Plasma ferritin and pregnancy outcome

OBJECTIVE: Plasma ferritin is considered the best measure of total body iron, with low levels diagnostic of iron deficiency. High levels have been associated with inflammation and infection. We determined the relationship between plasma ferritin, birth weight, and preterm delivery. STUDY DESIGN: Plasma ferritin and hematocrit values were measured at 19, 26, and 36 weeks' gestational age and correlated with birth weight and preterm delivery (less than or equal to 32 and <37 weeks) in 580 indigent black women. RESULTS: Hematocrit levels measured at any gestational age did not correlate significantly with birth weight or preterm delivery. Regardless of the gestational age of sampling, ferritin levels in the lowest quartile did not correlate significantly with subsequent preterm delivery. However, at 26 weeks, compared with the three lower quartiles, ferritin levels in the highest quartile were significantly associated with preterm delivery less than or equal to 32 weeks, 6.5% versus 2.3% (p = 0.02), with preterm delivery <37 weeks, 14% versus 8% (p = 0.04), and with birth weight <1500 gm, 6.5% versus 2.0% (p = 0.01). Plasma ferritin levels in the highest quartile at 19, 26, and 36 weeks were associated with birth weight less than or equal to 2500 gm, 14% versus 8% (p = 0.03), 12% versus 7% (p = 0.05), and 10% versus 2% (p = 0.0001), respectively compared with the lower quartiles. Ferritin levels in the highest quartile were always associated with a lower mean birth weight than were those in the lower three quartiles: 19 weeks, 2999 gm versus 3225 gm, (p = 0.002); 26 weeks, 3065 gm versus 3257 gm, (p = 0.005); and 36 weeks, 3182 gm versus 3323 gm, (p = 0.009). Regression analyses controlling for multiple potential confounders confirmed that at 26 weeks ferritin levels in the highest quartile had an odds ratio and 95% confidence interval for preterm birth <37 weeks of 2.0 (1.1 to 3.8), preterm delivery less than or equal to 32 weeks of 2.7 (0.99 to 7.6), birth weight less than or equal to 1500 gm of 3.9 (1.2 to 12.2), and birth weight less than or equal to 2500 gm of 2.0 (1.0 to 4.0) compared with the three lower ferritin quartiles. CONCLUSION: High, but not low, plasma ferritin levels, especially at 26 weeks, were strongly associated with subsequent preterm delivery and birth weight.