Maternal anemia and offspring failure to thrive–results from a large population-based cohort

Objective: To evaluate whether an association exists between maternal anemia and offspring failure to thrive (FTT) during childhood. Methods: A population-based cohort analysis was performed, comparing the risk for FTT among children (up to 18 years old) based on maternal hemoglobin (Hb) levels, upon postpartum discharge. Maternal Hb levels were categorized into 3 levels: <9.0 (moderate–severe anemia), 9.0–11.0 (mild anemia), and ≥11.0 g/dL (no anemia). FTT diagnosis was based on hospital records. All singletons born between 1991 and 2014 and discharged alive without congenital malformations were included. A survival curve was constructed to compare the cumulative FTT incidence, and a Weibull parametric survival analysis to assess the independent association between maternal anemia and offspring FTT while controlling for confounders. Results: Of the 214,305 included deliveries, 22,071 parturients (10.3%) were discharged with Hb <9.00; 83,932 (39.2%) with Hb between 9.0–11.0; and 108,302 (50.5%) with Hb ≥11.0 g/dL. FTT rates were 1.3% (n = 287), 1.2% (n = 967), and 1.1% (n = 1141) in the same groups, respectively (p =.003). The survival curve demonstrated a significantly higher cumulative incidence of FTT diagnosis in the moderate–severe maternal anemia group (p <.001). In the Weibull analysis, constructed for newborns with appropriate birthweight, both groups of maternal anemia were found to be independently associated with FTT related hospitalizations (mild anemia aHR, 1.1; 95%CI 1.002–1.219; p =.045, moderate-severe anemia aHR, 1.321; 95%CI, 1.141–1.529; p <.001). Conclusion: Maternal anemia is independently associated with long-term FTT in offspring, with increasing FTT rates proportional to anemia severity.