Serum Hepcidin Concentrations Decline during Pregnancy and May Identify Iron Deficiency: Analysis of a Longitudinal Pregnancy Cohort in The Gambia.
Serum Hepcidin Concentrations Decline during Pregnancy and May Identify Iron Deficiency: Analysis of a Longitudinal Pregnancy Cohort in The Gambia.
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DOI：
10.3945/jn.116.245373
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Prentice AM
中科院分区：
文献类型：
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作者：
Bah A;Pasricha SR;Jallow MW;Sise EA;Wegmuller R;Armitage AE;Drakesmith H;Moore SE;Prentice AM
背景：胎儿贫血是导致母婴不良结局的一个危险因素，在撒哈拉以南非洲地区很普遍。不到一半的产前贫血被认为对铁有反应;确定需要铁的妇女可能有助于有针对性的干预措施。铁的吸收是由铁调节激素铁调素。目的：我们试图描述铁调素的变化及其与妊娠第14、20和30周时铁储备、红细胞生成和炎症指标的相关性，并评估铁调素作为铁缺乏指标的诊断潜力。研究方法：我们测量血红蛋白和血清铁调素，铁蛋白，可溶性转铁蛋白受体（sTfR），和C-反应蛋白（CRP）在14，20和30周的妊娠在一个队列的395冈比亚妇女招募到一个随机对照试验。通过线性回归测量与铁调素的相关性，并分析每个时间点铁调素对铁缺乏的诊断测试准确性[受试者操作特征曲线下面积（AUCROC）、灵敏度、特异性、临界值]。结果：贫血患病率从孕14周时的34.6%上升到孕20周时的50.0%。铁调素浓度下降之间的研究登记和20周，而铁蛋白下降之间的20和30周的妊娠。铁调素的变化解释了铁蛋白，sTfR，CRP下降，在怀孕期间。铁调素检测铁缺乏（定义为铁蛋白<15 μg/L）的AUCROC值在14、20和30周分别为0.86、0.83和0.84。铁调素作为铁缺乏的指标上级于血红蛋白和sTfR。结论：在冈比亚孕妇，铁调素似乎是一个有用的诊断测试缺铁，并可能使案件的铁将是有益的识别。孕中期铁调素抑制提示产前铁干预的最佳时机。血红蛋白不能有效识别妊娠期缺铁。本试验在www.isrctn.com上注册为ISRCTN 49285450。
Background: Antenatal anemia is a risk factor for adverse maternal and fetal outcomes and is prevalent in sub-Saharan Africa. Less than half of antenatal anemia is considered responsive to iron; identifying women in need of iron may help target interventions. Iron absorption is governed by the iron-regulatory hormone hepcidin. Objective: We sought to characterize changes in hepcidin and its associations with indexes of iron stores, erythropoiesis, and inflammation at weeks 14, 20, and 30 of gestation and to assess hepcidin’s diagnostic potential as an index of iron deficiency. Methods: We measured hemoglobin and serum hepcidin, ferritin, soluble transferrin receptor (sTfR), and C-reactive protein (CRP) at 14, 20, and 30 wk of gestation in a cohort of 395 Gambian women recruited to a randomized controlled trial. Associations with hepcidin were measured by using linear regression, and hepcidin’s diagnostic test accuracy [area under the receiver operating characteristic curve (AUCROC), sensitivity, specificity, cutoffs] for iron deficiency at each time point was analyzed. Results: The prevalence of anemia increased from 34.6% at 14 wk of gestation to 50.0% at 20 wk. Hepcidin concentrations declined between study enrollment and 20 wk, whereas ferritin declined between 20 and 30 wk of gestation. The variations in hepcidin explained by ferritin, sTfR, and CRP declined over pregnancy. The AUCROC values for hepcidin to detect iron deficiency (defined as ferritin <15 μg/L) were 0.86, 0.83, and 0.84 at 14, 20, and 30 wk, respectively. Hepcidin was superior to hemoglobin and sTfR as an indicator of iron deficiency. Conclusions: In Gambian pregnant women, hepcidin appears to be a useful diagnostic test for iron deficiency and may enable the identification of cases for whom iron would be beneficial. Hepcidin suppression in the second trimester suggests a window for optimal timing for antenatal iron interventions. Hemoglobin does not effectively identify iron deficiency in pregnancy. This trial was registered at www.isrctn.com as ISRCTN49285450.