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Nutritional Epidemiology

Maternal Iron Deficiency Anemia Affects Postpartum Emotions and Cognition¹

John L. Beard², Michael K. Hendricks^*, Eva M. Perez^*, Laura E. Murray-Kolb, Astrid Berg^*, Lynne Vernon-Feagans, James Irlam^*, Washiefa Isaacs^*, Alan Sive^* and Mark Tomlinson^*

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802; ^* School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; and School of Education, University of North Carolina, Chapel Hill, NC 27599

²To whom correspondence should be addressed. E-mail: jbeard{at}psu.edu.

The aim of this study was to determine whether iron deficiency anemia (IDA) in mothers alters their maternal cognitive and behavioral performance, the mother-infant interaction, and the infant’s development. This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers. This prospective, randomized, controlled, intervention trial was conducted in South Africa among 3 groups of mothers: nonanemic controls and anemic mothers receiving either placebo (10 µg folate and 25 mg vitamin C) or daily iron (125 mg FeS0₄, 10 µg folate, 25 mg vitamin C). Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum (n = 81). Maternal hematologic and iron status, socioeconomic, cognitive, and emotional status, mother-infant interaction, and the development of the infants were assessed at 10 wk and 9 mo postpartum. Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers. However, iron treatment resulted in a 25% improvement (P < 0.05) in previously iron-deficient mothers’ depression and stress scales as well as in the Raven’s Progressive Matrices test. Anemic mothers administered placebo did not improve in behavioral measures. Multivariate analysis showed a strong association between iron status variables (hemoglobin, mean corpuscular volume, and transferrin saturation) and cognitive variables (Digit Symbol) as well as behavioral variables (anxiety, stress, depression). This study demonstrates that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor African mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development, but the constraints around this relation will have to be defined in larger studies.

KEY WORDS: • iron • postpartum • maternal • cognition • behavior

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