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Community and International Nutrition

Preconception Hemoglobin and Ferritin Concentrations Are Associated with Pregnancy Outcome in a Prospective Cohort of Chinese Women¹

Alayne G. Ronnenberg², Richard J. Wood^*, Xiaobin Wang, Houxun Xing^**, Chanzhong Chen, Dafang Chen^**,, Wenwei Guang^**, Aiqun Huang^**, Lihua Wang and Xiping Xu

Department of Environmental Health, Harvard School of Public Health, Boston; ^* Mineral Bioavailability Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA; Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA; ^** Institute for Biomedicine, Anhui Medical University, Anhui, China; and Center for Ecogenetics and Reproductive Health, Beijing Medical University, Beijing, China

²To whom correspondence should be addressed. E-mail: ronnenberg{at}comcast.net.

Prenatal anemia and iron deficiency are associated with adverse birth outcomes, but no previous studies have examined the relation between preconception anemia, iron deficiency, and pregnancy outcome in healthy women. We measured hemoglobin (Hb), ferritin, transferrin receptor (TfR), and vitamins B-6, B-12, and folate concentrations before pregnancy in 405 Chinese women (median time from sample collection to gestation end = 316 d). Both mild (95 Hb < 120 g/L) and moderate (Hb < 95 g/L) anemia were significantly associated with lower birthweight (139 and 192 g, respectively); iron-deficiency anemia alone (Hb < 120 g, ferritin < 12 µg/L, no B-vitamin deficiency) was associated with a 242-g decrease in birthweight. Both low (<12 µg/L) and high (60 µg/L) ferritin were also significantly associated with lower birthweight (106 and 123 g, respectively). The risks of low birthweight (LBW) and fetal growth restriction (FGR) were significantly greater among women with moderate anemia compared with nonanemic controls [odds ratio (OR): 6.5; 95% CI: 1.6, 26.7; P = 0.009 and OR: 4.6; 95% CI: 1.5, 13.5; P = 0.006, respectively]. TfR and low ferritin were not associated with adverse birth outcome, but elevated ferritin, which could be a marker of inflammation, was associated with increased risk of LBW (OR: 2.2; 95% CI: 0.9, 5.7; P = 0.09) and FGR (OR: 2.7; 95% CI: 1.3, 5.6; P = 0.008). Preconception anemia, particularly iron-deficiency anemia, was associated with reduced infant growth and increased risk of adverse pregnancy outcome in Chinese women.

KEY WORDS: • anemia • China • ferritin • pregnancy • transferrin receptor