PREVALENCE OF IRON DEFICIENCY AND IRON DEFICIENCY ANEMIA IN 3 TO 5 MONTHS OLD BREASTFED HEALTHY INFANTS

Main Article Content

Dr. Ruhail Ahmad Baba
Dr. Waseem Yousuf
Dr. Syed Tariq
Dr. Shahzad Shabir Mir
Dr. Wamiq Farooq

Keywords

Iron deficiency, Iron deficiency anemia, Infants, Maternal anemia, Maternal health

Abstract

Background: The vulnerability of infants to iron deficiency (ID) and iron deficiency anemia (IDA) is well-recognized globally, given that iron demands are elevated during this period of rapid physical and cognitive development.


Aim: To assess the prevalence of iron deficiency and iron deficiency anemia in exclusively breastfed 3 to 5 month’s old infants, born at term with a birth-weight of ≥2500 grams and  the Influence of Socioeconomic Status, Gender, Gestational Age, and Mode of Delivery on Infant Iron Status.


Methods: Prospective Cross-sectional study carried in the Postgraduate Department of Pediatrics at 500 Bedded Children Hospital, Associated Hospital Government Medical College, Srinagar involving   130 healthy infants, aged 3 to 5 months, who were exclusively breastfed, along with their mothers.  Ethical clearance was obtained from the Ethical and Medical Review Board of the Government Medical College, Srinagar, prior to initiating the study. Written informed consent was obtained from all mothers. The study adhered to the principles outlined in the Infants were primarily recruited during routine vaccination visits or as asymptomatic siblings of children attending the nutrition clinic. Eligible infants were selected based on strict inclusion and exclusion criteria to ensure homogeneity of the study population. Blood samples were obtained to measure hemoglobin (Hb) and serum ferritin levels in both infants and mothers. Chi square test was used to analyze the relationship between two categorical variables and to compare a continuous variable at baseline and follow up. A, P-value of <0.05 was considered as statistically significant.  


Results: Out of 130 infants, 28 (21.54%) were diagnosed with iron deficiency. 19 infants (14.62%) had iron deficiency anemia, characterized by low hemoglobin and serum ferritin levels. 13 infants exhibited anemia (Hb <10.5 g/dL) but had normal ferritin levels (>12 ng/mL), suggesting that their anemia may have been caused by factors such as vitamin B12 deficiency or other nutritional deficiencies, genetic disorders, hemoglobinopathies. There was a significant relationship between maternal and infant iron status. 46.43% of infants with ID had mothers who also had ID, and 47.36% of infants with IDA were born to mothers with IDA. There was a socioeconomic gradient in the prevalence of ID and IDA. Marked increase in both ID and IDA with increasing age, particularly in the group of infants aged 151–180 days.


Conclusion:  Our study reveals a significant relationship between maternal anemia and infant iron deficiency anemia with notable increase in prevalence as infants’ age; these findings are consistent with existing literature that emphasizes the critical role of maternal health in influencing infant iron status and highlights the need for timely intervention

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References

1. Pasricha SR, Drakesmith H, Black J, et al. Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013 Apr 4;121(14):2607-17.
2. Domellöf M, Braegger C, Campoy C, et al; ESPGHAN Committee on Nutrition. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014;58(1):119-29.
3. World Health Organization. The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation. Geneva; 2001.
4. Joan Younger Meek, Lawrence Noble. Policy Statement: Breastfeeding and the Use of Human Milk. From the American Academy of Pediatrics Policy Statement. PEDIATRICS. 2022;150(1).
5. Victora C, Bahl R, Barros A, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–490.
6. Ziegler E, Fomon S, Nelson S, et al. Cow milk feeding in infancy: Further observations on blood loss from the gastrointestinal tract. J. Pediatr. I 1990;16:11-18.
7. Puolakka J, Jänne O, Vihko R. Evaluation by serum ferritin assay of the influence of maternal iron stores on the iron status of newborns and infants. Acta Obstet. Gynecol. Scand., Suppl. 1980;95:53–56.
8. Scholl TO, Johnson WG. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr. 2000;7:1295–1303.
9. World Health Organization. Indicators for assessing infant and young child feeding practices – Part I: definition. 2008.
10. Jessri M, Farmer AP, Maximova K, et al; APrON Study Team. Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study. BMC Pediatr. 2013 May 16;13:77.
11. WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
12. World Health Organization. Vitamin and Mineral Nutrition Information System (WHO/NMH/NHD/MNM/11.2). 2011.
13. World Health Organization. Global Database on Child Growth and Malnutrition: Descriptions.
14. Kumar N, Gupta N, Kishore J. Kuppuswamy's socioeconomic scale: updating income ranges for the year 2012. Indian J Public Health. 2012;56:103–4.
15. Azmeraw M, Kassaw A, Habtegiorgis SD, et al. Prevalence of anemia and its associated factors among children aged 6-23 months, in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2023 Dec 2;23(1):2398.
16. Krishnaswamy S, Bhattarai D, Bharti B, et al. Iron Deficiency and Iron Deficiency Anemia in 3-5 months-old, Breastfed Healthy Infants. Indian J Pediatr. 2017 Jul;84(7):505-508.
17. Nathalie J Lambrecht, Mark L Wilson, Andrew D Jones. Assessing the Impact of Animal Husbandry and Capture on Anemia among Women and Children in Low- and Middle-Income Countries: A Systematic Review, Advances in Nutrition. 2019;10(2):331-344.
18. Rosa F.S.V. Marques, José A.A.C. Taddei, Fábio A. Lopez, et al. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev Assoc Med Bras. 2014; 60(1):18-22.
19. Anand T, Rahi M, Sharma P, et al. Issues in Prevention of Iron Deficiency Anemia in India. Nutrition. 30. 10.1016/j.nut.2013.11.022.
20. Lozoff B, Beard J, Connor J, et al. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutritional Reviews. 2006;64(5 Pt 2), S34-S43.
21. Smith A, Jones L, Miller T. Social determinants of health in maternal and child nutrition: Implications for practice. Nutrition Reviews. 2019;77(7), 487-502.
22. Dewey KG, Cohen RJ, Rivera LL, et al. Effects of age of introduction of complementary foods on iron status of breastfed infants in Honduras. Am J Clin Nutr 1998;67:878–84.
23. Andersson O, Lindquist B, Lindgren M, et al. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr. 2015; 169 : 631 – 8 .
24. Van Rheenen P, Brabin BJ. Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing and industrialised countries: a systematic review. Ann Trop Paediatr 2004;24:3-16.
25. Ziegler E. Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers. Nutrition Reviews. 2011;69(S1), S37-S42.
26. Milman N, Graudal N, Nielsen OJ, et al. Serum erythropoietin during normal pregnancy: relationship to hemoglobin and iron status markers and impact of iron supplementation in a longitudinal, placebo-controlled study on 118 women. International journal of hematology. 1997 Aug 1;66(2):159-68.
27. Murray-Kolb L, Beard J. Iron treatment normalizes cognitive functioning in young women. American Journal of Clinical Nutrition. 2007;85(3), 778-787.