Maternal Perceived Stress during Pregnancy Increases Risk for Low Neonatal Iron at Delivery and Depletion of Storage Iron at One Year

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J Pediatr. 2018 Sep;200:166-173.e2. doi: 10.1016/j.jpeds.2018.04.040. Epub 2018 Jun 14.

Maternal Perceived Stress during Pregnancy Increases Risk for Low Neonatal Iron at Delivery and Depletion of Storage Iron at One Year

Rendina DN¹, Blohowiak SE², Coe CL¹, Kling PJ³

Author information

^{1 – Department of Psychology, Harlow Center for Biological Psychology, Madison, WI.}
^{2 – School of Medicine and Public Health, Madison, WI; Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison, Madison, WI.}
^{3 – School of Medicine and Public Health, Madison, WI; Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison, Madison, WI. Electronic address: pkling@pediatrics.wisc.edu.}

Abstract

OBJECTIVE: To investigate the impact of maternal stress during pregnancy on newborn iron and stage 1 iron deficiency at 1 year of age.

STUDY DESIGN: In total, 245 mothers and their newborn infants (52% male; 72% white) were recruited at the Meriter Hospital Birthing Center on the basis of known risk factors for iron deficiency. Umbilical cord blood hemoglobin and zinc protoporphyrin/heme (ZnPP/H) were determined to evaluate erythrocyte iron and plasma ferritin was determined to reflect storage iron. Mothers retrospectively reported stress experienced previously during pregnancy on a 25-item questionnaire. Blood was also was collected from 79 infants who were breastfed at 1 year of age.

RESULTS: Maternal recall of distress and health concerns during pregnancy correlated with cord blood ZnPP/H indices (r = 0.21, P < .01), even in the absence of major traumatic events. When concurrent with other known risks for iron deficiency, including maternal adiposity, socioeconomic status, and race, maternal stress had a summative effect, lowering cord blood iron. At 1 year, 24% of infants who were breastfed had moderate iron deficiency (plasma ferritin <12 µg/L). Higher cord blood ZnPP/H was predictive of this moderate iron deficiency (95% CI 0.26-1.47, P = .007). When coincident with maternal reports of gestational stress, the likelihood of low plasma ferritin at 1 year increased 36-fold in breastfed infants as compared with low-stress pregnancies (95% CI 1.33-6.83, P = .007).

CONCLUSIONS: Maternal recall of stress during pregnancy was associated with lower iron stores at birth. High cord blood ZnPP/H, reflecting low erythrocyte iron, was correlated with the likelihood of stage 1 iron deficiency at 1 year, when rapid growth can deplete storage iron in breastfed infants.

KEYWORDS: iron deficiency; psychosocial; risk factors; sex

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