Original Article

Association between Iron Supplementation, Dietary Iron Intake and Risk of Moderate Preterm Birth: A Birth Cohort Study in China

Abstract

Abstract

Background: To evaluate the independent and collective effects of maternal iron supplementation and dietary iron intake upon the risk of moderate preterm birth and its subtypes.

Methods: In this birth cohort study, 1019 pregnant women with moderate preterm birth and 9160 women with term birth were recruited at Gansu Provincial Maternity and Child Care Hospital from 2010-2012 in China. Unconditional logistic regression models were utilized to evaluate the association between maternal iron supplementation, dietary iron intake, and the risk of moderate preterm birth and its subtypes.

Results: Compared with non-users, iron supplement users exerted a protective effect upon the overall (OR=0.54, 95%CI=0.40-0.72) and spontaneous moderate preterm birth (OR=0.39, 95%CI=0.33-0.83). Compared with the 25th quartiles of dietary iron intake, either before or during pregnancy, it exerted a significantly protective effect upon those who had the highest quartiles of dietary iron intake (OR=0.87, 95%CI=0.82-0.95 for the highest quartiles of dietary iron intake before pregnancy OR=0.85, 95%CI=0.79-0.91). Positive association was observed between the additive scale and multiplicative scale for preterm birth, spontaneous preterm rather than medically indicated preterm.

Conclusion: Iron supplements (60 mg/day) and high-iron intake (>25.86 mg/day before pregnancy, >30.46 mg/day during pregnancy) reduced the risk of moderate preterm birth. Positive correlation is found between the additive scale and multiplicative scale for preterm birth, spontaneous preterm birth.

 

 

 

1. Blencowe H, Cousens S, Oestergaard MZ, et al (2012). National, regional, and worldwide estimates of preterm birth rate in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet, 379(9832):2162-72.
2. Liu L, Johnson HL, Cousens S, et al (2012). Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet, 379(9832):2151-61.
3. McLean E, Cogswell M, Egli I, et al (2009). Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr, 12(4):444-54.
4. Ferri C, Procianoy RS, Silveira RC (2014). Prevalence and risk factors for iron-deficiency anemia in very-low-birth-weight preterm infants at 1 year of corrected age. J Top Pediatr, 60(1):53-60.
5. Stevens GA, Finucane MM, DeRegil LM, et al (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health, 1(1):e16-25.
6. Scholl TO, Hediger ML, Fischer RL, et al (1992). Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr, 55(5):985-8.
7. Lee HS, Kim MS, Kim MH, et al (2006). Iron status and its association with pregnancy outcome in Korean pregnant women. Eur J Clin Nutr, 60(9):1130-5.
8. Tunçalp Ӧ, PenaRosas JP, Lawrie T, et al (2017). WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival. BJOG, 124(6):860-862.
9. Haste FM, Brooke OG, Anderson HR, et al(1991). The effect of nutritional intake on outcome of pregnancy in smokers and non-smokers. Br J Nutr, 65(3):347-54.
10. Shastri L, Mishra PE, Dwarkanath P, et al (2015). Association of oral iron supplementaion with birth outmes in non-anaemic South Indian pregnant women. Eur J Clin Nutr, 69(5): 609-13.
11. Chan KK, Chan BC, Lam KF, et al (2009). Iron supplement in pregnancy and development of gestational diabetes-a randomised placebo-controlled trial. BJOG, 116(6):789-97.
12. Falahi E, Akbari S, Ebrahimzade F, et al (2011). Impact of prophylactic iron supplementation in healthy pregnant women on maternal iron status and birth outcome. Food Nutr Bull, 32(3):213-7.
13. Qiu J, He X, Cui H, et al (2014). Passive Smoking and Preterm Birth in Urban China. Am J Epidemiol, 180(1):94-102.
14. Liu X, Ling L, Zhang H, et al (2015). Folic acid supplementation, dietary folate intake and risk of preterm birth in China. Eur J Nutr, 55(4):1411-22.
15. Zhao N, Qiu J, Zhang Y, et al (2015). Ambient air pollutant PM10 and risk of preterm birth in Lanzhou, China. Environ Int, 76:71-7.
16. World Health Organization (2016). Preterm Birth. http://www.who.int/ mediacentre/ factsheets/fs363/en/.
17. Spong CY, Mercer BM, D'Alton M, et al (2011). Timing of indicated late-preterm and early-term birth. Obstet Gynecol, 118:323-333.
18. Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine (1999). Table of food components (national representative values). ed. People's Hygiene Press, Beijing.
19. Mutsert RD, Jager KJ, Zoccali C, et al (2009). The effec of jiont exposures: examining the presence of interaction. Kidney Int, 75(7):677-81.
20. Andersson T, Alfredsson L, Kllberg H, et al (2005). Caluculating measures of biological interaction. Eur J Epidemiol, 20(7): 575-9.
21. Scholl TO. (2005). Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr, 81(5):1218S-1222S.
22. Mei Z, Cogswell ME, Looker AC, et al (2011). Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Am J Clin Nutr, 93(6):1312-20.
23. Bothwell TH (1995). Overview and mechanisms of iron regulation. Nutr Rev, 53(9):237-45.
24. Swensen AR, Harnack LJ, Ross JA (2001). Nutritional assessment of pregnant women enrolled in the Special Supplemental Program for Women, Infants, and Children (WIC). J Am Diet Assoc, 101(8): 903-8.
25. Ladipo OA (2000). Nurtition in pregnancy: mineral and vitamin supplements. Am J Clin Nutr, 72:280S-290S.
26. Rahman MM, Abe SK, Rahman MS, et al (2016). Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr, 103(2):495-504.
27. Haider B, Olofin I, Wang M, et al (2013). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ, 346:f3443.
28. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, et al (2015). Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev, 22(7): CD004736.
29. Siega-Riz AM, Hartzema AG, Turnbull C, et al (2006). The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: a randomized controlled trial. Am J Obstet Gynecol, 194(2):512-9.
30. Shinar S, Skornick-Rapaport A, Maslovitz S (2017). Iron supplementation in singleton pregnancy: Is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? a randomized controlled trial. J Perinatol, 37(7):782-786.
31. Cogswell ME, Parvanta I, Ickes L, et al (2003). Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr, 78(4):773-81.
32. Dewey KG, Oaks BM (2017). U-shaped curve for risk associated with maternal iron status or supplementation. Am J Clin Nutr, 106:1694S-1702S.
Files
IssueVol 50 No 6 (2021) QRcode
SectionOriginal Article(s)
Published2021-06-10
Keywords
Iron supplementation Dietary iron intake Moderate preterm birth

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shao Y, Mao B, Qiu J, Bai Y, Lin R, He X, Lin X, Lv L, Tang Z, Zhou M, Xu X, Yi B, Liu Q. Association between Iron Supplementation, Dietary Iron Intake and Risk of Moderate Preterm Birth: A Birth Cohort Study in China. Iran J Public Health. 50(6):1177-1187.