Session 4: Mineral metabolism and body composition Iron status of breast-fed infants

Abstract

Fe deficiency is a common nutritional disorder during infancy, particularly in low-income countries. The Fe status of a breast-fed infant is strongly influenced by the body Fe content at birth, which is determined by factors that operate before birth (maternal Fe status before and during pregnancy; infant gestational age and birth weight) and at the time of delivery (the timing of umbilical cord clamping). Delaying the clamping of the umbilical cord for 2 min can increase body Fe content by approximately 33% (75 mg), and results in greater Fe stores at 6 months of age. After birth, male gender and a rapid rate of weight gain are associated with lower Fe status. During the first half of infancy dietary Fe requirements depend on Fe stores at birth. For an exclusively-breast-fed full-term normal-birth-weight infant with delayed umbilical cord clamping, whose mother had adequate Fe status during pregnancy, the Fe provided from stores and breast milk is sufficient for ≥6 months, but before this time higher-risk infants may become Fe deficient. Fe supplementation can be beneficial for high-risk infants, but can have adverse effects on growth and morbidity of Fe-replete infants. After 6 months most breast-fed infants will require complementary foods that are rich in Fe.

Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial

“…[1][2]5 In utero, at term gestation, one-third of the fetus's blood volume is in the placenta at any one time. At the time of birth, a major shift occurs in the cardiac output to the lungsFchanging from 8 to 10% in fetal life to 50% in neonatal life.…”

“…1 When the cord is cut immediately, the infant does not receive the additional blood volume from placental transfusion, representing a loss of 25 mg kg -1 of iron or 33% less body iron. 2 This loss can affect iron stores and may place the infant at risk for iron deficiency and anemia during infancy. [1][2][3][4][5] Although delaying the clamping and cutting of the cord at birth optimizes placental transfusion, it is not always feasible at the time of cesarean section.…”

“…2 This loss can affect iron stores and may place the infant at risk for iron deficiency and anemia during infancy. [1][2][3][4][5] Although delaying the clamping and cutting of the cord at birth optimizes placental transfusion, it is not always feasible at the time of cesarean section. Waiting up to two or three minutes (or until pulsations cease) before clamping the cord can seem like a long time during a cesarean section.…”

“…This has the potential to affect iron stores and may place the infant at risk for iron deficiency and anemia. [2][3][4][5] The practice of immediate cord clamping (ICC) is not based on a specific rationale or supporting evidence. Yet, the practice impacts approximately 1.5 million infants each year.…”

Nutritional Anaemia and Obesity in the Eastern Mediterranean Region: The Protective Role of Breastfeeding for Two Years

“…Some studies have shown that supplementation during pregnancy may not be necessary (13) and may increase the risk of LBW and on the contrary others suggest that supplementation is recommended (14) . Furthermore some workers suggest that breastfeeding is protective for infants (15,16) and for the breastfeeding mother by preserving and building her iron stores. This is achieved by enhancing absorption of iron and preventing blood loss and inducing lactational amenorrhea (17) .…”