THE EFFECT OF MATERNAL ANEMIA AND IRON-DEFICIENCY ON THE RATIO OF FETAL WEIGHT TO PLACENTAL WEIGHT

Objective - To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure. Design - Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women. Setting - John Radcliffe Hospital, Oxford. Subjects - 8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts. Main outcome measures - Placental weight and the ratio of placental weight to birthweight. Results - Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight. Conclusions - Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.