Iron-deficiency and non-iron-deficiency anemia in pregnancy and infant health in India
BACKGROUND: The global burden and distribution of iron deficiency is largely unknown. Most studies in Low and middle Income Countries (LMICs) use hemoglobin/anemia as a proxy for iron deficiency; however, hemoglobin is neither a sensitive nor specific measure of iron deficiency. Interventions preventing anemia in pregnant women in India and globally focus on supplementation with iron and folic acid; however, these interventions have had limited success in reducing the burden of anemia in pregnancy and low birth weight (LBW) in infants.
GAP: This study will assess the prevalence of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) in Eastern Maharashtra and their associations with infant health outcomes (birth weight, gestational age at birth, weight-for-gestational-age z-score and infant hemoglobin concentration at 6 weeks).
Hypothesis 1: Iron Deficiency Anemia (IDA) will have a stronger association with infant health outcomes than non-iron deficiency anemia (NIDA).
Hypothesis 2: Anemia during the first trimester will have the strongest association with poor infant health outcomes; and anemia during either the 1st or 3rd trimester will be associated with poor infant health outcomes.
METHODS: This study is nested in the NICHD Global Network for Women’s & Children’s Health Research Maternal Newborn Health (MNH) registry - a prospective, observational population-based registry. The Thrasher-supported sub-study will select a representative sample of n=200 mothers in Eastern Maharashtra and will add: 1) blood draws in the first trimester to assess iron status; 2) an additional study visit in the 3rd trimester to assess hemoglobin; 3) a heel prick for infant hemoglobin at 6 weeks, and 4) new questionnaires on maternal diet and adherence with iron-folic acid supplementation.
IMPACT: This study will elucidate the burden of iron deficiency in pregnancy and its impact on infant health outcomes in Eastern Maharashtra. We plan to develop and test (with a randomized controlled trial) an integrated intervention that targets both IDA and NIDA in pregnancy in Eastern Maharashtra, with the goal of reducing low birthweight and infant anemia.