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dc.contributor.authorFowkes, FJI
dc.contributor.authorMoore, KA
dc.contributor.authorOpi, DH
dc.contributor.authorSimpson, JA
dc.contributor.authorLangham, F
dc.contributor.authorStanisic, DI
dc.contributor.authorUra, A
dc.contributor.authorKing, CL
dc.contributor.authorSiba, PM
dc.contributor.authorMueller, I
dc.contributor.authorRogerson, SJ
dc.contributor.authorBeeson, JG
dc.date.accessioned2020-03-17T03:59:45Z
dc.date.available2020-03-17T03:59:45Z
dc.date.issued2018
dc.identifier.issn1741-7015
dc.identifier.doi10.1186/s12916-018-1146-z
dc.identifier.urihttp://hdl.handle.net/10072/392384
dc.description.abstractBackground: Low birth weight (LBW) and preterm birth (PTB) are major contributors to infant mortality and chronic childhood morbidity. Understanding factors that contribute to or protect against these adverse birth outcomes is an important global health priority. Anaemia and iron deficiency are common in malaria-endemic regions, but there are concerns regarding the value of iron supplementation among pregnant women in malaria-endemic areas due to reports that iron supplementation may increase the risk of malaria. There is a lack of evidence on the impact of iron deficiency on pregnancy outcomes in malaria-endemic regions. Methods: We determined iron deficiency in a cohort of 279 pregnant women in a malaria-endemic area of Papua New Guinea. Associations with birth weight, LBW and PTB were estimated using linear and logistic regression. A causal model using sequential mediation analyses was constructed to assess the association between iron deficiency and LBW, either independently or mediated through malaria and/or anaemia. Results: Iron deficiency in pregnant women was common (71% at enrolment) and associated with higher mean birth weights (230 g; 95% confidence interval, CI 118, 514; p < 0.001), and reduced odds of LBW (adjusted odds ratio, aOR = 0.32; 95% CI 0.16, 0.64; p = 0.001) and PTB (aOR = 0.57; 95% CI 0.30, 1.09; p = 0.089). Magnitudes of effect were greatest in primigravidae (birth weight 351 g; 95% CI 188, 514; p < 0.001; LBW aOR 0.26; 95% CI 0.10, 0.66; p = 0.005; PTB aOR = 0.39, 95% CI 0.16, 0.97; p = 0.042). Sequential mediation analyses indicated that the protective association of iron deficiency on LBW was mainly mediated through mechanisms independent of malaria or anaemia. Conclusions: Iron deficiency was associated with substantially reduced odds of LBW predominantly through malaria-independent protective mechanisms, which has substantial implications for understanding risks for poor pregnancy outcomes and evaluating the benefit of iron supplementation in pregnancy. This study is the first longitudinal study to demonstrate a temporal relationship between antenatal iron deficiency and improved birth outcomes. These findings suggest that iron supplementation needs to be integrated with other strategies to prevent or treat infections and undernutrition in pregnancy to achieve substantial improvements in birth outcomes.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.relation.ispartofpagefrom156:1
dc.relation.ispartofpageto156:10
dc.relation.ispartofissue1
dc.relation.ispartofjournalBMC Medicine
dc.relation.ispartofvolume16
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode11
dc.subject.keywordsAnaemia
dc.subject.keywordsIron deficiency
dc.subject.keywordsLow birth weight
dc.subject.keywordsMalaria
dc.subject.keywordsPlasmodium falciparum
dc.titleIron deficiency during pregnancy is associated with a reduced risk of adverse birth outcomes in a malaria-endemic area in a longitudinal cohort study
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationFowkes, FJI; Moore, KA; Opi, DH; Simpson, JA; Langham, F; Stanisic, DI; Ura, A; King, CL; Siba, PM; Mueller, I; Rogerson, SJ; Beeson, JG, Iron deficiency during pregnancy is associated with a reduced risk of adverse birth outcomes in a malaria-endemic area in a longitudinal cohort study, BMC Medicine, 2018, 16 (1), pp. 156:1-156:10
dcterms.dateAccepted2018-08-03
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2020-03-17T03:57:38Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
gro.hasfulltextFull Text
gro.griffith.authorStanisic, Danielle


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