Iron status, serum folate and B(12) values in pregnancy and postpartum: report from a study in Jordan

A high prevalence of anemia has been reported in Jordan affecting women of childbearing age and infants/preschool children. This paper considers maternal iron, folate and B(12) status, with possible implications for both maternal and infant health.

A case-control study of infants born to anemic (Hb <11 g/dL) (n=107) and non-anemic mothers (n=125) from birth to one year, was conducted in a lower middle-class urban setting in Amman, Jordan. Maternal hematology included full blood count (FBC), plasma ferritin, transferrin saturation, serum folate and B(12) at term, and FBC and ferritin at 6 months postpartum. Serum B(12) was reassessed at 6 and 12 months postpartum if antenatal values were low. Infant FBC and ferritin were assessed in cord blood and at 3, 6, 9 and 12 months, and zinc protoporphyrin (ZPP) from 6 months.

Anemic mothers (mean [SD] Hb 9.9 [0.7] g/dL) had significantly lower antenatal values for Hb, MCV, MCH, transferrin saturation, plasma ferritin and serum folate than non-anemic mothers (mean Hb 12.2 [0.9] g/dL), which persisted at 6 months postpartum. Antenatal B(12) values were low (<200 pg/mL) in 67% of samples (26% <100 pg/mL), evenly distributed between the groups, and, therefore, not related to maternal anemia. Low values persisted in 27% (n=127) and in 61% (n=31), respectively, at 6 and 12 months postpartum. Iron deficiency anemia (Hb <11 g/dL and either ferritin <12 mcg/L or ZPP >35 mcg/dL) affected 72% of infants, with significantly higher incidence in those born to anemic mothers. Ambiguous hematology in 11% of infants may have reflected other nutritional deficiencies, including vitamin B(12), where mothers had depleted values.

Iron, folate and B(12) status should be monitored during pregnancy/lactation in developing countries, where nutritional deprivation is more prevalent and women of childbearing age often have a high fertility rate and inadequate inter-pregnancy interval to replenish body stores. Infant health may also be at risk through a compromised endowment of these micronutrients at birth.