Is there any relation between anemia of maternal and low birth weight?

Maternal anemia needs to be severe to affect the fetus. However, there is a

large body of international literature on the associations of neonatal and pediatric iron
deficiency anemia with adverse outcomes including potential poor cognitive
outcomes. It is not clear what proportion of this early life anemia is related to
maternal iron deficiency during pregnancy, or whether there is any trimester-
associated risk that is more highly associated with neonatal iron deficiency. Elevated
Hb early in pregnancy has been associated with poor perinatal outcome, including
stillbirth, low birth weight, and SGA neonates.
In a case-control study, women with stillbirths had a significantly higher
incidence of Hb levels that were higher than 14.5 g/dL than did control women
without stillbirths. Although the mechanism for this association is unknown, the
authors hypothesized that high Hb may be a marker of inadequate plasma-volume
expansion and hence reduced blood flow to the intervillous space. An alternative
explanation is that global placental dysfunction leads to reduced production of the
steroid and peptide hormones responsible for maternal plasma volume expansion.
Although there is no association between maternal third trimester Hb and
cord-blood Hb, maternal Hb or ferritin was significantly associated with cord-blood
ferritin. In several studies, the umbilical cord-blood ferritin levels of infants whose
mothers were iron deficient were reduced, compared with those of infants whose
mothers were not iron deficient. Yet, infants whose ferritin levels were low were not
anemic and had normal iron kinetics, and their serum ferritin values were not in the
iron-deficient range. In a study of newborns of women with severe folate deficiency,
Pritchard and colleagues found normal neonatal levels of folate neonatal levels of
folate.
Colomer and colleagues found that 1-year-old infants had a 5.7 fold increase
in risk for anemia if their mothers were anemic at delivery. In another interesting trial,
iron supplementation in women who were not anemic in the first trimester was
associated with a significant reduction in the incidence of birth weight less than 2500
g and in the incidence of SGA neonates. This trial randomized nonanemic women to
receive 30 mg ferrous sulfate or placebo by 20 weeks’ gestation. Almost 17% of the
placebo-treated women but only 4% of the iron-treated women had low-birth-weight
neonates, and 18% and 7%, respectively, had babies that were SGA. These
provocative results, indicating that improved iron reserves enhance fetal growth
independent of anemia status, may be generalizable only to populations with a high
incidence of smoking, because 36% to 40% of the women in each group smoked.
However, another randomized trial of routine versus indicated (by an Hb level less
than 10 g/dL) treatment with iron revealed no difference in perinatal outcome or long-
term outcome, including subsequent pregnancies.

Reference:
Sarah J. Kilpatrick, MD, PhD. Creasy and Resnik's Maternal-Fetal Medicine:
Principles and Practice, 55, 918-931.e3. Elsavier, Clinical Key.