THE EFFECT OF MATERNAL ANEMIA AND IRON DEFICIENCY ON FETAL ERYTHROPOIESIS: COMPARISON BETWEEN SERUM ERYTHROPOIETIN, HEMOGLOBIN AND FERRITIN LEVELS IN MOTHERS AND NEWBORNS
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Keywords
Maternal anemia; Iron deficiency; Fetal erythropoiesis; Erythropoietin; Ferritin; Cord blood; Hemoglobin; Pregnancy outcome.
Abstract
Background: Maternal anemia and iron deficiency during pregnancy remain major health concerns in developing countries and are closely linked to adverse perinatal outcomes. Iron plays an essential role in oxygen transport and erythropoiesis, and its deficiency in pregnancy affects both maternal and fetal hematologic balance. This study was conducted to evaluate the relationship between maternal anemia, iron status, and fetal erythropoietic activity through the comparison of serum erythropoietin, hemoglobin, and ferritin levels in mothers and their newborns.
Methods: A prospective, cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Pak International Medical College and its affiliated hospitals, from January 2024 to January 2025. A total of 72 mother–newborn pairs were enrolled at term gestation. Maternal venous blood samples were obtained within 24 hours before delivery, and cord blood was collected immediately after birth. Hemoglobin, ferritin, and erythropoietin concentrations were measured using standard automated and immunoassay methods. Statistical analysis was performed using SPSS version 26.0, with p < 0.05 considered significant.
Results: Anemic mothers had significantly lower mean hemoglobin and ferritin levels (9.4 ± 0.8 g/dL and 18.6 ± 7.3 ng/mL, respectively) compared with non-anemic mothers (12.1 ± 0.6 g/dL and 41.2 ± 10.4 ng/mL, p < 0.001). Maternal serum erythropoietin levels were markedly elevated in anemic women (55.2 ± 14.6 mIU/mL vs. 32.4 ± 8.2 mIU/mL, p < 0.001). Neonates born to iron-deficient mothers showed significantly lower cord hemoglobin and ferritin but higher erythropoietin concentrations, indicating a compensatory fetal response. A positive correlation was found between maternal and cord hemoglobin (r = 0.46, p < 0.001) and ferritin (r = 0.39, p = 0.002), while maternal ferritin correlated negatively with cord erythropoietin (r = –0.51, p < 0.001).
Conclusion: Maternal anemia and iron deficiency significantly influence fetal erythropoiesis. Reduced maternal iron stores lead to higher maternal and fetal erythropoietin production but are insufficient to prevent diminished neonatal iron reserves and hemoglobin levels. Early detection and correction of anemia in pregnancy are essential to support optimal fetal hematologic development and reduce neonatal morbidity.
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Anjum Mahmood
Associate Professor, Department of Obstetrics and Gynaecology, Pak International Medical College, Peshawar, Pakistan
Azra Parveen
Department of Obstetrics and Gynaecology, Health Department, Government of Sindh, Maternal and Child Health Center (MCH) Nazimabad District, Central Karachi, Pakistan
Amena Arif
Assistant Professor, Department of Biochemistry, Federal Medical College, Islamabad, Pakistan
Aneela Shabbir
Assistant Professor, Department of Biochemistry, Foundation University Islamabad, Pakistan
Sabeen Khalid
Assistant Professor, Department of Biochemistry, CMH Kharian Medical College,
Kharian, Pakistan
Azhar Ijaz
Associate Professor, Department of Physiology, Loralai Medical College, Loralai,
Balochistan, Pakistan