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Maternal hemoglobin and iron status in early pregnancy and childhood cardiac outcomes
Hugo G Quezada-Pinedo1, Vincent Jaddoe2, Romy Gaillard2
1The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Insights
Maternal iron status in early pregnancy impacts boys' heart function long-term. Anemia was linked to larger heart volumes in boys, suggesting a sex-specific effect on cardiovascular development.
Area of Science:
- Cardiovascular Physiology
- Maternal-Fetal Health
- Iron Metabolism
Background:
- Iron homeostasis dysregulation affects adult cardiac function in a sex-specific manner.
- The long-term impact of maternal iron status during pregnancy on offspring cardiovascular health, and its sex-dependency, remains unclear.
Purpose of the Study:
- To investigate the sex-specific association between maternal iron status in early pregnancy and cardiac outcomes in 10-year-old children.
- To determine if maternal anemia or iron levels influence children's cardiac structure and function.
Main Methods:
- A population-based cohort study of 1972 mother-child pairs.
- Maternal hemoglobin and ferritin measured in early pregnancy; cardiac MRI at age 10 to assess cardiac function (RVEDV, LVEDV, RVEF, LVEF) and structure (LVM, LMVR).
- Analysis stratified by sex, with adjustments for confounders and multiple testing.
Main Results:
- In boys, increased maternal hemoglobin was associated with smaller right and left ventricular end-diastolic volumes (RVEDV and LVEDV).
- Maternal anemia in early pregnancy was linked to higher LVEDV in boys at age 10.
- No significant associations were found for other cardiac outcomes or in girls.
Conclusions:
- Maternal iron status dysregulation during early pregnancy may have lasting effects on boys' cardiac function, specifically RVEDV and LVEDV.
- Further research is needed to elucidate the underlying mechanisms of these sex-specific cardiovascular alterations.
Background & Aims:
Dysregulation of iron homeostasis is associated with cardiac alterations in a sex-dependent manner in adults. It is unknown whether iron status during pregnancy has long-term impact on cardiovascular health, and if this association is influenced by sex. Therefore, this study aimed to evaluate sex-specific association between maternal iron status during early pregnancy and cardiac outcomes in children aged 10 years.
Methods:
In a population-based cohort study among 1972 mother-child pairs, hemoglobin and ferritin were measured in early pregnancy (<18 weeks) and categorized into anemia (hemoglobin<11 g/dL), elevated hemoglobin (hemoglobin≥13.2 g/dL), iron deficiency (ferritin<15 μg/L), and iron overload (ferritin>150 μg/L). At 10 years of age, cardiac MRI was performed to measure right and left cardiac outcomes of function (ventricular end-diastolic volume (RVEDV and LVEDV) and ejection fraction (RVEF and LVEF)), and structure (left ventricular mass (LVM), and left ventricular mass-to-volume ratio (LMVR)). Results are presented for boys and girls separately and models were adjusted for confounders and multiple testing.
Results:
In boys, one standard deviation score (SDS) increase in maternal hemoglobin was associated with lower RVEDV and LVEDV (difference (95%CI) -0.10 (-0.17, -0.03) SDS and -0.09 (-0.16, -0.03) SDS, respectively). In boys, maternal anemia, as compared to normal hemoglobin levels, was associated with higher LVEDV (difference 0.34 (0.10, 0.59) SDS). No associations were observed for other cardiac outcomes and for ferritin in boys. No associations were observed in girls.
Conclusion:
In boys, dysregulated iron status during early pregnancy might permanently alter cardiovascular RVEDV and LVEDV function. Underlying mechanisms need further study.
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