Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
Department of Pediatrics, Division of Neonatology, University of Rochester School of Medicine, Rochester, NY, USA.
J Nutr. 2021 Jul 1;151(7):1824-1833. doi: 10.1093/jn/nxab093.
Maintaining adequate iron status during pregnancy is important for the mother and her developing fetus. Iron homeostasis is influenced by 3 regulatory hormones: erythropoietin (EPO), hepcidin, and erythroferrone (ERFE). To date, normative data on ERFE across pregnancy and its relations to other hormones and iron status indicators are limited.
The objective of this study was to characterize maternal ERFE across pregnancy and at delivery and evaluate the utility of hepcidin, ERFE, and EPO in identifying women with increased iron needs.
ERFE was measured in extant serum samples collected from 2 longitudinal cohorts composed of women carrying multiple fetuses (n = 79) and pregnant adolescents (n = 218) at midgestation (∼26 wk) and delivery (∼39 wk). Receiver operating characteristic curves were generated to characterize the predictive ability of serum ERFE, hepcidin, and EPO and their ratios to identify women at increased risk of iron deficiency and anemia.
In these pregnant women, mean ERFE was 0.48 ng/mL at both ∼25 wk of gestation and at delivery. ERFE was positively associated with EPO at midgestation (β = 0.14, P = 0.002, n = 202) and delivery (β = 0.12, P < 0.001, n = 225) but was not significantly associated with maternal hepcidin at any time point surveyed. Of all hormones measured at midgestation and delivery, EPO was best able to identify women with anemia (AUC: 0.86 and 0.75, respectively) and depleted iron stores (AUC: 0.77 and 0.84), whereas the hepcidin-to-EPO ratio was best able to identify women with iron deficiency anemia (AUC: 0.85 and 0.84).
Maternal ERFE was significantly associated with EPO but was not able to identify women with gestational iron deficiency. At term, the hepcidin-to-EPO ratio, an index that accounts for both iron status and erythropoietic demand, and EPO were the strongest indicators of maternal iron deficiency and anemia. This trial was registered at clinicaltrials.gov as NCT04517734 (https://clinicaltrials.gov/ct2/show/NCT04517734).
在妊娠期间维持足够的铁状态对母亲及其发育中的胎儿都很重要。铁稳态受 3 种调节激素的影响：促红细胞生成素（EPO）、铁调素和红细胞生成素（ERFE）。迄今为止，关于妊娠期间 ERFE 的正常值及其与其他激素和铁状态指标的关系的数据有限。
本研究的目的是描述妊娠期间 ERFE 的变化，并在分娩时评估其特征，同时评估铁调素、ERFE 和 EPO 在识别铁需求增加的女性中的作用。
从由多胎妊娠妇女（n=79）和青少年孕妇（n=218）组成的 2 个纵向队列的现有血清样本中测量 ERFE，这些样本分别在妊娠中期（约 26 周）和分娩时（约 39 周）采集。生成受试者工作特征曲线，以描述血清 ERFE、铁调素和 EPO 及其比值识别缺铁和贫血风险增加的女性的预测能力。
在这些孕妇中，ERFE 在妊娠中期（约 25 周）和分娩时的平均值均为 0.48ng/ml。ERFE 与妊娠中期（β=0.14，P=0.002，n=202）和分娩时（β=0.12，P<0.001，n=225）的 EPO 呈正相关，但与任何时间点的母体铁调素均无显著相关性。在妊娠中期和分娩时测量的所有激素中，EPO 对贫血（AUC：0.86 和 0.75）和铁储量减少（AUC：0.77 和 0.84）的识别能力最强，而铁调素与 EPO 的比值对铁缺乏性贫血的识别能力最强（AUC：0.85 和 0.84）。
母体 ERFE 与 EPO 显著相关，但不能识别妊娠缺铁的女性。在妊娠末期，铁调素与 EPO 的比值（一种同时考虑铁状态和红细胞生成需求的指标）和 EPO 是母亲缺铁和贫血的最强指标。该试验在 clinicaltrials.gov 注册为 NCT04517734（https://clinicaltrials.gov/ct2/show/NCT04517734）。
