Association Between Serum Ferritin Concentration and Risk of Adverse Maternal and Fetal Pregnancy Outcomes: A Retrospective Cohort Study

Abstract

Objective

This study evaluated the associations of serum ferritin (SF) concentration during pregnancy with the risk of adverse maternal and fetal pregnancy outcomes.

Methods

We conducted a retrospective study of 2327 pregnant women from 2015 to 2020 in Guangdong, China. SF concentrations were measured at 16–18th and 28–32th week of gestation. Logistic regression models were applied to estimate the association between SF concentration and the risk of adverse pregnancy outcomes.

Results

After multivariable adjustment, the odds ratio (OR) of the highest quartile of SF concentration at 16–18th week of gestation was 1.43 (95% confidence interval [CI]: 1.09, 1.89) for gestational diabetes mellitus (GDM) and 1.79 (95% CI: 1.15, 2.79) for small for gestational age (SGA) when compared with the lowest quartile. At 28–32th week of gestation compared with the lowest quartile, women with SF in the highest quartile had an increased risk of SGA (OR: 1.62; 95% CI: 1.01, 2.62). Moreover, the lowest quartile of SF concentration decreased risk of SGA by 90% (95% CI: 0.01, 0.80) when compared with the highest quartile among pregnancy women with GDM.

Conclusion

Elevated SF concentrations increased the risk of GDM and SGA during pregnancy. Maintaining an appropriately low level of maternal SF at 28–32th week of gestation in women with GDM could reduce the risk of SGA.

Keywords:

• ferritin
• adverse pregnancy outcomes
• gestational diabetes mellitus
• small for gestational age

Highlights

1. The risk of SGA reduced with the appropriate decrease of SF concentrations at 28–32th weeks of gestation among pregnancy women with GDM;

2. More drastic changes in SF concentrations across the 16–18th and 28–32th weeks of gestation were attributed to a higher risk of developing SGA;

3. Higher mean SF concentration contributes to developing SGA;

4. The association between SF and adverse maternal and fetal pregnancy outcomes was studied in a relatively large sample.

Abbreviations

SF, Serum ferritin; GDM, Gestational diabetes mellitus; OR, Odds ratio; AOR, Adjusted odds ratio; CI, Confidence interval; SGA, Small for gestational age; IDA, Iron deficiency anaemia; BMI, Body mass index; LBW, Low birth weight; LGA, large for gestational age; ROS, Reactive oxygen species; IR, insulin resistance.

Data Sharing Statement

To protect the privacy of pregnant women, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

Participants written informed consent forms at the beginning of the study. The protocol for this study was approved by the Ethics Committee of the Union Shenzhen Hospital of Huazhong University of Science and Technology (No. 2019072644) and all methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki).

Acknowledgments

We thank the mothers and children who participated in this study and all the doctors and nurses in the Department of gynecology and obstetrics of Union Shenzhen Hospital of Huazhong University of Science and Technology for their effort and time to take part in this study.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [grant number 82103821], the Shenzhen Science and Technology Innovation Committee [grant number JCYJ20190809102203602; JCYJ20210324112400002] and the Guangdong Basic and Applied Basic Project [grant number 2019A1515110456].