Open Access
Ciulei, Mihaela A.
Graduate Program:
Nutritional Sciences
Master of Science
Document Type:
Master Thesis
Date of Defense:
September 21, 2017
Committee Members:
  • Laura E. Murray-Kolb, Thesis Advisor
  • Connie J. Rogers, Committee Member
  • Penny Margaret Kris-Etherton, Committee Member
  • iron deficiency
  • mother-infant interactions
  • randomized controlled trial
  • iron supplementation
  • Bangladesh
  • Emotional Availability Scales
Iron deficiency (ID) is the most prevalent single nutrient deficiency in the world and 50% of anemia is due to ID. Mothers and children under the age of five, especially those from middle- and low-income settings, are the most affected by the deficiency. The consequences of the deficiency are known to impact both pregnant and non-pregnant women at the physical and psychosocial level. In children, ID is known to be a risk factor for inadequate development. The objective of this study was to explore the effects of six months of iron supplementation in infants between six to 18 months old on mother-infant interactions in a rural Bangladeshi sample. The data used for the current analysis are from a substudy of a larger longitudinal randomized, double-blind, placebo-controlled factorial community trial exploring the effects of iron and zinc on diarrhea and anemia outcomes. Infants were supplemented for six months with iron/folic acid (n=70), iron/folic acid and zinc given either in combination (n=70) or separately (alternating days; n=73), and placebo (n=69). In this substudy, mother-infant interaction was measured at baseline (n=91), midpoint (three months; n=263), and endpoint (six months; n=272). Iron status was assessed in both, mothers and infants at baseline and endpoint via serum ferritin, transferrin receptor, C-reactive protein, and hemoglobin (in the infants only). Mother-infant interactions were coded per the Emotional Availability Scales comprised of four maternal scales: sensitivity, structuring, non-intrusiveness, and non-hostility and two infant scales: responsiveness and involvement. Other measurements collected and which were related to mother-infant interactions include: socioeconomic status, mean upper arm circumference, weight-for-age Z score, child’s sex and age, maternal depressive symptoms and maternal reasoning ability. At baseline, there were no demographic differences between supplementation groups but maternal transferrin receptor and body iron levels differed by groups. Post six months of supplementation to infants, infants differed significantly among groups in iron status while mothers did not. Cross-sectional analyses indicated that there were no differences between groups on scores of the emotional availability subscales at any time point. Longitudinal analyses indicated that scores at endpoint on the subscales (all except child scales) decreased compared to baseline regardless of supplement type and the magnitude of change did not differ between groups. These findings indicate that mother-infant interactions in this sample were not affected by supplement type, but other factors were important. Positive contributors to the outcome were higher maternal reasoning ability, higher maternal and infant iron status, increased days of breastfeeding, infant’s older age, and higher socio-economic status. Future analyses on these data will investigate the relation between infant and maternal iron status and mother-infant interactions irrespective of the supplementation groups. Considering the importance of mother-infant interactions on child development in our societies, future studies and policy makers should consider taking into account the aforementioned contributors with the hope that the well-being of mothers and infants could be improved.