Iron-deficiency anemia (IDA) affects an estimated 1 to 2 billion people worldwide.

1 In developing countries, over 50% of pregnant women are anemic,2 and 3 as are 46% to 66% of children under 4 years, with half attributed to iron deficiency (ID).4 In the United States, the prevalence of dietary ID has markedly declined in infants in the last 30 years, but poor, minority, and/or immigrant infants and toddlers remain at increased risk.5 Common gestational conditions, such as intrauterine growth restriction and diabetes mellitus during gestation, expose infants to non-dietary ID in the late fetal/neonatal period on nondietary grounds. Given the number of infants potentially affected, understanding the adverse effects of early ID on the developing brain is crucial. Studies in humans have demonstrated that iron deficiency anemia (IDA) during the first 2 years of life is associated with impaired cognitive and motor development that can persist despite the correction of the anemia (Lozoff et al., 2007). Most studies focused on standardized
developmental test scores as the major outcome measure, generally using the Bayley Scales of Infant Development. Eight studies of iron-deficient anemic infants used careful definition of iron status and included comparison groups. All of them consistently found that iron-deficient anemic infants had lower mental test scores than the scores of comparison group infants, and five of seven studies reported that iron-deficient anemic infants had lower motor test scores as well.5-11 In addition to cognitive and

motor impacts, research in humans indicates that affect, or emotionality, is influenced by IDA in infants and toddlers (Lozoff, Klein, & Prabucki, 1986; Lozoff,Wolf, & Jimenez, 1996; Lozoff,Wolf, Urrutia, & Viteri, 1985; Lozoff et al., 1998, 2003, 2007; Rahmanifar et al., 1993; Wachs, Kanashiro, & Gurkas, 2008;Wachs, Pollitt, Cueto, Jacoby, & Creed-Kanashiro, 2005; Williams et al., 1999). Using the Infant Behaviour Record (part of the Bayley Scales), examiners have
rated iron-deficient infants as unresponsive to the usual test stimuli, inattentive, unhappy, fearful, withdrawn from the examiner, solemn, and tense. 12-16 Regarding this social-emotional behavior, more recent studies have again found that infants with iron-deficiency anemia showed no positive affect; showed less pleasure and delight; were more wary, hesitant, and easily tired; and were less playful (Lozoff et al, 1998; Lozoff, Klein, &Prabucki, 1986; Lozoff et al., 2003). Virtually every study that compared social-emotional behavior of infants with IDA to nonanemic infants found the former to be more wary, hesitant, solemn, unhappy, or closer to their mothers. (kayclark 696) Four of six trials that assessed social-emotional domain showed affective improvements of giving iron supplements; infants showed more positive affect and social interaction. (kayclark)

Despite the consistency of previous results, there is limited information about the effect of iron deficiency on social-emotional behavior as compared to its effect on cognitive development. However, both domains can equally result from direct effects of ID on associated brain systems.

Jarang ID without anemia Jarang prenatal Purpose of study is to

METHODS Population China is a rapidly developing country where infants are generally well-nourished but ID often occurs among pregnant women and infants, especially in rural areas. The study community is Fuyang county, about one and a half hour from Hangzhou. The major agricultural products of this rural areas in the north of Zhejiang province are rice, fish, bamboo, and silk. Average annual per capita income is under $1000. The mean age at marriage is 25-26 years. With a population over 2.5 million, there are more than 5000 births per year and an average of 14 births per day at Fuyang Maternal and Childrens Hospital. Average birth weight is 3.22 kg, with 5.4% prematurity and 5.0% low birth weight. Rural women in this area typically do not return to work until the child enters preschool and do not leave home until 4-6 weeks postpartum. The average age at weaning from the breast is 12-15 months. Sample Selection Cord blood for 1122 healthy full-term infants born at the Maternity and Childrens Hospital of Fuyang county were tested. Permission to determine infant iron status from cord blood and at 9 month (blood screen consent) will be obtained shortly after admission to the maternity unit from randomly selected mothers with uncomplicated term pregnancies. Mothers with problems that may interfere with fetal iron status and/or impair developmental or behavioral outcome were not contacted (e.g. chronic illness, parasites, maternal diabetes, intrauterine growth restriction, alcohol exposure, premature birth, etc.). All infants who had been born healthy, full-term, of uncomplicated births, who were free of acute and chronic medical problems were invited to join the study at 9-month of age. The final sample consisted of 198 9-month infants, who were classified into 2 groups based on their cord blood ferritin level. Based on the procedure in a recent review from Georgieffs lab,139 this study used the cut-off <60 g/L for prenatal iron-deficient and 60 g/L for normal. Further criterion for
Prenatal ID will be 2 or more abnormal cord ferritin measures, using the same cut-offs. (kalo baru use prelimianaryl analysis 1998 p.26))

This study compare 9-month infants with prenatal iron deficiency (n = 28) against infants with better cord ferritin status (n = 170). The prenatal ID group was similar to the comparison group with respect to a variety of characteristics that could possi