Iron Deficiency Anemia, Neurodevelopmental Abnormality, Autism Spectrum Disorder
Conditions
Keywords
Anemia, Iron Deficiency Anemia, Intravenous iron, India, Low birth weight, Pediatrics, Neurodevelopment
Brief summary
As a follow-up to the RAPIDIRON Trial (NCT05358509), this study will follow the previously randomized mothers as well as their offspring after birth to assess neurodevelopmental, hematologic, and health outcomes. The study's overarching goal is to determine if the offspring born to RAPIDIRON Trial mothers in the intravenous iron groups, compared to the oral iron group, will achieve superior neurodevelopment, iron stores, and growth at specific time points during the first three years of life. Differences will be assessed between offspring based on the iron deficiency anemia (IDA) treatment of the mother.
Detailed description
The RAPIDIRON-KIDS Study has two primary hypotheses: 1. Infants born to RAPIDIRON Trial maternal participants from the intravenous (IV) iron arms will have higher hemoglobin and ferritin levels at birth (determined by cord blood) and at 4 months of age compared to infants born to mothers in the oral arm; and 2. Offspring born to RAPIDIRON Trial participants who received IV iron treatment will have higher developmental quotients (DQs) on the cognitive domain of the Bayley Scales of Infant Development (BSID) at 2 years of age compared to offspring born to RAPIDIRON Trial participants given oral iron treatment. The specific aims of this study are as follows: * To provide evidence that a single-dose of IV iron (either ferric carboxymaltose or iron isomaltoside, also known as ferric derisomaltose) given to pregnant women in the second trimester during the RAPIDIRON Trial will prove more effective for prevention of neonatal and postnatal iron deficiency in the offspring than the oral iron given to pregnant women per the parent trial protocol * To assess if the offspring of women in the parent trial IV iron arms have better neurodevelopmental outcomes compared to the offspring of women treated with oral iron; and * To determine longer-term hematologic effects in previously randomized mothers by obtaining ongoing hematologic indices, documented history of transfusion and hospitalization, and quality of life based on the use of a validated instrument. This study will recruit pregnant mothers currently participating in the RAPIDIRON Trial, who will be approached to give consent for themselves and their offspring for participation in the RAPIDIRON-KIDS Study. Participation in RAPIDIRON-KIDS will involve assessments at birth, 6 weeks, 4 months, 12 months, 24 months, and 36 months of age. In addition to iron status, anthropometry, and questionnaires relating to child feeding and maternal quality of life, the following neurobehavioral tests will be utilized to assess the offspring at various timepoints: Preferential Looking Test, Ages & Stages Questionnaire 3, Bayley Scales of Infant Development, Behavioral Rating Scale, India Scale for Assessment of Autism, and the Child Behavior Checklist for Ages 1.5-5. Please see the protocol for additional details.
Interventions
DRUGFerric carboxymaltose
As part of the RAPIDIRON Trial, maternal participants randomized to intervention arm 1 were given a single dose of ferric carboxymaltose between 14 and 17 weeks of pregnancy.
As part of the RAPIDIRON Trial, maternal participants randomized to intervention arm 2 were given a single dose of iron isomaltoside between 14 and 17 weeks of pregnancy.
DRUGFerric Sulfate
As part of the RAPIDIRON Trial, maternal participants randomized to the active comparator arm were given 200 ferrous sulfate tablets immediately after randomization (\ 12 weeks of pregnancy). Participants were instructed to take two tablets a day, with each tablet containing 60mg elemental iron.
Sponsors
Jawaharlal Nehru Medical College
S. Nijalingappa Medical College
Raichur Institute of Medical Sciences
Thomas Jefferson University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Informed consent of the RAPIDIRON Trial participant for their study inclusion and that of their offspring for the RAPIDIRON-KIDS Study * Expressed intent of the RAPIDIRON Trial participant to remain in the designated Karnataka research are for delivery and during the follow-up period for the RAPIDIRON-KIDS Study to enable participation in study visits * For the offspring - live-born singleton infants of Karnataka maternal participants randomized and treated in the RAPIDIRON Trial, if consent is provided by the mother
Exclusion criteria
* Unwillingness of maternal participant to provide RAPIDIRON-KIDS Study consent for herself and her offspring
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Offspring hemoglobin | Birth | Offspring hemoglobin concentration in g/dL |
| Offspring ferritin | Birth | Offspring serum ferritin concentration in ng/mL |
| Cognitive Domain of Bayley Scales of Infant Development (BSID) | 24 months of age | Developmental quotient (DQ) on the cognitive domain of the Bayley Scales of Infant Development (BSID), conducted at 24 months of age. The Cognitive Domain of the BSID-IV contains 81 items, each item with a minimum score of 0 and a maximum score of 2. A lower score is a bad outcome and a higher score is a good outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Maternal ferritin | 4, 12, and 24 month visits | Maternal serum ferritin concentration in ng/mL |
| Offspring head circumference | Birth, 4, 12, 24, and 36 months of age | Offspring head circumference measured in cm |
| Infant and Young Child Feeding Practices | Birth, 6 weeks, 4, 12, and 24 months of age | A composite questionnaire used to measure feeding practices based upon breastfeeding, dietary diversity, meal frequency, iron supplementation, and iron-fortified foods. |
| Maternal hemoglobin concentration | 4, 12, and 24 month visits | Maternal hemoglobin concentration measured in g/dL |
| Offspring hemoglobin | 12 months of age | Offspring hemoglobin concentration in g/dL |
| Offspring ferritin | 12 months of age | Offspring serum ferritin concentration in ng/mL |
| Preferential Looking Time | 4 and 12 months of age | Performance on Preferential Looking Time assessment - scored as the percentage of time spent looking at the novel object during the test phase |
| Motor and language domains of the Bayley Scales of Infant Development (BSID) | 24 months of age | Developmental quotient (DQ) on the motor and language domains of the Bayley Scales of Infant Development (BSID), conducted at 24 months of age. The motor domain of the BSID-IV contains 79 items, and the language domain contains 104 items. Minimum score on each item is 0, maximum score is 2. A lower score is a bad outcome and a higher score is a good outcome. |
| Bayley Scales of Infant Development (BSID) | 36 months of age | Developmental quotients (DQs) on all domains of the Bayley Scales of Infant Development (BSID), conducted at 36 months of age. There are 5 domains, each many items. Each item has a minimum score of 0 and a maximum score of 2. A lower score is a bad outcome and a higher score is a good outcome. |
| Maternal well-being/quality of life | 4 and 12 month visits | Maternal well-being/quality of life, as measured by the World Health Organization Disability Assessment Schedule II (WHODAS-II). Uses 36 items to measure health and disability across six domains of life - cognitive, mobility, self care, relationship, life activities, and participation. Each item is given a score from 0 to 4, and all item scores are summed. Higher scores mean worse outcomes and higher disability status. |
| Behavior Rating Scale | 24 months of age | Score on the Behavior Rating Scale, as coded from a video recording undergoing the Bayley Scales of Infant Development (BSID). Each child is rated across nine behavioral domains. The minimum score in each domain is 0 and the maximum score is 5, with higher scores indicating more optimal behaviors. |
| Ages & Stages Questionnaire 3 | 12 months of age | Accepted and validated screening tool for neurodevelopment. Minimum score of 0, maximum score of 60. Lower score is a bad outcome, higher score is a good outcome. |
| Child Behavior Checklist for Ages 1.5-5 | 24 and 36 months of age | A parent-report questionnaire assessing internalizing and externalizing behaviors. Standardized t-scores will result, with a mean of 50 and standard deviation of 10. Higher scores indicate more symptoms (emotional/behavioral) and a worse outcome. |
| India Scale of Assessment for Autism | 36 months of age | A standardized screening tool for autism, validated for the Indian population. 40 items are rated from 1 to 5, with a higher score indicating increasing severity. |
| Offspring weight | 4, 12, 24, and 36 months of age | Offspring weight measured in kg |
| Offspring height | 6 weeks, 4, 12, 24, and 36 months of age | Offspring height measured in cm |
Other
| Measure | Time frame | Description |
|---|---|---|
| Maternal hospitalization | Birth to 3 years | Incidence of maternal hospitalization |
| Maternal transfusions | Birth to 3 years | Incidence of maternal blood transfusions |
| Offspring hospitalization | Birth to 3 years of age | Incidence of offspring hospitalization |
Countries
India
Outcome results
None listed