High Third-Trimester Ferritin Concentration: Associations With Very Preterm Delivery, Infection, and Maternal Nutritional Status

doi:10.1016/S0029-7844(98)00157-4

Obstetrics & Gynecology

Volume 92, Issue 2, August 1998, Pages 161-166

https://doi.org/10.1016/S0029-7844(98)00157-4 Get rights and content

Abstract

Objective: To determine whether a high concentration of serum ferritin during the third trimester is a marker of subclinical maternal infection and very preterm delivery and is associated with maternal nutritional status.

Methods: A total of 1162 gravidas was followed prospectively from entry to prenatal care (15.0 ± 4.9 completed weeks’ gestation) in Camden, New Jersey, between 1985 and 1995. Multiple logistic regression and analysis of covariance were used to examine the influence of serum ferritin on the outcomes of interest.

Results: High concentrations of serum ferritin (at or above the 90th percentile) at week 28, but not at entry to prenatal care, increased risk of preterm and very preterm delivery, but the risk changed if the concentration of ferritin declined from entry. If the concentration declined as expected, high ferritin concentration had no influence on outcome. If the concentration increased, then high ferritin concentration at week 28 was associated with very preterm delivery (adjusted odds ratio [AOR] 8.77; 95% confidence interval [CI] 3.90, 19.72), preterm delivery (AOR 3.81; 95% CI 1.93, 7.52), low birth weight (AOR 5.15; 95% CI 2.47, 10.72), clinical chorioamnionitis (AOR 2.56; 95% CI 1.01, 6.52), and symptoms of “flu” as an index of unmeasured infection (AOR 6.02; 95% CI 1.16, 31.17). Factors associated with failure of the ferritin concentration to decline included iron deficiency anemia earlier in pregnancy (AOR 3.98; 95% CI 1.17, 8.98) and lower levels of serum and red cell folate.

Conclusion: High serum ferritin concentration in the third trimester, resulting from a failure of ferritin to decline, is associated with very preterm delivery and markers of maternal infection. Iron deficiency anemia and other indicators reflecting poor maternal nutritional status earlier in pregnancy underlie this relationship.

Section snippets

Materials and methods

The Camden Study6, 7 examined the effect of risk factors (maternal growth and nutrition) during pregnancy in one of the poorest cities in the continental United States (based on criteria such as family income, welfare dependency, and childhood poverty).8 Gravidas with serious nonobstetric problems (eg, lupus, chronic hypertension, non–insulin-dependent diabetes mellitus, seizure disorders, malignancies, drug or alcohol abuse) were excluded from this study. Stratified by maternal age and parity,

Results

Maternal background characteristics are given in Table 1. Gestation at entry to prenatal care averaged 15.0 ± 4.9 (standard deviation [SD]) weeks’ gestation for the cohort, and the interquartile range was 11–19 weeks. Characteristics associated with higher serum ferritin concentration percentiles at week 28 included older maternal age, black ethnicity, maternal smoking (tobacco and marijuana), and funding for pregnancy care from sources other than Medicaid, primarily patient self-pay.

After

Discussion

At week 28, high concentrations of serum ferritin were associated with an increased risk of very preterm delivery, preterm delivery, and LBW. Risk of adverse pregnancy outcomes decreased as ferritin concentration decreased. There was no association between ferritin level measured early in pregnancy and preterm delivery or LBW, even when the concentration of ferritin was at or above the 90th percentile (at least 115.7 μg/L).

When the concentration decreased from entry, as expected, there was no

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The associations of low or replete iron status with birth outcomes are population specific. Research to replicate and extend these findings would be beneficial. These trials were registered at clinicaltrials.gov as NCT00970866 (Ghana) and NCT01239693 (Malawi).
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^☆: Supported in part by grants HD18269 from the National Institute of Child Health and Human Development and ES07437 from the National Institute of Environmental Health Services. I thank Isadore Ances, MD, Margaret Cofsky, MSN, Richard Fischer, MD, Paul Krueger, DO, and Courtney Malcarney, MD, for access to patients; and Mary Hediger, PhD, and Joan Schall, PhD, for data assistance with this research.

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Original ArticlesHigh Third-Trimester Ferritin Concentration: Associations With Very Preterm Delivery, Infection, and Maternal Nutritional Status☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Serum ferritin as a measure of iron stores during and after normal pregnancy with and without iron supplements

Acta Obstet Gynecol Scand Suppl

Trace elements in the infectious processes

Med Clin North Am

Serum ferritinA predictor of early spontaneous preterm delivery

Obstet Gynecol

Plasma ferritin and pregnancy outcome

Am J Obstet Gynecol

Weight gain, nutrition and pregnancy outcomeFindings from the Camden Study of teenage and minority gravidas

Semin Perinatol

Anemia vs iron deficiencyIncreased risk of preterm delivery in a prospective study

Am J Clin Nutr

Ranking the municipalities, a Rutgers regional report

Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term

J Infect Dis

Serum ferritin as an assessment of iron stores and other hematologic parameters during pregnancy

Obstet Gynecol

Epidemiologic research

Original Articles
High Third-Trimester Ferritin Concentration: Associations With Very Preterm Delivery, Infection, and Maternal Nutritional Status☆