countries, where nutritional deprivation is more prevalent and women of childbearing age often have a high fertility rate an d inadequate interpregnancy interval to replenish body stores. Infant healt h may also be at risk through a compromised endowment of these micronutrien ts at birth.