If a Woman Is Anemic Can Her Baby Become Iron Deficient if Breastfeeding
Abstruse
Objective:
Sectional breastfeeding is recommended till 6 months historic period. Factors regulating the breastmilk iron and lactoferrin levels are incompletely known. Because loftier prevalence of nutritional anemia in lactating mothers, we studied the iron status of lactating mothers, their breastmilk iron and lactoferrin levels to determine any relationship between them.
Design:
Prospective study with 6 months follow-up.
Setting:
Tertiary care referral hospital.
Subjects:
Hundred nonanemic and 100 anemic mothers with their babies recruited at birth. L-two nonanemic and 50 anemic mothers and their babies completed the 6-month follow-up.
Interventions:
Hemoglobin (Hb), total iron binding capacity (TIBC), percent transferrin saturation (%TS), serum fe (SI) and serum ferritin measured on day ane and vi months postpartum. Breastmilk fe and lactoferrin measured on 24-hour interval i, xiv weeks and 6 months after delivery.
Results:
Breastmilk fe decreased progressively from day i to 14 weeks and at 6 months in both groups, but no significant difference was noted between nonanemic and anemic mothers (P>0.05). Pregnant decline in breastmilk lactoferrin concentration from day 1 to 14 weeks in nonanemic and anemic mothers (P<0.001) noted. Hemoglobin, TIBC, %TS, SI and serum ferritin of both groups had no correlation with breastmilk iron and lactoferrin concentration on day one, 14 weeks and 6 months after delivery.
Conclusions:
Breastmilk fe and lactoferrin concentration had no relationship with the female parent's Hb and iron status.
Sponsorship:
This piece of work was carried out as office of thesis research under University of Delhi.
Introduction
Human milk is the ideal nutrient for infants because of its unique nutritional characteristics (Picciano, 2001). World Health Organisation unequivocally recommends that sectional breastfeeding is the platonic nutrition for infants and is sufficient to support optimal growth for start half-dozen months of life (WHO, 2001). Having said this, the adequacy of breastmilk with regard to its macro- and micro nutrient composition needs to be reassured especially in the face of high prevalence of nutritional deficiency in the lactating mothers in developing countries. The recently published NFHS-2 data gives a prevalence of 52–56.4% of atomic number 26 deficiency anemia amidst meaning and breastfeeding mothers (NFHS, 2000). It is a common conventionalities that anemic mothers secrete less iron and lactoferrin in their breastmilk.
Yet, scientific evidence, though small and reported mainly in developed countries, argues against this perception. Studies on lactating women of varying ethnic origins take shown that breastmilk atomic number 26 is independent of their hemoglobin (Hb) and iron condition (Loh and Sinnathuray, 1971). Breastmilk iron and lactoferrin levels are known to vary according to the blazon of milk, age of lactation and diurnal variation (Hall, 1979; Houghton et al., 1985). Because the varying epidemiological factors and the high degree of malnutrition and anemia in the lactating mothers of developing countries, the need for such a report was felt. Therefore, this study was undertaken to assess the fe status, breastmilk iron and lactoferrin levels in lactating women and to find out any relationship among them.
Materials and methods
Sample size
In this prospective study, later obtaining informed consent, the subjects willing to participate in the study and residing within a radius of 10 km of the institution were chosen from sequent deliveries and the mother–baby pair divided into 2 groups. Grouping A consisted of nonanemic mothers (Hb⩾11 g/dl) and their babies, while Group B comprised of anemic mothers (Hb 7–eleven m/dl) and their babies. Mothers in Group B were designated as iron scarce after considering their atomic number 26 parameters on day 1. The sample size was based on the fe and lactoferrin content of breastmilk as reported by Zavaleta et al. (1995). Using the following formula and keeping the level of significance (α)=0.05 and power of study (i-β)=0.90, the sample size obtained was 43, which was rounded to 50 for each group. Considering a follow-up charge per unit of fifty% at 6 months in our establishment, 100 mother–baby pairs were recruited in each group so as to consummate the follow-upwardly of 50 mothers till half dozen months
where σ ane=0.nine, σ 2=one.1, d=0.7.
Subjects
All mothers in this report had uneventful antenatal history, with an uncomplicated singleton vaginal commitment. The mothers with history of pre-eclampsia, antepartum hemorrhage, tuberculosis and other chronic diseases were excluded. The infants in both groups were term (gestational historic period 37–41 completed weeks), weighed ⩾2500 yard, had apgar score 8 or more at 1 min with no gross congenital malformations. Breastfeeding was started inside 30–lx min afterward nascency. All mothers were counseled almost exclusive breastfeeding and regular follow-up. Efforts were fabricated to contact the mothers for follow-up. All mothers were supplemented with iron and folic acid.
Sample collection and follow-up
Collection of blood sample from mothers on follow-up
Hemoglobin, total atomic number 26 binding capacity (TIBC), percent transferrin saturation (%TS), serum atomic number 26 (SI) and serum ferritin were measured on day 1 and 6 months postpartum. Ten milliliters of blood was collected by venipuncture in iron free test tube (vi ml), EDTA vial (2 ml) and plainly vial (2 ml). Serum was separated and stored at −20°C for the estimation of serum ferritin.
Hemoglobin was measured using the automated hematology prison cell counter MS-ix (Melit Schloesing Laboratories). Serum fe and TIBC were estimated as per the modified guidelines of International Committee for Standardization in Hematology (International Commission for Standardization in Hematology, 1978, 1990). Stored serum was thawed to room temperature and serum ferritin was measured using ELISA kit – Microwell Ferritin Environmental impact assessment (Syntron Bioresearch Inc).
Collection and assay of breastmilk
Breastmilk iron and lactoferrin were measured on day 1, 14 weeks and half-dozen months after delivery. Manual expression of breastmilk was demonstrated to the female parent on a model and she was requested to collect the breastmilk by transmission expression. After collecting around ten ml of foremilk in a sterile acrid-washed and rinsed iron-free container, the baby was breast-fed for about 15 min and thereafter an equal volume of hind milk from the same breast was collected. After mixing thoroughly, the samples were kept frozen at −20°C until analyzed. Breastmilk samples were thawed and mixed thoroughly before analysis. Milk was digested in full-bodied nitric acid and iron was estimated by atomic absorption spectrometry (Clegg et al., 1981). For lactoferrin estimation, milk fat was removed by centrifugation at 15 000 × k for xxx min and lactoferrin levels were measured by enzyme-linked immunoassay (ELISA) method in skimmed milk by a kit supplied by Calbiochem (Catalog number 427275).
Statistical analysis
Information technology was carried out using SPSS Software Packet (version ten.0). Comparison of medians was done by Isle of man–Whitney test. Comparing of means was carried out by repeated measure out ANOVA with Tukey'due south test. Correlation of fe parameters with breastmilk iron and lactoferrin was performed past elementary regression analysis.
Results
The mean historic period, parity, postpartum weight and elevation of nonanemic mothers were 24.64±2.63 years, 1.68±0.38, 43.81±4.41 kg and 146.89±6.49 cm, while the hateful historic period, parity, postpartum weight and acme of anemic mothers were 23.38±two.82 years, ii.02±0.44, 44.41±3.95 kg and 146.xl±vi.fourscore cm, respectively, and both the groups were comparable. At 14 weeks, 68 nonanemic mothers and 61 anemic mothers could exist followed. 50-two nonanemic mothers and 50 anemic mothers and their babies could complete the half dozen-calendar month follow-up.
At commitment, in that location was a meaning departure betwixt nonanemic and anemic mothers in the median and inter-quartile ranges for atomic number 26 parameters as analyzed by Mann–Whitney examination. Significant increase in Hb and serum ferritin was observed at half dozen months in both nonanemic and anemic mothers. Besides, at half dozen months after delivery, Group A (nonanemic) mothers had a significantly college Hb and serum ferritin than Group B (anemic) mothers (Tabular array 1).
Breastmilk iron decreased progressively from day i to fourteen weeks and fourteen weeks to half dozen months in both the groups, and the difference was statistically pregnant (P<0.001). Also, a pregnant decline was noted in breastmilk lactoferrin concentration from day i afterwards delivery to 14 weeks in both nonanemic and anemic mothers (P<0.001). However, no significant difference was noted in breastmilk iron and lactoferrin concentration betwixt nonanemic and anemic mothers at mean solar day 1, 14 weeks and half-dozen months afterwards delivery (P>0.05) (Figures 1 and 2).
Mean breastmilk iron concentration (mg/50) on mean solar day ane, 14 weeks and 6 months in nonanemic (Group A) and anemic mothers (Group B).
Mean breastmilk lactoferrin concentration (mg/ml) on 24-hour interval 1, xiv weeks and 6 months in nonanemic (Group A) and anemic mothers (Group B).
On day 1 later on delivery, meaning correlation was observed between Hb and breastmilk atomic number 26 in Group A (nonanemic mothers). No such correlation was observed in Grouping B (anemic). Withal, there was no correlation betwixt breastmilk atomic number 26 and the maternal atomic number 26 status in both nonanemic and anemic mothers. At six months, female parent's Hb, SI, TIBC, %TS and S. ferritin showed no significant correlation with breastmilk iron (Table 2).
No meaning correlation was observed betwixt the parity of nonanemic and anemic mothers with their breastmilk iron and lactoferrin concentration at mean solar day 1, fourteen weeks and 6 months later delivery (P>0.05) (Table 3).
Give-and-take
The concentrations of diverse trace elements present in breastmilk vary with nature of element and the period of lactation (Hurley and Lonnerdal, 1988). The concentration of a trace chemical element may also vary during a unmarried feeding (fore and hind milk) and from 1 individual to some other (Hurley and Lonnerdal, 1988). Differences in concentration of fore and hind milk have been documented for iron and selenium only not for other trace elements (Smith et al., 1982; Krebs et al., 1985).
A wide range of values for iron in the breastmilk (0.1–ane.six mg/l) have been reported in the literature at all stages of lactation (Khurana et al., 1970; Picciano and Guthrie, 1976; Murray et al., 1978; Simes et al., 1979; Celada et al., 1982; Feeley et al., 1983; Fransson et al., 1985; Zavaleta et al., 1995; Curran and Barness, 2004). Curran and Barness (2004) quoted a mean value of 1.0 mg/fifty for the atomic number 26 content of colostrum and iron concentration ranging 0.xx–0.80 mg/l for the mature breastmilk (15 days–15 months postpartum). The values reported in different studies may be due in part to differences in sampling procedures as well as stage of lactation. Iron content of human milk is highest in early transitional milk (0.97 mg/l) (Lauber and Reinhardt, 1979) but subtract steadily during lactation, reaching a level of approximately 0.35 mg/l at 1 calendar month of lactation to 0.20 mg/l at six months (Lemons et al., 1982; Lonnerdal, 1984). The diurnal variation in fe content of breastmilk tend to parallel those reported for fat content with significantly lower hateful values in the early morning feeding compared to tardily evening feeding (Hall, 1979; Fransson and Lonnerdal, 1980). No significant correlations were found between maternal historic period, parity or previous history of lactation and the fe content of milk at each phase of lactation (Celada et al., 1982).
Loh and Sinnathuray (1971) observed that while atomic number 26 content of breastmilk of Chinese, Indian and Malayan women varied with their indigenous origins, it appeared to be independent of maternal levels of Hb, SI and TIBC within the limits of their study. In a study of Indian women, Khurana et al. (1970) could find no relationship betwixt iron content of the breastmilk and their diet or socioeconomic status. Murray et al. (1978) in a written report on Nigerian mothers who fed their babies with breastmilk exclusively upwardly to half dozen months of historic period found no relationship betwixt atomic number 26 content of breastmilk and the iron status of the mothers.
In a written report by Zavaleta et al. (1995), the atomic number 26 concentrations in the colostrum were 0.8 and 0.ix mg/l in nonanemic and bloodless women, respectively, and by twenty-four hours 30 of lactation, the iron level had decreased significantly to values of 0.35 and 0.38 mg/l. Celada et al. (1982) establish no correlation between maternal Hb and breastmilk iron concentration. Another study performed on anemic women in India showed some correlation between maternal iron status and milk iron (Fransson et al., 1985). But milk atomic number 26 levels were only assessed during early on lactation, during which time milk iron concentration is known to vary considerably.
In our study, the mean breastmilk iron of nonanemic (0.89 mg/50) and bloodless mothers (0.86 mg/l) on 24-hour interval 1 after commitment was similar as reported past other workers. The breast milk iron concentration decreased significantly at xiv weeks and 6 months. Simply the concentration of iron in breastmik at 14 weeks and 6 months were in concordance with other studies (Picciano and Guthrie, 1976; Murray et al., 1978; Simes et al., 1979; Feeley et al., 1983; Zavaleta et al., 1995). Taken together, these results suggest that breastmilk iron concentration is highly regulated and determined past factors other than Hb level, circulating iron (serum iron) and iron stores (serum ferritin) (Fransson et al., 1985; Sigman and Lonnerdal, 1990a, 1990b). Also, breastmilk iron concentration had no relationship with mother'southward Hb, SI and South. ferritin at birth and vi months in both the groups. Although Hb level of the nonanemic mothers significantly correlated with breastmilk iron at birth, no relationship was observed at 6 months.
Little is known about the factors that influence milk lactoferrin levels, although it is known that concentration decreases during lactation (Lonnerdal et al., 1976). Zavaleta et al. (1995) plant the concentration of lactoferrin on mean solar day 2 in nonanemic and anemic mothers to exist vi.75 mg/ml (4.one–7.6) and 5.34 mg/ml (iii.6–xviii.2), respectively. Lactoferrin levels had decreased by twenty-four hours 30 to 3.67 mg/ml (3.i–6.ane) and 4.34 mg/ml (ii.ane–five.six), respectively. Our observations regarding breastmilk lactoferrin concentration of nonanemic and anemic mothers on day 1 afterwards delivery were in concordance with this report. In a study by Fransson et al. (1985), lactoferrin levels were found to be high in severely anemic women; all the same, the number of subjects was very low. Houghton et al. (1985) studied lactoferrin levels in Aborigine women in Australia and establish lower levels in milk from women with poor nutritional status than in milk for well-nourished women.
In the present study, at that place was a significant decline in breastmilk lactoferrin concentration from nascence to 14 weeks in both the groups. However, no such decline was observed from xiv weeks to 6 months in both the groups. Also, no pregnant difference was observed in breastmilk lactoferrin concentration at birth, fourteen weeks and 6 months between the nonanemic and anemic mothers. Parity of mothers in both the groups had no pregnant correlation with breastmilk lactoferrin concentration.
Milk protein synthesis is under multiple hormonal controls. Prolactin, corticosterone and insulin are known to touch gene expression of several milk proteins (Vanderhaar and Ziska, 1989). While atomic number 26 status is known to affect transferrin synthesis, it is not known whether iron status has any result on lactoferrin synthesis. However, if iron entry into the mammary gland is closely regulated, cellular atomic number 26 levels may be like in both iron deficiency and during adequate iron condition, and an effect would non exist expected.
The factors regulating concentration of iron and iron binding proteins in milk are incompletely understood. It has recently been suggested that the number of transferrin receptors in the mammary gland volition be up- or downregulated during iron deficiency or sufficiency and that this is a mechanism for homeostatic control of milk iron (Sigman and Lonnerdal, 1990a). Support for this hypothesis has been obtained in lactating rats with dissimilar iron status; mammary gland transferrin receptors were inversely correlated to iron condition (Sigman and Lonnerdal, 1990b). Thus, an anemic adult female would exist expected to have a high number of transferrin receptors in her mammary glands, thereby more efficiently 'extracting' the low levels of SI. On the other hand, the iron replete adult female would have a lower number of receptors in her gland, which easily accrue iron from relatively iron-saturated transferrin in her serum. In determination, it appears that iron and lactoferrin levels in milk are similar in anemic and nonanemic lactating women at all times.
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Guarantor: MMAF stands as guarantor and accountable for all parts of the completed manuscript, before and after publication.
Contributors: Shashiraj was the main investigator and wrote the manuscript. MMAF designed the report, was the principal supervisor and contributed to the manuscript. OS analysed the breastmilk results and contributed to the manuscript. UR analyzed the hematology results and contributed to the manuscript.
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Shashiraj, Faridi, 1000., Singh, O. et al. Female parent's iron status, breastmilk iron and lactoferrin – are they related?. Eur J Clin Nutr sixty, 903–908 (2006). https://doi.org/10.1038/sj.ejcn.1602398
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DOI : https://doi.org/10.1038/sj.ejcn.1602398
Keywords
- exclusive breastfeeding
- breastmilk iron
- lactoferrin
- hemoglobin
- iron condition
Further reading
If a Woman Is Anemic Can Her Baby Become Iron Deficient if Breastfeeding
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