AMERICAN JOURNAL OF HUMAN BIOLOGY 26:421–423 (2014)
Short Report
Lower Hemoglobin Levels in First Time Mothers from Cebu, Philippines JESSICA YOON,1 RUBABIN TOOBA,1 JUDITH BORJA,2 FE LARGADO,2 AND E.A. QUINN1* 1 Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri 63130 2 Office of Population Studies, University of San Carlos, Cebu, Philippines
ABSTRACT: Objectives: The association between parity and hemoglobin status in mothers is unclear. Closely spaced pregnancies may predict decreased hemoglobin in women, as these shorter intervals may limit the time available for iron repletion, or maternal age may be associated with general declines in hemoglobin. This study investigated the association between parity and hemoglobin status in a 1-year birth cohort of mothers from Cebu, Philippines, with variable parities. It was hypothesized that maternal parity would be inversely associated with hemoglobin status and that among multiparous mothers, interbirth interval, and prior breastfeeding duration would be positively associated with hemoglobin level. Methods: The study design was cross-section with participants (n 5 125) recruited from the Cebu Longitudinal Health and Nutrition Survey; all mothers were 24–25 years of age at the time of the study and currently breastfeeding infants less than 3 years of age. Hemoglobin was measured using B-Hemocue Analyzer. Detailed dietary information, health recalls, anthropometrics, and reproductive histories were available on all mothers. Results: Maternal parity ranged from 1 to 6 with an average of 2.2 (1.0) births. In this cross section of parity among similarly aged women, hemoglobin levels were significantly lower for primiparous (12.1 6 1.8) compared to multiparous mothers (13.2 6 1.5; P 5 0.03), despite similar antianemic usage during gestation. There was no significant association between prior interbirth interval, prior, or current breastfeeding duration and hemoglobin in multiparas. Conclusions: Low hemoglobin levels of primiparous women in this sample might indicate increased nutritional C 2014 Wiley Periodicals, Inc. V stress associated with first pregnancy. Am. J. Hum. Biol. 26:421–423, 2014.
Anemia is an important public health problem; the World Health Organization estimates that around the world, more than 25% of reproductive aged women are at risk (Benoist et al., 2008). The consequences of iron deficiency for both mothers and infants are well established (Benoist et al., 2008) and may differ by reproductive stage. For example, compared to reproductively cycling women, iron requirements are elevated during pregnancy but decreased during lactation (Milman, 2011; Piccano, 2003). The decrease in iron requirements is thought to reflect both the low levels of iron reported in human milk, 0.3–0.6 mg/100 ml (Dorea, 2001) and/or protective effects of lactational amenorrhea on maternal iron status, although both have been recently debated (Clancy et al., 2006; Picciano et al., 2003). There is also evidence that iron absorption is upregulated in lactating women (Picciano, 2003; Kalkwarf and Harrast, 1998), despite the lower iron requirements associated with lactation. One possibility is that during lactation, maternal iron stores may replete substantially (Dewey, 2004) although such repletion may not occur if dietary iron is limited (Miller, 2010). This may be especially important for women with closely spaced pregnancies and diets low in iron, who will have minimal time and resources to recover iron stores prior to the next pregnancy. Of specific difficulty in most studies is the ability to separate age and parity related changes in maternal hemoglobin levels, as age and parity are often collinear. Here, we specifically test the association between parity and hemoglobin during lactation in a one year birth cohort of women from Cebu, Philippines with variable parities (1–6 births). We hypothesized that women with higher parities and shorter birth intervals should have lower hemoglobin levels and be at greater risk of anemia than women with lower parities. C 2014 Wiley Periodicals, Inc. V
METHODS Mothers were drawn from the Cebu Longitudinal Health and Nutrition Survey (Cebu Study), a one-year birth cohort of more than 3000 individuals born from 1 May 1983 to 30 April 1984 in 33 communities in the metro area of Cebu City, Philippines. During 2007–2008, all 132 currently lactating female participants from the Cebu Study were recruited for a study of maternal physiology, health, and milk composition; all agreed to participate. Study design was approved by the Northwestern University Institutional Review Board and the Office of Population Studies at the University of San Carlos. Study participants were screened for total hemoglobin status (BHemoglobin analyzer, Hemocue), anemia was defined using the World Health Organization guidelines of
Short Report
Lower Hemoglobin Levels in First Time Mothers from Cebu, Philippines JESSICA YOON,1 RUBABIN TOOBA,1 JUDITH BORJA,2 FE LARGADO,2 AND E.A. QUINN1* 1 Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri 63130 2 Office of Population Studies, University of San Carlos, Cebu, Philippines
ABSTRACT: Objectives: The association between parity and hemoglobin status in mothers is unclear. Closely spaced pregnancies may predict decreased hemoglobin in women, as these shorter intervals may limit the time available for iron repletion, or maternal age may be associated with general declines in hemoglobin. This study investigated the association between parity and hemoglobin status in a 1-year birth cohort of mothers from Cebu, Philippines, with variable parities. It was hypothesized that maternal parity would be inversely associated with hemoglobin status and that among multiparous mothers, interbirth interval, and prior breastfeeding duration would be positively associated with hemoglobin level. Methods: The study design was cross-section with participants (n 5 125) recruited from the Cebu Longitudinal Health and Nutrition Survey; all mothers were 24–25 years of age at the time of the study and currently breastfeeding infants less than 3 years of age. Hemoglobin was measured using B-Hemocue Analyzer. Detailed dietary information, health recalls, anthropometrics, and reproductive histories were available on all mothers. Results: Maternal parity ranged from 1 to 6 with an average of 2.2 (1.0) births. In this cross section of parity among similarly aged women, hemoglobin levels were significantly lower for primiparous (12.1 6 1.8) compared to multiparous mothers (13.2 6 1.5; P 5 0.03), despite similar antianemic usage during gestation. There was no significant association between prior interbirth interval, prior, or current breastfeeding duration and hemoglobin in multiparas. Conclusions: Low hemoglobin levels of primiparous women in this sample might indicate increased nutritional C 2014 Wiley Periodicals, Inc. V stress associated with first pregnancy. Am. J. Hum. Biol. 26:421–423, 2014.
Anemia is an important public health problem; the World Health Organization estimates that around the world, more than 25% of reproductive aged women are at risk (Benoist et al., 2008). The consequences of iron deficiency for both mothers and infants are well established (Benoist et al., 2008) and may differ by reproductive stage. For example, compared to reproductively cycling women, iron requirements are elevated during pregnancy but decreased during lactation (Milman, 2011; Piccano, 2003). The decrease in iron requirements is thought to reflect both the low levels of iron reported in human milk, 0.3–0.6 mg/100 ml (Dorea, 2001) and/or protective effects of lactational amenorrhea on maternal iron status, although both have been recently debated (Clancy et al., 2006; Picciano et al., 2003). There is also evidence that iron absorption is upregulated in lactating women (Picciano, 2003; Kalkwarf and Harrast, 1998), despite the lower iron requirements associated with lactation. One possibility is that during lactation, maternal iron stores may replete substantially (Dewey, 2004) although such repletion may not occur if dietary iron is limited (Miller, 2010). This may be especially important for women with closely spaced pregnancies and diets low in iron, who will have minimal time and resources to recover iron stores prior to the next pregnancy. Of specific difficulty in most studies is the ability to separate age and parity related changes in maternal hemoglobin levels, as age and parity are often collinear. Here, we specifically test the association between parity and hemoglobin during lactation in a one year birth cohort of women from Cebu, Philippines with variable parities (1–6 births). We hypothesized that women with higher parities and shorter birth intervals should have lower hemoglobin levels and be at greater risk of anemia than women with lower parities. C 2014 Wiley Periodicals, Inc. V
METHODS Mothers were drawn from the Cebu Longitudinal Health and Nutrition Survey (Cebu Study), a one-year birth cohort of more than 3000 individuals born from 1 May 1983 to 30 April 1984 in 33 communities in the metro area of Cebu City, Philippines. During 2007–2008, all 132 currently lactating female participants from the Cebu Study were recruited for a study of maternal physiology, health, and milk composition; all agreed to participate. Study design was approved by the Northwestern University Institutional Review Board and the Office of Population Studies at the University of San Carlos. Study participants were screened for total hemoglobin status (BHemoglobin analyzer, Hemocue), anemia was defined using the World Health Organization guidelines of
