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Park: Maternal Anemia and Vitamin D deficiency: associations with neonatal hemoglobin levels and the vitamin D status
Original Article

Perinatology 2017;28(1):4-10.

Published online: 19 March 2017

DOI: https://doi.org/10.14734/PN.2017.28.1.04

Maternal Anemia and Vitamin D deficiency: associations with neonatal hemoglobin levels and the vitamin D status

Sook-Hyun Park, MD, PhD

Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to Sook-Hyun Park, MD, PhD Department of Pediatrics, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: + 82-53-200-5704 Fax: + 82-53-425-6683 E-mail: park_sh@knu.ac.kr

Received 19 October 201630 December 2016       Accepted 1 January 2017

Copyright © 2017 The Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate maternal anemia and vitamin D deficiency and their associations with the neonatal hemoglobin (Hb) levels and the vitamin D status.

Methods

This retrospective study enrolled a total of 120 newborns delivered at Kyungpook National University Children's Hospital between June 2015 and June 2016. Maternal anemia was defined as an Hb level<11 g/dL and vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25-OHD) concentration<20 ng/mL.

Results

The mean neonatal and maternal serum 25-OHD concentrations were 20.1±12.5 ng/ mL, and 16.9±7.3 ng/mL, respectively. Sixty-eight (56.7%) of the infants and 85 (70.8%) of the mothers were vitamin D deficient. The mean maternal hemoglobin levels were 11.7±1.6 g/dL, and 38 (31.7%) of the mothers had anemia. Thirty-four (89.5%) of mothers with anemia were vitamin D deficient. After adjusting for the confounding factors, maternal vitamin D deficiency increased the risk of maternal anemia by 4.061 times (95% confidence interval [CI], 1.238–13.320; P=0.021), and neonatal vitamin D deficiency by 8.283 times (95% CI, 2.861-23.980; P<0.001) compared with maternal vitamin D non-deficiency group. One-year older maternal age decreased the risk of neonatal vitamin D deficiency (odds ratio, 0.913; 95% CI, 0.841–0.991; P=0.029).

Conclusion

Maternal vitamin D deficiency increased the risk of maternal anemia and neonatal vitamin D deficiency regardless of maternal ferritin concentrations under non-inflammatory condition. A younger maternal age may be a risk factor for neonatal vitamin D deficiency associated with maternal anemia, and maternal vitamin D deficiency.

Keywords: Anemia, Vitamin D deficiency, 25-hydroxyvitamin D

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Table 1.
Baseline Characteristics of the Participants
Parameter  
Neonatal characteristics  
Male 64 (53.3)
Gestational age (wks) 33.6±3.1
Birth weight (g) 2,105±632
Height (cm) 43.9±4.8
Head circumference (cm) 30.4±2.6
Small for gestational age 2 (1.7)
Ceserean section 83 (69.2)
Laboratory findings  
Hemoglobin (g/dL) 15.6±1.8
Iron (μg/dL) 122.0±55.4
TIBC (μg/dL) 195.1±57.1
Transferrin saturation (%) 64.6±26.8
Ferritin (mg/dL) 135.0±102.4
Calcium (mg/dL) 9.8±0.7
Phosphorous (mg/dL) 5.5±0.7
Alkaline phosphatase (U/L) 180.6±50.9
25-OHD (ng/mL) 20.1±12.5
VDD 68 (56.7)
Maternal characteritis  
Age (years) 32±5
Diabetes 14 (11.7)
PIH or preeclampsia 7 (5.8)
Hemoglobin (g/dL) 11.7±1.6
BUN (mg/dL) 7.3±3.1
Creatinine (mg/dL) 0.60±0.12
Ferritin (mg/dL) 27.6±17.9
25-OHD (ng/mL) 16.9±7.3

The values in table are mean±SD or number (%). Abbreviation: TIBC, total iron binding capacity; 25-OHD, 25-hydroxyvitamin D;; VDD, vitamin D deficiency; PIH, pregnancy-induced hypertension; BUN, blood urea nitrogen.

Table 2.
Comparison of Clinical and Laboratory Characteristics Associations with Maternal Anemia and Vitamin D Deficiency
Parameters Maternal Laboratory Findings
Hb<11 (g/dL) Hb≥11 (g/dL) P-value 25-OHD<20 (ng/mL) 25-OHD ≥20 (ng/mL) P-value
Number 38 (31.7) 82 (68.3)   85 (70.8) 35 (29.2)  
Season     0.159     0.526
Spring 6 (15.8) 22 (26.8)   20 (23.5) 8 (22.9)  
Summer 14 (36.8) 33 (40.2)   30 (35.3) 17 (48.6)  
Fall 12 (31.6) 12 (14.6)   18 (21.2) 6 (17.1)  
Winter 6 (15.8) 15 (18.4)   17 (20.0) 4 (11.4)  
Neonatal characteristics            
Male 22 (57.9) 42 (51.2) 0.558 40 (47.1) 24 (68.6) 0.044
Gestational age (wks) 33.2±3.2 33.6±3.0 0.428 33.4±3.2 33.6±2.6 0.567
Birth weight (g) 2112±692 2102±607 0.941 2097±615 2125±682 0.836
Height (cm) 44.0±4.8 43.8±5.0 0.834 43.9±5.3 43.9±5.5 0.954
Head circumference (cm) 30.5±2.5 30.3±2.8 0.701 30.6±2.5 30.1±2.8 0.416
Hb (g/dL) 15.7±1.9 15.3±1.6 0.390 15.3±1.7 16.1±2.0 0.072
Iron (μg/dL) 121.6±58.7 122.9±48.4 0.909 122.8±53.6 120.3±60.5 0.836
TIBC (μg/dL) 178.0±45.6 203.1±60.4 0.025 193.2±61.6 199.5±44.8 0.538
Transferrin saturation (%) 70.0±24.4 62.0±27.7 0.134 66.1±26.0 61.0±28.9 0.373
Ferritin (mg/dL) 150.5±92.5 127.9±106.4 0.261 141.8±108.7 118.6±84.4 0.214
Calcium (mg/dL) 9.7±0.7 9.8±0.7 0.247 9.8±0.7 9.7±0.7 0.922
Phosphorous (mg/dL) 5.5±0.7 5.4±0.7 0.646 5.4±0.7 5.6±0.8 0.239
Alkaline phosphatase (U/L) 189.7±57.1 176.4±47.5 0.183 185.7±53.9 168.2±40.9 0.087
25-OHD (ng/mL) 13.4±11.0 23.2±11.9 <0.001 15.5±7.4 31.3±15.1 <0.001
VDD 33 (86.8) 35 (42.7) <0.001 61 (71.8) 7 (20.0) <0.001
Maternal characteristics            
Age (yrs) 31±5 33±4 0.002 31±5 34±4 0.001
Diabetes 2 (5.3) 12 (14.6) 0.221 12 (14.1) 2 (5.7) 0.230
PIH or preeclampsia 4 (10.5) 3 (3.7) 0.206 7 (8.2) 0 (0.0) 0.105
Ceserean section 25 (65.8) 58 (70.7) 0.672 57 (67.1) 26 (74.3) 0.518
Hb (g/dL) 9.9±1.2 12.5±0.9 <0.001 11.4±1.6 12.4±1.1 <0.001
Ferritin (mg/dL) 25.7±20.3 28.4±16.7 0.445 27.3±19.5 28.1±13.3 0.787
25-OHD (ng/mL) 13.0±5.4 18.8±7.4 <0.001 13.1±3.7 26.3±5.0 <0.001
Anemia - - - 34 (40.0) 4 (11.4) 0.002
VDD 34 (89.5) 51 (62.2) 0.002 - - -

The values in table are mean±SD or number (%). Abbreviation: Hb, hemoglobin; 25-OHD, 25-hydroxyvitamin D; VDD, vitamin D deficiency; PIH, pregnancy-induced hypertension; BUN, blood urea nitrogen; TIBC, total iron binding capacity.

Table 3.
Multiple Regression Analysis of the Factors Associated with Neonatal Hemoglobin Levels and 25-Hydroxyvitamin D Concentrations
Parameters Neonatal Hb (g/dL) Neonatal 25-OHD (ng/mL)
β P-value β P-value
Neonatal factors        
Gestational age (wks) 0.207 0.053 0.053 0.921
Birth weight (g) 0.000 0.998 -0.005 0.074
Hb (g/dL) - - 0.114 0.810
Ferritin (mg/dL) -0.006 0.001 0.016 0.068
25-OHD (ng/mL) 0.005 0.810 - -
Maternal factors        
Age (yrs) -0.029 0.401 0.002 0.990
Hb (g/dL) -0.046 0.710 2.154 <0.001
Ferritin (mg/dL) -0.009 0.357 -0.074 0.110
25-OHD (ng/mL) 0.038 0.213 1.058 <0.001

Abbreviations: 25-OHD, 25-hydroxyvitamin D; Hb, hemoglobin; TIBC, total iron binding capacity.

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