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Maternal Serum Ferritin and Fetal Growth

From the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama.

Address reprint requests to: Jinrong Hou, MD Department of Obstetrics and Gynecology University of Alabama at Birmingham Civitan International Research Center Building 1719 Sixth Avenue South, Room 329 Birmingham, AL 35294 E-mail: jhou{at}civmail.circ.uab.edu

Objective: To determine the relationship between maternal serum ferritin and concentrations and specific types of fetal growth restriction (FGR).

Methods: Serum ferritin concentrations were measured at approximately 25 and 36 weeks’ gestation in 480 multiparas with singleton fetuses who participated in a study of risk factors for repeated FGR. Asymmetric FGR was defined by low birth weight for gestational age criteria and a ponderal index less than 2.32, and symmetric FGR was defined by the same birth weight for gestational age criteria and a ponderal index of at least 2.32.

Results: Among 480 infants, 370 were appropriate for gestational age (AGA), 58 had asymmetric FGR, and 52 had symmetric FGR. Higher ferritin concentrations were associated with black race, maternal age 25 years or older, and smoking. Mothers of asymmetric-FGR infants had higher mean ferritin levels than mothers of AGA infants at 25 weeks’ (38.0 versus 20.2 µg/L, P < .01) and 36 weeks’ gestation (21.0 versus 13.3 µg/L, P < .01), whereas mothers of symmetric-FGR infants had significantly lower ferritin levels at 36 weeks (8.3 µg/L). For mothers with serum ferritin levels of at least 26 µg/L (highest quartile at 25 weeks), the adjusted odds ratio (OR) for asymmetric-FGR infants was 3.4, 95% confidence interval (CI) 1.6, 7.2. There was a similar association between the highest quartile of serum ferritin at 36 weeks (at least 20 µg/L) and asymmetric FGR (adjusted OR 2.7, 95% CI 1.3, 5.8). Women with serum ferritin levels less than 3 µg/L (lowest quartile at 36 weeks) had an adjusted OR for symmetric-FGR infants of 2.2, 95% CI 1.01, 4.6.

Conclusion: High maternal serum ferritin levels are associated with asymmetric FGR, whereas low serum ferritin levels are associated with symmetric FGR.