Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;35(1):43-53.
doi: 10.1007/s12291-018-0794-2. Epub 2018 Oct 5.

Differential Iron Status and Trafficking in Blood and Placenta of Anemic and Non-anemic Primigravida Supplemented with Daily and Weekly Iron Folic Acid Tablets

Hari Shankar  1   2   3 , Neeta Kumar  4 , Rajat Sandhir  2 , Sanjay Pandey  5 , Saurabh Singh  5 , Priyanka Verma  1 , M P Singh  6 , Tulsi Adhikari  7 , Suneeta Mittal  8   9 , D N Rao  1
Affiliations

Differential Iron Status and Trafficking in Blood and Placenta of Anemic and Non-anemic Primigravida Supplemented with Daily and Weekly Iron Folic Acid Tablets

Hari Shankar et al. Indian J Clin Biochem. 2020 Jan.

Abstract

Abstract: The molecular mechanism of iron transfer across placenta in response to maternal anemic status/ iron supplementation is not clear. We hypothesized that maternal iron/ anemia status during early trimesters can be utilized as a biomarker tool to get estimates of placental iron status. Early interventions can be envisaged to maintain optimum placental/ foetal iron levels for healthy pregnancy outcomes. One hundred twenty primigravida were recruited and divided into non-anemic and anemic group on the basis of hemoglobin levels. The groups were randomly allocated to receive daily and weekly iron folic acid (IFA) tablets till six weeks postpartum. Hematological and iron status markers in blood and placenta were studied along with the delivery notes. Weekly IFA supplementation in anemic primigravidas resulted in significantly reduced levels of hematological markers (p < 0.01); whereas non-anemic primigravidas showed lower ferritin and iron levels, and higher soluble transferrin receptor levels (p < 0.05). At baseline, C-reactive protein and cortisol hormone levels were also significantly lower in non-anemic primigravidas (p < 0.05). A significantly decreased placental ferritin expression (p < 0.05); and an increased placental transferrin expression was seen in anemic primigravidas supplemented with weekly IFA tablets. A significant positive correlation was observed between serum and placental ferritin expression in anemic pregnant women (r = 0.80; p < 0.007). Infant weight, gestational length and placental weight were comparable in both the supplementation groups. To conclude, mother's serum iron / anemia status switches the modulation in placental iron transporter expression for delivering the optimum iron to the foetus for healthy pregnancy outcomes.

Trial registration: Clinical Trial Registry-India: CTRI/2014/10/005135.

Keywords: Iron deficiency anemia; Iron folic acid supplementation; Iron transport; Placenta; Pregnancy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram showing recruitment and study design
Fig. 2
Fig. 2
Change in ferritin expression in human term placentas obtained from anemic and non-anemic pregnant women supplemented with daily and weekly IFA tablets (a) The representative bands of ferritin (~19 kDa) and b-actin (42 kDa) protein expression. (b) Decreased ferritin protein expression in weekly IFA supplementation group in non-anemic and anemic pregnant women compared with daily IFA supplementation group. Values are expressed as Mean ± SE. *Significant difference between WISG and DISG of anemic pregnant women (p ≤ 0.05)
Fig. 3
Fig. 3
Correlation between placental ferritin expression and serum ferritin during third trimester of pregnancy (a & b) Non-anemic pregnant women supplemented with weekly (n = 22) and daily (n = 24) IFA tablets respectively (c & d) Anemic pregnant women supplemented with weekly (n = 19) and daily (n = 24) IFA tablets respectively. Unit of measurement for serum ferritin expressed as ng/ml
Fig. 4
Fig. 4
Correlation between placental ferritin expression and soluble transferrin receptors (sTfR) during third trimester of pregnancy (a & b) Non-anemic pregnant women supplemented with weekly (n = 22) and daily (n = 24) IFA tablets respectively (c & d) Anemic pregnant women supplemented with weekly (n = 24) and daily (n = 24) IFA tablets respectively. Unit of measurement for serum sTfR expressed as μg/ml
Fig. 5
Fig. 5
Immunohistochemistry on non-anemic and anemic placenta. Pictures showing transferrin receptor-1 (TfR-1) localization in the perivascular stroma (**), endothelium of stem vessel (***), villous stroma (VS), villous trophoblast (arrow head). A: Anemic pregnant women supplemented with weekly IFA tablets (n = 24), original magnification 20x; B: non-anemic pregnant women supplemented with weekly IFA tablets (n = 22), original magnification 20x; C: Anemic pregnant women supplemented with daily IFA tablets (n = 24), original magnification 20x; D: non-anemic pregnant women supplemented with daily IFA tablets (n = 24), original magnification 20x
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Daily oral iron supplementation during pregnancy.
    Finkelstein JL, Cuthbert A, Weeks J, Venkatramanan S, Larvie DY, De-Regil LM, Garcia-Casal MN. Finkelstein JL, et al. Cochrane Database Syst Rev. 2024 Aug 15;8(8):CD004736. doi: 10.1002/14651858.CD004736.pub6. Cochrane Database Syst Rev. 2024. PMID: 39145520 Free PMC article.

References

    1. De Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993–2005. In: WHO Global Database on Anaemia. World Health Organization. 2008. http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf. Accessed 26 July 2013.
    1. Milman N. Oral iron prophylaxis in pregnancy: not too little and not too much! J Pregnancy. 2012 doi: 10.1155/2012/514345. - DOI - PMC - PubMed
    1. Widdowson EM, Spray CM. Chemical development in utero. Arch Dis Child. 1951;26:205–214. doi: 10.1136/adc.26.127.205. - DOI - PMC - PubMed
    1. Li Y-Q, Yan H, Bai B. Change in iron transporter expression in human term placenta with different maternal iron status. Eur J Obstet Gynecol Reprod Biol. 2008;140:48–54. doi: 10.1016/j.ejogrb.2008.02.012. - DOI - PubMed
    1. Orberger G, Fuchs H, Geyer R, Gessner R, Köttgen E, Tauber R. Structural and functional stability of the mature transferrin receptor from human placenta. Arch Biochem Biophys. 2001;386:79–88. doi: 10.1006/abbi.2000.2177. - DOI - PubMed

LinkOut - more resources