First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia

Raden Tina Dewi Judistiani; Tita Husnitawati Madjid; Budi Handono; Hadyana Sukandar; Setyorini Irianti; Lani Gumilang; Sefita Aryuti Nirmala; Budi Setiabudiawan

doi:10.1155/2020/8880045

First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia

Anemia. 2020 Oct 8:2020:8880045. doi: 10.1155/2020/8880045. eCollection 2020.

Authors

Raden Tina Dewi Judistiani¹, Tita Husnitawati Madjid², Budi Handono², Hadyana Sukandar¹, Setyorini Irianti², Lani Gumilang³, Sefita Aryuti Nirmala³, Budi Setiabudiawan⁴

Affiliations

¹ Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
² Post Graduate Study in Obstetrics and Gynecology Specialists, Faculty of Medicine, Universitas Padjadjaran, Dr Hasan Sadikin Hospital, Bandung, Indonesia.
³ Bachelor in Midwifery Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
⁴ Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr Hasan Sadikin Hospital, Bandung, Indonesia.

Abstract

Introduction: Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting.

Objective: This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (Sysmex^R). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR).

Result: One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, p < 0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml.

Conclusion: This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.