AUTHOR=Babacheva Evgeniya , Rallis Dimitrios , Christou Helen , Mitsiakos George , Mikos Themistoklis , Dampala Kalliopi , Tsakalidis Christos , Kioumi Anna , Goulis Dimitrios G. , Soubasi Vasiliki 

TITLE=Maternal diabetes and the role of neonatal reticulocyte hemoglobin content as a biomarker of iron status in the perinatal period

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.1011897

DOI=10.3389/fendo.2022.1011897

ISSN=1664-2392

ABSTRACT=Abstract
Aims: We aimed to evaluate the effects of maternal diabetes on neonatal iron status, utilizing mean reticulocyte hemoglobin content (MCHr) as an early marker of iron status, and examine the association between neonatal MCHr, red cell indices, and ferritin. 
Materials and Methods: We conducted a prospective case-control study in a tertiary neonatal unit of a University Hospital from 2018 to 2020. We enrolled 126 maternal-infant pairs of mothers whose pregnancy was associated with diabetes and 74 maternal-infant pairs from uncomplicated pregnancies. Erythrocyte indices [hemoglobin, hematocrit, reticulocytes, MCHr, mean corpuscular volume (MCV), percent (%) hypochromia, and ferritin] were analyzed within the first twelve hours after birth. Erythrocyte parameters were compared between infants of the diabetes group and controls. We examined the correlation of the neonatal MCHr with perinatal characteristics, including gestation, birth weight, maternal body mass index, the erythrocytic indices, maternal diabetes, maternal obesity, prematurity, gender, small-for-gestational-age status, maternal preeclampsia, delivery mode, and maternal anemia. Finally, we evaluated the discordance between neonatal MCHr and neonatal ferritin.
Results: Infants of the diabetes group had a significantly lower mean corpuscular volume (MCV) (121.3±9.4 fL vs. 124.6±10 fL, p=0.049) and MCHr (32.6 pg vs. 34.2 pg, p=0.003) compared with infants of uncomplicated pregnancies. Neonatal MCHr was significantly correlated with maternal hypochromia (r=-0.237, p=0.004) and neonatal MCV (r=0.674, p<0.001). Maternal anemia was significantly more common in the diabetes group. Neonatal MCHr was significantly associated with maternal diabetes [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.05-0.58, p=0.003) and maternal preeclampsia (OR 0.17, 95% CI 0.02-0.92, p=0.019), after adjusting for maternal anemia, maternal obesity, prematurity, sex, small-for-gestational-age status, and delivery mode. There was significant discordance between neonatal MCHr and neonatal ferritin (p=0.001). 
Conclusions: MCHr was significantly lower in infants of mothers whose pregnancy was associated with diabetes compared with infants of non-diabetic mothers and correlated with neonatal and maternal red cell indices of iron deficiency. Since there was significant discordance between neonatal MCHr and ferritin during the first postnatal day, it is possible that MCHr could be used as a screening test for iron deficiency, especially in infants.