Effect of the maternal βE-globin gene on hematologic responses to iron supplementation during pregnancy

Abstract

Background: It is customary in Southeast Asia to treat pregnant anemic women with iron supplements, but anemia in this region may be complicated by thalassemia and hemoglobinopathies, which lead to an ineffective response. Objective: The aim was to determine whether routine iron supplementation during pregnancy in this area, which has a high prevalence of thalassemia and hemoglobinopathies, is an effective control strategy for iron deficiency anemia. Design: A prospective study was conducted. Seventy-six pregnant women, including 43 who were heterozygous for the hemoglobin E (Hb E) gene, 20 who were heterozygous for Hb E and had ␣-thalassemia, and 13 who were homozygous Hb E, as well as 77 pregnant women who had no thalassemia gene, participated in this investigation. All pregnant women received a daily dose of 120 mg elemental Fe for an average of 133.5 d. Hematologic variables and serum ferritin concentrations were measured before supplementation and after supplementation at the gestational age of 28 -32 wk. Differences in hematologic variables and serum ferritin were assessed. Results: Significant differences in hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin responses were found between the nonthalassemia group and the 3 groups with the Hb E gene after adjustment for the following baseline values: age, body mass index, duration of iron supplementation, and ferritin concentration. Significant differences in the improvements in mean corpuscular volume and mean corpuscular hemoglobin values between the 3 groups indicate a poorer response at the cellular level in the pregnant women with the Hb E gene. Further analysis showed a significant difference in the hemoglobin response only for women who were homozygous for Hb E. Conclusion: Iron supplementation during pregnancy is not beneficial for pregnant women who are homozygous for Hb E, but a routine intervention should not cause iron overload, as judged from this short observation period.Am J Clin Nutr 2007;85:474 -9.

Iron status and inherited haemoglobin disorders modify the effects of micronutrient powders on linear growth and morbidity among young Lao children in a double-blind randomised trial

“…Thus, both ferritin and sTfR are affected by IHbD and, therefore, do not reflect Fe status alone. This is in agreement with previous findings that different types of IHbD respond differently to Fe supplementation (35) , and it has been shown that hepcidin concentrations and Fe absorption differ by IHbD type (13,14) .…”

Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country

“…However, the individuals tested had been derived from a population in Bangkok and not from a population of the Northeast of the country, where anemia and iron deficiency are common and Thalassemia is a public health problem [30,31]. Haemoglobin E (Hb E) is the most common trait for hemoglobinopathies prevalent in the Northeast of Thailand [32]. Adjusted HbA1c values were higher in a group of Asians in comparison to white individuals with Impaired Glucose Tolerance (IGT) but the adjusted HbA1c difference was insignificant (5.78% versus 6% respectively) [29].…”

Control of iron deficiency anemia in low- and middle-income countries

“…In one study, supplementation to pregnant women with hemoglobulin E heterozygote or homozygote states did not seem to cause iron overload. 55 Hemoglobinopathies contribute considerably but variably to the burden of anemia, potentially distorting estimates of the prevalence of IDA. 54 For example, in Thailand, hemoglobinopathy was found to be a greater contributor to anemia than iron deficiency in schoolchildren and pregnant women, 56,57 whereas in rural Indian children, hemoglobinopathy was only a minor contributor.…”