MATERNAL IRON DEFICIENCY ANEMIA AFFECTS POSTPARTUM EMOTIONS AND COGNITION Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, Irlam J, Isaacs W, Sive A and Tomlinson M. Maternal iron deficiency anemia affects postpartum emotions and cognition. The Journal of Nutrition. 2005:135(2): Megan Hatch and Adrienne Holloway

Background Iron deficiency anemia is the most prevalent single nutrient deficiency worldwide:  Affects large numbers of children and women in developing countries  Only nutrient deficiency that is widespread in industrialized countries  Major consequences in poor pregnancy outcome, impaired physical & cognitive development, increased morbidity in children & decreased work productivity  Anemia contributes to 20% of maternal deaths Iron deficiency anemia is the most prevalent single nutrient deficiency worldwide. Studies on iron deficiency anemia has focused on children due to its effects seen in cognitive development and learning abilities, bu. John L. Beard, Professor of Nutrition at Penn State University was among the first researchers to concentrate on the functional consequences of iron deficiency on neurophysiology and cognition in adults.

Purpose of the Study The purpose of this study was to examine the relationship between iron status in young African mothers postpartum, particularly iron deficiency anemia and its influence on cognitive and behavioral performance. an-women.jpg

Study Design  Study conducted in Khayelitsha, South Africa  Prospective randomized controlled double blind intervention  Subjects were recruited at well-baby visits 6-8 weeks postpartum  Hematological screening for inclusion into the study: Hemoglobin (Hb): g/L Mean Corpuscular Volume* (MCV): <80 fL Transferrin Saturation* (TSAT): < 15% Serum Ferritin* (Ft): < 12 mcg/L *Subjects only required to have two of three values

Study Design Other factors:  Age (18-30 years old)  Mother’s education level  Socioeconomic level Cognitive/Psychological Testing  Digit Symbol Test  Raven’s Colored Progressive Matrices Test  Edinburgh Postnatal Depression Scale  Perceived Stress Scale  Spielberger State Trait Anxiety Inventory

Study Design Three groups: (95-enrolled; 81completed)  IDA-PL: Anemic mothers given daily dose of 25mg of vitamin C and 10 mcg of folic acid (21)  IDA-Fe: Anemic mothers given daily dose of 25mg of vitamin C,10 mcg of folic acid and125 mg FeSO 4 (30)  CN : Nonanemic mothers received no supplementation (30) Intervention: 10 weeks to 9 months postpartum

Results-Hematological Tests Iron status in the IDA-Fe subjects improved as evidenced by significant changes in Hb, TSAT and Ft. Hb significantly increased in the IDA-PL group. The CN exhibited no hematologic changes.

Results-Psychological Tests Cognitive Tests: The IDA-Fe group showed a 25% improvement on the Raven’s Test and scored significantly higher on the Digit Symbol Test. The IDA-PL group showed no significant changes. The EPDS, STAI and Perceived Stress Scale were significantly to hunger and income.**

Author’s Conclusion There is a possible association between IDA and postpartum depression, stress and cognition. Depression and stress respond to iron therapy. Implication: Poor behavioral and cognitive function is likely to affect mother and child interactions and the baby’s development.

Limitations  Psychological testing measures that were utilized were insufficient for conclusions made as it relates to the connection between depression and iron status  Supplementation during the study for the control group  Small selective group  Lack of follow-up evaluations

Question… Given the results of the study do you think iron supplementation could be helpful in the treatment of postpartum depression?