Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 559-567 (doi:10.1542/peds.2007-0151)
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ARTICLE

Fetal Alcohol Exposure, Iron-Deficiency Anemia, and Infant Growth

R. Colin Carter, MDa, Sandra W. Jacobson, PhDb, Christopher D. Molteno, MDc and Joseph L. Jacobson, PhDb,d

a Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts; Departments of
b Psychiatry and Behavioral Neurosciences
d Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
c Department of Psychiatry, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa

OBJECTIVES. Our goals were to determine whether prenatal alcohol exposure is associated with an increased incidence of iron-deficiency anemia in infancy and to compare effects of fetal alcohol exposure and iron-deficiency anemia on infant growth. We also tested whether effects of fetal alcohol exposure on growth are mediated or moderated by iron-deficiency anemia.

METHODS. A total of 96 infants born to mothers from the Coloured (mixed ancestry) community in Cape Town, South Africa, were recruited prenatally; 42 mothers drank heavily during pregnancy, and 54 abstained or drank small amounts of alcohol. Growth was assessed at birth and 6.5 and 12 months, and iron-deficiency anemia was assessed at 6.5 or 12 months.

RESULTS. Infants whose mothers binge drank during pregnancy (≥4 drinks per occasion) were 3.6 times more likely to be diagnosed with iron-deficiency anemia at 12 months than were infants whose mothers did not binge drink. Prenatal alcohol exposure was associated with reduced weight at birth, 6.5 months, and 12 months and with shorter length at 6.5 and 12 months. Iron-deficiency anemia was related to reduced 12-month weight and head circumference and to slower growth velocity between 6 and 12 months. The effects of prenatal alcohol on weight were not mediated by iron-deficiency anemia; however, they were seen primarily in infants with iron-deficiency anemia.

CONCLUSIONS. The association of maternal binge drinking with an increased incidence of iron-deficiency anemia may reflect disruption of accumulation of fetal iron stores or postnatal deficiencies in iron uptake, absorption, or intake. Moreover, iron deficiency seems to exacerbate the prenatal alcohol effects on growth.

Key Words: fetal alcohol exposure • FASD • iron deficiency anemia • growth retardation • binge drinking during pregnancy • birth weight • growth velocity

Abbreviations: FAS—fetal alcohol syndrome • IDA—iron-deficiency anemia • AA—absolute alcohol • Hgb—hemoglobin concentration • MCV—mean corpuscular volume • MCH—mean corpuscular hemoglobin concentration • RDW—red cell distribution width

Accepted Apr 13, 2007.