Association of low birthweight and small for gestational age with maternal ferritin levels: A retrospective cohort study in China

Abstract

BackgroundBirthweight have profound impacts on health status throughout lifetime, however, the relationship between maternal ferritin level in pregnancy and birthweight of the newborn remains controversial.ObjectiveThis retrospective cohort research was to analyze the association between maternal ferritin levels during pregnancy with birthweight outcomes, primarily for low birthweight (LBW) and small for gestational age (SGA).MethodsNewborns weighing lower than 2,500 grams were defined as LBW. SGA is defined as birthweight lower than the 10th percentile of the distribution of newborns' birthweight of the same gestational age. Multivariable logistic regressions have been used to explore the association of maternal ferritin levels and birthweight related outcomes, in which the ferritin concentration was logarithm transformed in the model. We further used restricted cubic spline models to explore linear/non-linear dose–response manners of ferritin level and birthweight outcomes.ResultsA total of 3,566 pregnant women were included in the study. In the results of the present study, we observed that maternal ferritin levels were linearly associated with the risk of LBW (p-trend = 0.005) and SGA (p-trend = 0.04), with the adjusted odds ratios (ORs) of 1.78 (95% CI 1.37–2.32) for LBW and 1.87 (95% CI 1.38–2.54) for SGA with an increase in Ln-ferritin concentrations per unit. The adjusted ORs across quartiles of ferritin levels were 2.14 (95% CI 1.03–4.47) for Quartile 2, 3.13 (95% CI 1.47–6.69) for Quartile 3, and 3.63 (95% CI 1.52–8.68) for Quartile 4 for LBW. The adjusted ORs of LBW and SGA among women using supplemental iron were 0.56 (95% CI 0.38, 0.85) and 0.65 (95% CI 0.40, 1.05) compared with non-users, respectively.ConclusionsOur findings found a linear dose–response relationship between ferritin levels and an increased risk of poor birthweight outcomes, suggesting that maternal ferritin level during pregnancy may provide an additional predictor for differentiating poor birthweight related outcomes. Further exploration should be conducted to ensure maternal ferritin thresholds and iron supplement doses.

Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review

“…Preventive strategies were divided into the 10 following categories: midwifery care, health promotion programs for smoking cessation, alcohol reduction during pregnancy, folic acid, vitamin D, iron, and zinc supplementation, a well-balanced diet, COVID-19 vaccination and cannabis use during pregnancy. The most significant and high-quality publications focusing on preventive strategies [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] are summarized in Table 1 .…”

“…Martínez-Galiano et al found a positive correlation between iron intake during pregnancy and SGA [ 28 ]. What is more, in a retrospective cohort study conducted in China, Tao et al found a linear dose-response relationship between ferritin levels and an increased risk of poor birthweight outcomes [ 29 ]. These data suggest that maternal ferritin level may be an additional differentiating factor for risk assessment of SGA.…”