Serum hepcidin and iron status parameters in pregnant women and the association with adverse maternal and fetal outcomes: a study protocol for a prospective cohort study

Abstract

IntroductionHepcidin production is normally upregulated by iron stores, and in obesity has been shown to be overexpressed and correlated with low iron status. The increased hepcidin may restrain the iron release from the cells by affecting the expression of ferroportin, which probably associates with the development of diabetes complication. First, we investigate the difference of serum hepcidin and iron parameters between obese and non-obese pregnant women; second, we examine the correlation between serum hepcidin and adverse maternal and neonatal outcomes in pregnant women.Methods and analysisThis is a mono-centre, prospective cohort study with a study (obese) and a control group (non-obese women). In the first trimester, 188 singleton pregnancies will be recruited. Thereof, we expect 75 with a body mass index (BMI) ≥30 kg/m2 and 113 with a BMI 18.5–30 kg/m2. Serum hepcidin, iron and haematological parameters will be measured at 11–14, 24–28, 32–36 weeks of gestation and at time of delivery. Blood pressure, weight, BMI and smoking status will be examined at all visits. We will assess the composite endpoints adverse maternal outcomes (including pre-eclampsia, gestational hypertension, gestational diabetes mellitus, haemorrhage, placenta abruption) and adverse neonatal outcomes (preterm birth, intrauterine growth restriction, preterm premature rupture of membranes, Apgar score <7 at 5 min, stillbirth, neonatal death).Recruitment has started in April 2019.Ethics and disseminationThis study received ethical approval from the ethics committee in Basel. The results of the study will be published in a peer-reviewed journal, and presented at national scientific conferences.Trial registration number NCT03792464.

Prevalence of Anemia, Iron Deficiency during the Second Trimester of Gestation in Pregnant Women: A Comparative Study of Walled and New Lahore City Population

“…Our studies found less prevalence of iron deficiency NC-29.3% and WC-23.3%, significantly less than expected [43]. This may also be due to the progressive rise of iron absorption during the second trimester of gestation and its relation with hepcidin as a critical player of iron homeostasis during pregnancy [35,38,44,45].…”

“…A newly emerged marker for iron homeostasis hepcidin is also used for the detection of anemia during pregnancy [28,35].…”

Response of Iron Deficiency Markers to Blood Lead Levels and Synergistic Outcomes at Prenatal Stage

“…[19][20][21] Iron deficiency was identified by lower blood iron and ferritin concentrations 22 Hepcidin, a newly discovered marker for iron homeostasis, is also considered to identify anemia during pregnancy. 23,24…”

Correlation Between High Serum Ferritin Level and Gestational Diabetes: A Systematic Review

“…It is associated with indices of glucose metabolism, such as fasting blood glucose, fasting insulin level, and glucose value response to the glucose challenge test [ 44 ]. A high hepcidin level may represent a risk of feto-maternal complication [ 45 ]. Rawal et al discussed that in pregnancy, higher iron status (as represented by an elevated level of hepcidin and ferritin and a reduced ratio between sTfR and ferritin) was shown to be substantially associated with increased risk of GDM [ 25 ].…”