Behavioral consequences at 5 y of neonatal iron deficiency in a low-risk maternal-infant cohort.

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dc.contributor.authorMcCarthy, Elaine K.
dc.contributor.authorMurray, Deirdre M.
dc.contributor.authorHourihane, Jonathan O'B.
dc.contributor.authorKenny, Louise C.
dc.contributor.authorIrvine, Alan D.
dc.contributor.authorKiely, Mairead E.
dc.contributor.funderNational Children's Research Centreen
dc.contributor.funderHealth Research Boarden
dc.contributor.funderScience Foundation Irelanden
dc.date.accessioned2021-02-09T15:21:19Z
dc.date.available2021-02-09T15:21:19Z
dc.date.issued2021-01-29
dc.date.updated2021-02-09T15:00:49Z
dc.description.abstractBackground: Iron is critical to the developing brain, but fetal iron accretion is compromised by several maternal and pregnancy-related factors. Little consideration has been given to the long-term neurologic consequences of neonatal iron deficiency, especially in generally healthy, low-risk populations. Objective: We aimed to investigate the association between neonatal iron deficiency and neurologic development at 2 and 5 y of age. Design: We measured umbilical cord serum ferritin concentrations in the prospective maternal–infant Cork BASELINE (Babies after SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints) Birth Cohort. Lifestyle and clinical data were collected from 15 weeks of gestation to 5 y of age. Standardized neurologic assessments were performed at 2 y [Bayley Scales of Infant Development/Child Behavior Checklist (CBCL)] and 5 y (Kaufman Brief Intelligence Test/CBCL). Results: Among 697 maternal–infant pairs, median (IQR) cord ferritin concentrations were 200.9 (139.0, 265.8) µg/L; 8% had neonatal iron deficiency (ferritin <76 µg/L). Using fully adjusted models, there was no association between neonatal iron deficiency and cognitive or behavioral outcomes at 2 or 5 y. We conducted an a priori sensitivity analysis in 306 high-risk children, selected using known risk factors for neonatal iron deficiency (smoking/obesity/cesarean section delivery/small-for-gestational age birth). In this high-risk subgroup, children with iron deficiency at birth (12%) had similar cognitive outcomes, but the behavioral assessments showed higher internalizing [9.0 (5.3, 12.0) compared with 5.0 (3.0, 10.0), P = 0.006; adjusted estimate (95% CI): 2.8 (0.5, 5.1), P = 0.015] and total [24.5 (15.3, 40.8) compared with 16.0 (10.0, 30.0), P = 0.009; adjusted estimate (95% CI): 6.6 (0.1, 13.1), P = 0.047] problem behavior scores at 5 y compared with those born iron sufficient. Conclusions: We have demonstrated lasting behavioral consequences of neonatal iron deficiency in high-risk children from our generally healthy, low-risk maternal–infant cohort. Although larger investigations are warranted, this study provides strong association data to suggest that interventions and strategies targeting the fetal and neonatal period should be prioritized for the prevention of iron deficiency and associated neurologic consequences.en
dc.description.sponsorshipNational Children's Research Centre, Ireland (The Cork BASELINE Birth Cohort Study); Health Research Board of Ireland (SCOPE Ireland Study (CSA 02/2007));en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleidnqaa367en
dc.identifier.citationMcCarthy, E. K., Murray, D. M., Hourihane, J. O. B., Kenny, L. C., Irvine, A. D. and Kiely, M. E. (2021) 'Behavioral consequences at 5 y of neonatal iron deficiency in a low-risk maternal–infant cohort', The American Journal of Clinical Nutrition, nqaa367 (10 pp). doi: 10.1093/ajcn/nqaa367en
dc.identifier.doi10.1093/ajcn/nqaa367en
dc.identifier.endpage10en
dc.identifier.issn1938-3207
dc.identifier.journaltitleThe American Journal of Clinical Nutritionen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/11054
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2272/IE/Irish Centre for Fetal and Neonatal Translational Research (INFANT)/en
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Spokes Programme/13/SP INFANT/B2888/IE/Personalise Nutrition for the Preterm Infant (PiNPoiNT)/en
dc.rights© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. This is a pre-copyedited, author-produced version of an article accepted for publication in The American Journal of Clinical Nutrition following peer review. The version of record is available online at: https://doi.org/10.1093/ajcn/nqaa367en
dc.subjectIron deficiencyen
dc.subjectBehavioren
dc.subjectInternalizing problemsen
dc.subjectExternalizing problemsen
dc.subjectNewborn infantsen
dc.subjectNeonatalen
dc.subjectMaternal healthen
dc.subjectMaternal obesityen
dc.subjectCesarean sectionen
dc.subjectBirth cohorten
dc.titleBehavioral consequences at 5 y of neonatal iron deficiency in a low-risk maternal-infant cohort.en
dc.typeArticle (peer-reviewed)en
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