Academic Unit of Obstetrics & Gynaecology, University of Manchester, Manchester, UK.
Nutr Rev. 2013 Aug;71(8):528-40. doi: 10.1111/nure.12049. Epub 2013 Jun 6.
Infection is a major cause of neonatal death in developing countries. This review investigates whether host iron status affects the risk of maternal and/or neonatal infection, potentially contributing to neonatal death, and summarizes the iron acquisition mechanisms described for pathogens causing stillbirth, preterm birth, and congenital infection. In vitro evidence shows that iron availability influences the severity and chronicity of infections that cause these negative outcomes of pregnancy. In vivo evidence is lacking, as relevant studies of maternal iron supplementation have not assessed the effect of iron status on the risk of maternal and/or neonatal infection. Reducing iron-deficiency anemia among women is beneficial and should improve the iron stores of babies; moreover, there is evidence that iron status in young children predicts the risk of malaria and, possibly, the risk of invasive bacterial diseases. Caution with maternal iron supplementation is indicated in iron-replete women who may be at high risk of exposure to infection, although distinguishing between iron-replete and iron-deficient women is currently difficult in developing countries, where a point-of-care test is needed. Further research is indicated to investigate the risk of infection relative to iron status in mothers and babies in order to avoid iron intervention strategies that may result in detrimental birth outcomes in some groups of women.
感染是发展中国家新生儿死亡的主要原因。本综述调查了宿主铁状态是否会影响产妇和/或新生儿感染的风险，从而可能导致新生儿死亡，并总结了导致死产、早产和先天性感染的病原体所描述的铁获取机制。体外证据表明，铁的可用性会影响导致这些妊娠不良结局的感染的严重程度和慢性程度。体内证据缺乏，因为有关孕产妇铁补充的相关研究并未评估铁状态对产妇和/或新生儿感染风险的影响。减少妇女缺铁性贫血是有益的，并且应该改善婴儿的铁储存；此外，有证据表明，幼儿的铁状态可预测疟疾的风险，并且可能可预测侵袭性细菌疾病的风险。在铁储备充足且可能面临高感染风险的妇女中，应谨慎使用孕产妇铁补充剂，尽管在发展中国家，目前难以区分铁储备充足和铁缺乏的妇女，因此需要一种即时检测方法。需要进一步研究以调查母亲和婴儿的铁状态与感染风险之间的关系，以避免在某些妇女群体中可能导致不良分娩结局的铁干预策略。
