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Review
. 2023 Aug 30;15(17):3798.
doi: 10.3390/nu15173798.

The Interaction between Psychological Stress and Iron Status on Early-Life Neurodevelopmental Outcomes

Affiliations
Review

The Interaction between Psychological Stress and Iron Status on Early-Life Neurodevelopmental Outcomes

Brie M Reid et al. Nutrients. .

Abstract

This review presents evidence from animal and human studies demonstrating the possible connection and significant impact of poor iron status and psychological distress on neurocognitive development during pregnancy and the neonatal period, with implications for long-term cognition. Stress and iron deficiency are independently prevalent and thus are frequently comorbid. While iron deficiency and early-life stress independently contribute to long-term neurodevelopmental alterations, their combined effects remain underexplored. Psychological stress responses may engage similar pathways as infectious stress, which alters fundamental iron metabolism processes and cause functional tissue-level iron deficiency. Psychological stress, analogous to but to a lesser degree than infectious stress, activates the hypothalamic-pituitary-adrenocortical (HPA) axis and increases proinflammatory cytokines. Chronic or severe stress is associated with dysregulated HPA axis functioning and a proinflammatory state. This dysregulation may disrupt iron absorption and utilization, likely mediated by the IL-6 activation of hepcidin, a molecule that impedes iron absorption and redistributes total body iron. This narrative review highlights suggestive studies investigating the relationship between psychological stress and iron status and outlines hypothesized mechanistic pathways connecting psychological stress exposure and iron metabolism. We examine findings regarding the overlapping impacts of early stress exposure to iron deficiency and children's neurocognitive development. We propose that studying the influence of psychological stress on iron metabolism is crucial for comprehending neurocognitive development in children exposed to prenatal and early postnatal stressors and for children at risk of early iron insufficiency. We recommend future directions for dual-exposure studies exploring iron as a potential mediating pathway between early stress and offspring neurodevelopment, offering opportunities for targeted interventions.

Keywords: infancy; inflammation; iron status; neurodevelopment; pregnancy; psychological stress.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Exposure to psychological stress triggers the hypothalamic pituitary adrenocortical (HPA axis) response. The HPA axis response to a stressor begins with the release of corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) by neurons in the medial parvocellular region of the paraventricular nucleus of the hypothalamus. These hormones stimulate the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which triggers the adrenal cortex to produce glucocorticoids. These hormones bind to corticosteroid receptors (the glucocorticoid receptor (GR) and the mineralocorticoid receptor (MR)) throughout the brain and regulate gene expression, leading to various physiological and psychological effects [10]. The key to the HPA axis is feedback loops to maintain homeostasis. Once the perceived stressor has subsided, the feedback loops at multiple levels, including the hypothalamus, hippocampus, and frontal cortex, shut down the HPA axis and return the organism to homeostasis [10]. If a stressor is chronic, dysregulated cortisol output is seen in acute stress responses and the diurnal pattern of cortisol. These cortisol patterns are associated with epigenetic changes, increases in proinflammatory cytokines, and brain and behavior changes. We hypothesize that increased IL-6 from psychological stress impacts key pathways between iron metabolism and brain development. Figure created with Biorender.com [87].

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