PubMed · 8992570
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A Widmer. 1996-11-26. [A case from practice (364)].. https://pubmed.ncbi.nlm.nih.gov/8992570/
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OBJECTIVE: To compare the effect of unmodified cows' milk and iron supplemented formula milk on psychomotor development in infants from inner city areas when used as the main milk source. DESIGN: Double blind, randomised intervention trial. SETTING: Birmingham health centre. SUBJECTS: 100 infants, mean age 7.8 months (range 5.7 to 8.6 months), whose mothers had already elected to use unmodified cows' milk as their infant's milk source. INTERVENTION: Changing to an iron supplemented formula milk from enrolment to 18 months of age, or continuing with unmodified cows' milk. MAIN OUTCOME MEASURES: Developmental assessments using Griffiths scales at enrolment and at 18 and 24 months. RESULTS: 85 participants completed the trial. There were no significant differences in haemoglobin concentration between the two groups at enrolment, but by 18 months of age 33% of the unmodified cows' milk group, but only 2% of the iron supplemented group, were anaemic (P<0.001). The experimental groups had Griffiths general quotient scores that were not significantly different at enrolment, but the scores in both groups declined during the study. By 24 months the decrease in the mean scores in the unmodified cows' milk group was 14.7 whereas the decrease in the mean scores in the iron supplemented group was 9.3 (P<0.02, 95% confidence interval 0.4 to 10.4). Mean subquotient scores were considerably lower in the unmodified cows' milk group at 24 months; significantly so for personal and social scores (P<0.02, 1.2 to 16.8 [corrected]). CONCLUSION: Replacing unmodified cows' milk with an iron supplemented formula milk up to 18 months of age in infants from inner city areas prevents iron deficiency anaemia and reduces the decline in psychomotor development seen in such infants from the second half of the first year.
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Pregnancy and postpartum anaemia occurs worldwide, particularly in developing countries where it accounts for substantial maternal and infant morbidity and mortality. The main cause is iron deficiency, primarily of dietary origin: 20% of the world population are estimated to have some degree of trace element deficiency. Even in industrialized countries iron deficiency anaemia is common in pregnancy due to the negative iron balance created by the high fetal demand for iron. It is compounded by blood loss during and after delivery, particularly in the absence of adequate prevention and treatment. The main effects of pregnancy and postpartum anaemia (defined by the WHO as hemoglobin values < 110 g/l and < 100 g/l, respectively) present for the mother an increased susceptibility to infection and premature delivery and for the baby intrauterine growth retardation and the consequences of prematurity. Diagnosis and differential diagnosis are thus a major obstetric concern. Iron deficiency can be particularly difficult to diagnose in postpartum anaemia because ferrritin is often falsely elevated due to concurrent infection. Prevention with oral iron + folic acid supplementation has proven effective, as has intravenous iron in more severe cases, while the addition of recombinant erythropoietin augments the effect of iron alone.