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Maternal Iron Deficiency Anemia Affects Postpartum Emotions and Cognition

CITATION:  Beard, J.L., Hendricks, M.K., Perez, E.M., Murray-Kolb, L.E., Berg, A., Vernon-Feagans, L., Irlam, J., Isaacs, W., Sive, A., & Tomlinson, M. (2005). Maternal Iron Deficiency Anemia Affects Postpartum Emotions And Cognition. The American Society for Nutritional Sciences Journal of Nutrition, 135: 267-272. 

ABSTRACT:  The aim of this study was to determine whether iron deficiency anemia (IDA) in mothers alters their maternal cognitive and behavioral performance, the mother-infant interaction, and the infant’s development. This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers. This prospective, randomized, controlled, intervention trial was conducted in South Africa among 3 groups of mothers: nonanemic controls and anemic mothers receiving either placebo (10 g folate and 25 mg vitamin C) or daily iron (125 mg FeS04, 10 g folate, 25 mg vitamin C). Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum (n = 81). Maternal hematologic and iron status, socioeconomic, cognitive, and emotional status, mother-infant interaction, and the development of the infants were assessed at 10 wk and 9 mo postpartum. Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers. However, iron treatment resulted in a 25% improvement (P < 0.05) in previously iron-deficient mothers’ depression and stress scales as well as in the Raven’s Progressive Matrices test. Anemic mothers administered placebo did not improve in behavioral measures. Multivariate analysis showed a strong association between iron status variables (hemoglobin, mean corpuscular volume, and transferrin saturation) and cognitive variables (Digit Symbol) as well as behavioral variables (anxiety, stress, depression). This study demonstrates that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor African mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development, but the constraints around this relation will have to be defined in larger studies.

References

1. World Health Organization (1992) The Prevalence of Anemia in Women: A Tabulation of Available Information 2nd ed. 1992 WHO/MCH/MSM/92.2 .

2. Lozoff, B., Jimenez, E. & Wolf, A.W. (1991) Long-term developmental outcome of infants with iron deficiency. N. Engl. J. Med. 325:687-694.[Abstract]

3. Walter, T., de Andraca, I., Chadud, P. & Perales, C. G. (1989) Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatrics 84:7-17.[Abstract]

4. Pollit, E. (1989) Behavioral effects of iron deficiency in childhood. Am. J. Clin. Nutr. 50(suppl.):666-667.

5. Aukett, M. A., Parks, Y. A., Scott, P. H. & Wharton, B. A. (1986) Treatment with iron increases weight gain and psychomotor development. Arch. Dis. Child. 61:849-857.[Abstract]

6. Groner, N. A., Holtzman, N. A., Charney, E. & Mellits, D. (1986) A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women. J. Adolesc. Health Care 7:44-48.[Medline]

7. Ballin, A., Berar, M. & Rubinstein, U. (1992) Iron state in the female adolescent. Am. J. Dis. Child. 146:803-805.[Medline]

8. Seshadri, S. & Gopaldas, T. (1989) Impact of iron supplementation on cognitive functions in pre-school and school aged children: the Indian experience. Am. J. Clin. Nutr. 50:675-686.[Medline]

9. Bruner, A. B., Joffe, A., Duggan, A. K., Casella, J. F. & Brandt, J. (1996) Randomized study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 348:992-996.[Medline]

10. Beard, J. (1995) One person’s view of iron deficiency, development and cognitive function. Am. J. Clin. Nutr. 62:709-710.[Medline]

11. Corwin, E. J., Murray-Kolb, L. E. & Beard, J. L. (2003) Low hemoglobin level is a risk factor for postpartum depression. J. Nutr. 133:4139-4142.[Abstract/Free Full Text]

12. Tucker, D. M., Sandstead, H. H., Swenson, R. A., Sawler, B. G. & Penland, J. G. (1982) Longitudinal study of brain function and depletion of iron stores in individual subjects. Physiol. Behav. 29:737-740.[Medline]

13. Beard, J. L., Borel, M. J. & Derr, J. (1990) Impaired thermoregulation and thyroid function in iron deficiency anemia. Am. J. Clin. Nutr. 52:813-819.[Abstract]

14. Lukaski, H. C., Hall, C. B. & Nielsen, F. H. (1992) Thermogenesis and thermoregulatory function of iron-deficient women without anemia. Aviat. Space Environ. Med. 61:913-920.

15. Beard, J. L. & Connor, J. R. (2003) Iron status and neural functioning, Annu. Rev. Nutr. 23:41-58.

16. Borne, L. T., Langenhoven, M. L., Steyn, K., Jooste, P. L., Laubscher, J. A. & Van der Vyver, E. (1993) Nutrient intake in the urban African population of the Cape Peninsula, South Africa. The Brisk study. Central Afr. J. Med. 39:238-247.[Medline]

17. Cook, J. D. (1999) Defining optimal body iron. Proc. Nutr. Soc. 58:489-495.[Medline]

18. Cox, J. L., Holden, J. M. & Sagovsky, R. (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry 150:872-876.[Medline]

19. Raven, J. C. (1960) Guide to the Standard Progressive Matrices 1960 H. K. Lewis Press London, UK.

20. Cohen, S., Kamarck, T. & Mermelstein, R. (1983) A global measure of perceived stress. J. Health Soc. Behav. 24:385-396.[Medline]

21. Murray, L., Cooper, P. J., Wilson, A. & Romaniuk, H. (2003) Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: 2. Impact on the mother-child relationship and child outcome. Br. J. Psychiatry 182:420-427.[Abstract/Free Full Text]

22. Anger, W. K., Liang, Y. X., Nell, V., Kang, S. K., Cole, D., Bazylewicz-Walczak, B., Rohlman, D. S. & Sizemore, O. J. (2000) Lessons learned—15 years of the WHO-NCTB: a review. Neurotoxicology 21:837-846.[Medline]

23. Magwaza, A. S. & Bhana, K. (1991) Stress, locus of control, and psychological status in black South African migrants. J. Soc. Psychol. 131:157-164.[Medline]

24. Field, T. (1998) Maternal depression effects on infants and early interventions. Prev. Med. 27:200-203.[Medline]

25. Cooper, P. J., Tomlinson, M., Swartz, L., Woolgar, M., Murray, L. & Molteno, C. (1999) Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br. J. Psychiatry 175:554-558.[Abstract]

26. Cooper, P. J., Landman, M., Tomlinson, M., Molteno, C., Swartz, L. & Murray, L. (2002) Impact of a mother-infant intervention in an indigent peri-urban South African context: pilot study. Br. J. Psychiatry 180:76-81.[Abstract/Free Full Text]

27. Halterman, J. S., Kaczorowski, J. M., Aligne, C. A., Auinger, P. & Szilagyi, P. G. (2001) Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics 107:1381-1386.[Abstract/Free Full Text]

28. Bodnar, L. M., Cogswell, M. E. & Scanlon, K. S. (2002) Low income postpartum women are at risk of iron deficiency. J. Nutr. 132:2298-2302.[Abstract/Free Full Text]

29. Preziosi, P., Prual, A., Galan, P., Daouda, H., Boureima, H. & Hercberg, S. (1997) Effect of iron supplementation on the iron status of pregnant women: consequences for newborns. Am. J. Clin. Nutr. 66:1178-1182.[Abstract]

30. Singla, P. N., Tyagi, M., Hankar, R., Dash, D. & Kumar, A. (1996) Fetal iron status in maternal anemia. Acta Paediatr 85:1327-1330.[Medline]

31. Gaspar, M. J., Ortega, R. M. & Moreiras, O. (1993) Relationship between iron status in pregnant women and their new-born infants. Acta Obstet. Gynecol. Scand. 72:534-537.[Medline]