Adapting prenatal iron supplementation to maternal needs results in optimal child neurodevelopment: a follow-up of the ECLIPSES Study

Abstract

Background: Prenatal prescription of standard iron supplements to prevent iron deficiency appears not to be appropriate for all women and their children, as some women may be at risk of iron deficiency and others at risk of iron excess early in pregnancy. The present study aimed to assess whether prenatal iron supplementation adapted to the needs of each pregnant woman affects their child's neurodevelopment.

Methods: Follow-up of a community-based RCT involving 503 mother-child pairs. Non-anaemic pregnant women recruited in Tarragona (Spain) early in pregnancy were prescribed a daily iron dose based on their initial haemoglobin levels: Stratum 1 (Hb = 110-130 g/L, 80 or 40 mg/d of iron) and Stratum 2 (Hb > 130 g/L, 40 or 20 mg/d of iron). Women receiving 40 mg/d were considered the control group in each Strata. The child's neurodevelopment was assessed at 40 days of age using the Bayley Scales of Infant Development-III (BSID-III). Adjusted multiple regression models were used.

Results: Multiple regression analyses showed no association between the intervention and control group within each Strata on the BSID-III scores on any of the developmental scales in children, including cognitive, language, and motor development: Stratum 1 (β 1.46, 95%CI -2.15, 5.07; β 1.30, 95%CI -1.99, 4.59; and β 2.04, 95%CI -3.88, 7.96, respectively) and Stratum 2 (β -4.04, 95%CI -7.27, 0.80; β -0.36, 95%CI -3.47, 2.75; and β -3.76, 95%CI -9.30, 1.78, respectively).

Conclusions: In non-anaemic women in early pregnancy, no differences were found in the cognitive, language and motor development of children at 40 days of age between the dose of iron tested in each case -adjusted to initial Hb levels- compared to the dose of the control group. Further studies are guaranteed to confirm our findings.

Trial registration: The ECLIPSES study was registered at www.clinicaltrialsregister.eu as EudraCT number 2012-005,480-28.

Keywords: Cognitive development; Iron supplementation; Language development; Motor development; Neurodevelopment; Prenatal.

Fig. 1

Flowchart of the study. Hb, haemoglobin; GW, gestational week

Fig. 2

Effect of iron supplementation on the neurodevelopment of children at around 40 days of life. The control group in each Stratum were women who received the commonly prescribed dose of 40 mg/d of iron. Models adjusted for maternal age at recruitment, parity, pregnancy planning, familiar socioeconomic status, smoking at recruitment, baseline maternal body mass index, gestational weight gain, maternal anxiety during pregnancy, postpartum depression, serum biomarker levels at the first and third trimester of pregnancy (haemoglobin, ferritin, vitamin D and polyunsaturated fatty acids), serum biomarker levels at the first trimester of pregnancy (red blood cell folate and vitamin B₁₂₎, physical activity during pregnancy, adherence to Mediterranean diet and daily energy intake at the first trimester of pregnancy, child’s age at assessment, child’s sex, gestational age, Apgar test scores, head circumference at birth, and type of feeding at birth and assessment. Odds Ratios express the chance to go from low to middle-high cognitive development and language development, and from low-middle to high motor development