|Widen, Elizabeth - Columbia University - New York|
|Bentley, Margaret - University Of North Carolina|
|Kayira, Dumbani - University Of North Carolina|
|Chasela, Charles - University Of Witwatersrand|
|Daza, Eric - University Of North Carolina|
|Kacheche, Zebrone - University Of North Carolina|
|Tegha, Gerald - University Of North Carolina|
|Jamieson, Denise - Centers For Disease Control And Prevention (CDCP) - United States|
|Kourtis, Athena - Centers For Disease Control And Prevention (CDCP) - United States|
|Van Der Horst, Charles - University Of North Carolina|
|Adair, Linda - University Of North Carolina|
Submitted to: Journal of Nutrition
Publication Type: Review Article
Publication Acceptance Date: 12/12/2013
Publication Date: 12/31/2013
Citation: Widen, E.M., Bentley, M.E., Kayira, D., Chasela, C., Daza, E.J., Kacheche, Z.K., Tegha, G., Jamieson, D.J., Kourtis, A.P., Van Der Horst, C.M., Allen, L.H., Shahab-Ferdows, S., Adair, L. 2013. Changes in soluble transferrin receptor and hemoglobin concentrations in Malawian mothers are associated with those values in their exclusively breastfed, HIV-exposed infants. Journal of Nutrition. DOI: 10.3945/jn.113.177915.
Interpretive Summary: Iron status of the pregnant woman during pregnancy affects the amount of iron stored in her infant at birth. However it is uncertain whether iron status of the mother during lactation affects that of her exclusively breastfed infant. We therefore assessed infant and maternal iron status in exclusively breastfeeding women and their infants in Malawi enrolled in the Breastfeeding, Antiretrovirals and Nutrition Study. In this randomized controlled trial the women, who were all HIV positive, were randomly assigned to a lipid-based micronutrient supplement (LNS), or no LNS, and maternal, infant, or no antiretroviral drugs during the first 24 wk of lactation. In the total sample of 1926 mother-infant pairs, after controlling for initial infant hemoglobin values a 1 g/L higher maternal hemoglobin at 12, 18 and 24 wk was associated with a respective 0.06 (P=0.01), 0.10 (P<0.001), and 0.06 (P=0.01) g/L increase in hemoglobin in the infant. In a subsample of mothers and infants who also had measures of iron status (serum ferritin and transferrin receptors [TfR]) at 2 wk (n=352 pairs), 6 wk (n=167 pairs) and 24 wk (n=519 pairs), change in infant hemoglobin and iron status measures was compared to the corresponding change in the same maternal measures, adjusting for the initial values which were made at 2 or 6 wk postpartum. In this subsample there was a fall in maternal TfR and an increase in hemoglobin between the initial measurement and 24 wk, which were associated with the same pattern in infants. Thus maternal iron status both during pregnancy and postpartum is important for protecting infant iron status.
Technical Abstract: Infant iron status at birth is influenced bymaternal iron status during pregnancy; however, there are limited data on the extent to which maternal iron status is associated with infant iron status during exclusive breastfeeding. We evaluated how maternal and infant hemoglobin and iron status [soluble transferrin receptors (TfR) and ferritin] were related during exclusive breastfeeding in HIV-infected women and their infants. The Breastfeeding, Antiretrovirals, and Nutrition Studywas a randomized controlled trial in Lilongwe, Malawi, in which HIV-infected women were assigned with a 2 3 3 factorial design to a lipid-based nutrient supplement (LNS), or no LNS, and maternal, infant, or no antiretroviral drug, and followed for 24 wk. Longitudinal models were used to relate postpartummaternal hemoglobin (n = 1926) to concurrently measured infant hemoglobin, adjusting for initial infant hemoglobin values. In a subsample, change in infant iron status (hemoglobin, log ferritin, log TfR) between 2 (n = 352) or 6 wk (n = 167) and 24 wk (n = 519) was regressed on corresponding change in the maternal indicator, adjusting for 2 or 6 wk values. A 1 g/L higher maternal hemoglobin at 12, 18, and 24 wk was associated with a 0.06 g/L (P = 0.01), 0.10 g/L (P < 0.001), and 0.06 g/L (P = 0.01), respectively, higher infant hemoglobin. In the subsample, a reduction in maternal log TfR and an increase in hemoglobin from initial measurement to 24 wk were associated with the same pattern in infant values (log TfR b =20.18mg/L, P < 0.001; hemoglobin b = 0.13 g/L, P = 0.01). Given the observed influence of maternal and initial infant values, optimizing maternal iron status in pregnancy and postpartum is important to protect infant iron status.