Maternal anemia and offspring failure to thrive – results from a large population-based cohort

Abstract

Objective

To evaluate whether an association exists between maternal anemia and offspring failure to thrive (FTT) during childhood.

Methods

A population-based cohort analysis was performed, comparing the risk for FTT among children (up to 18 years old) based on maternal hemoglobin (Hb) levels, upon postpartum discharge. Maternal Hb levels were categorized into 3 levels: <9.0 (moderate–severe anemia), 9.0–11.0 (mild anemia), and ≥11.0 g/dL (no anemia). FTT diagnosis was based on hospital records. All singletons born between 1991 and 2014 and discharged alive without congenital malformations were included. A survival curve was constructed to compare the cumulative FTT incidence, and a Weibull parametric survival analysis to assess the independent association between maternal anemia and offspring FTT while controlling for confounders.

Results

Of the 214,305 included deliveries, 22,071 parturients (10.3%) were discharged with Hb <9.00; 83,932 (39.2%) with Hb between 9.0–11.0; and 108,302 (50.5%) with Hb ≥11.0 g/dL. FTT rates were 1.3% (n = 287), 1.2% (n = 967), and 1.1% (n = 1141) in the same groups, respectively (p = .003). The survival curve demonstrated a significantly higher cumulative incidence of FTT diagnosis in the moderate–severe maternal anemia group (p < .001). In the Weibull analysis, constructed for newborns with appropriate birthweight, both groups of maternal anemia were found to be independently associated with FTT related hospitalizations (mild anemia aHR, 1.1; 95%CI 1.002–1.219; p = .045, moderate-severe anemia aHR, 1.321; 95%CI, 1.141–1.529; p < .001).

Conclusion

Maternal anemia is independently associated with long-term FTT in offspring, with increasing FTT rates proportional to anemia severity.

Keywords:

• Developmental implications
• failure to thrive
• long-term consequences
• low hemoglobin levels
• perinatal outcome

Ethics approval

The study protocol was approved by the SUMC institutional review board and informed consent was exempt (SUMC IRB Committee #0220-17-SOR).

Disclosure statement

Omer Kaplan wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.