Abstract
Background/objectives
Poorer motor development is reported in infants with iron deficiency (ID). The role of timing, duration and severity is unclear. We assessed relations between ID timing, duration, and severity and gross motor scores, neurological integrity, and motor behavior quality at 9 months.
Subjects/methods
Iron status was determined at birth and 9 months in otherwise healthy term Chinese infants. The 9-month motor evaluation included the Peabody Developmental Motor Scale (PDMS-2), Infant Neurological International Battery (INFANIB), and motor quality factor. Motor outcomes were analyzed by ID timing (fetal–neonatal, infancy), duration, and severity. For severity, we also considered maternal iron status.
Results
The data were available for 1194 infants. Iron status was classified as fetal–neonatal and infancy ID (n = 253), fetal–neonatal ID (n = 256), infancy ID (n = 288), and not ID (n = 397). Compared with not ID, infants with fetal–neonatal or infancy ID had lower locomotion scores (effect size ds = 0.19, 0.18) and those with ID in both periods (longer duration) had lower locomotion and overall PDMS-2 gross motor scores (ds = 0.20, 0.18); ID groups did not differ. More severe ID in late pregnancy was associated with lower INFANIB Vestibular function (p = 0.01), and total score (p = 0.03). More severe ID in infancy was associated with lower scores for locomotion (p = 0.03), overall gross motor (p = 0.05).
Conclusions
Fetal–neonatal and/or infancy ID was associated with lower overall gross motor development and locomotion test scores at 9 months. Associations with ID severity varied by ID timing: more severe ID in late pregnancy, poorer neurological integrity; more severe ID in infancy, poorer gross motor development.
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Acknowledgements
This work was funded by a grant from the US National Institutes of Health (R01 HD052069), which included funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Office of Dietary Supplements, provided support for the infancy study and laboratory measures of iron status for mothers and infants, Betsy Lozoff, Principal Investigator. Vifor Pharma, Ltd. provided financial support for the pregnancy study. São Paulo Research Foundation – FAPESP/Brazil (2014/00018-0) and Methodist University of Piracicaba – UNIMEP/Brazil provided financial support for Denise CC Santos. The content is solely the responsibility of the authors and does not necessarily represent the official views of funding sources. Authors had full control of primary data and did not have an agreement with the funders that limited their ability to complete the research as planned.
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Betsy Lozoff was an unpaid speaker at 2 seminars supported by Lee’s Pharmaceutical Holdings Limited. The topic was iron deficiency and child development (Shanghai, 11 April 2010, and Beijing, 15 May 2011). The company covered hotel accommodations and, for the 2011 seminar, internal airfare between Hangzhou and Beijing. The authors declare that they have no other competing interests.
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Denise C. C. Santos, Rosa M. Angulo-Barroso and Ming Li contributed equally to this work.
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Santos, D.C.C., Angulo-Barroso, R.M., Li, M. et al. Timing, duration, and severity of iron deficiency in early development and motor outcomes at 9 months. Eur J Clin Nutr 72, 332–341 (2018). https://doi.org/10.1038/s41430-017-0015-8
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DOI: https://doi.org/10.1038/s41430-017-0015-8
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