To determine whether there is an association between the total breastfeeding duration and iron stores, iron deficiency, and iron deficiency anemia in healthy urban children.
A cross-sectional study of healthy children, aged 1 to 6 years, seen for primary health care between December 2008 and July 2011 was conducted through the TARGet Kids! practice-based research network. Univariate and adjusted regression analyses were used to evaluate an association between total breastfeeding duration and serum ferritin, iron deficiency, and iron deficiency anemia.
Included were 1647 healthy children (median age 36 months) with survey, anthropometric, and laboratory data. An association was found between increasing duration of breastfeeding and lower serum ferritin (P = .0015). Adjusted logistic regression analysis revealed the odds of iron deficiency increased by 4.8% (95% confidence interval: 2%–8%) for each additional month of breastfeeding. Exploratory analysis suggested an increasing cumulative probability of iron deficiency with longer total breastfeeding duration with an adjusted odds ratio of 1.71 (95% confidence interval: 1.05–2.79) for iron deficiency in children breastfed over versus under 12 months of age. The relationship between total breastfeeding duration and iron deficiency anemia did not meet statistical significance.
Increased total breastfeeding duration is associated with decreased iron stores, a clinically important association warranting additional investigation.
Comments
association between duration of exclusive breastfeeding and iron deficiency
One-third of all babies born in the US are delivered surgically, with their umbilical cords cut quickly. Early cutting of the cord, before it has finished pulsing deprives babies of a boost in iron levels that are enough to sustain a baby until it starts iron-rich solid foods, around 6 months of age.
Delayed cord clamping for premature infants is supported by ACOG in their December 2012 Committee Opinion. Delayed cord clamping was found to be of benefit for infants born of anemic mothers (Gupta 2002). A Swedish study suggested that babies who had cord clamping delayed by at least three minutes had higher iron stores when checked at four months old. These babies were also less likely to be anemic. (BMJ Nov 2011)
The NHS in the UK is reexamining its cord clamping recommendations based on a review of evidence.
It is interesting that all of the newborns in this paper's sample were healthy.
I wish the authors had considered the timing of cord clamping in this lovely paper.
warmly, Nikki Lee RN, BSN, MS, IBCLC, ANLC
Conflict of Interest:
None declared