Iron deficiency anemia among women: An issue of health equity

Iron deficiency is the most common and widespread nutritional deficiency in the world. For women, the risk of iron deficiency and iron deficiency anemia increases due to iron demands during pregnancy and regular iron losses due to menstruation during reproductive years. These interrelated conditions are of public health concern as they are highly prevalent, and the negative consequences such as chronic fatigue, cognitive impairment and poor quality of life are broad and multifaceted. People of low socioeconomic status are at higher risk of iron deficiency due to low intake of expensive iron-rich foods, and decreased access to healthcare. In this review, we applied a health equity lens to describe the current state of care for women with iron deficiency with or without anemia. We have highlighted several structural challenges that span from the laboratory diagnosis, inconsistent screening guidelines, and stigma associated with heavy menstrual bleeding, to treatment barriers.

Beneficios del uso del hierro parenteral como alternativa eficaz en el manejo de la anemia gestacional en Colombia

Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada “anemia dilucional”, existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.

Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study

BACKGROUND

The symptoms of anemia and depression are very similar suggesting that there may be an association between the two entities. The aim of this study is to assess whether postpartum anemia (PPA) is an independent risk factor for de novo postpartum depression (PPD)in women undergoing elective cesarean section.

METHODS

Women after an uncomplicated term cesarean section were recruited and their hemoglobin and iron status were measured on day 3-5 post section and again at 6 weeks. Postpartum depression was screened using the Edinburgh Postnatal Depression Scale (EPDS) and functional capacity was assessed with the RAND 12-item Health survey.

RESULTS

One hundred and three women completed the study. The incidence of probable postpartum depression (PPD) as defined by EPDS score ≥ 10 was 17% at 6 weeks. There was no difference in hemoglobin or iron status in women who had PPD compared to those without (OR-0.69; 95% CI-0.15-2.49). Similarly, there was no significant association between low hemoglobin and maternal functional status (OR -1.03; 95% CI-0.34 - 2.94).

CONCLUSIONS

Neither anemia or low iron stores were found to be an independent risk factors for postpartum depression or decreased postpartum functional capacity in women who undergo an elective cesarean section.

Iron deficiency in gynecology and obstetrics: clinical implications and management

Iron deficiency is the commonest cause of anemia during pregnancy; however, its prevalence is highly determined by nutritional and socioeconomic status. Oral iron is the frontline therapy, but is often poorly tolerated. Awareness of the available intravenous formulations is essential for management. Before delivery, risk factors such as multiparity and heavy uterine bleeding increase the prevalence of iron deficiency and should be motivation for early diagnosis and treatment. Neonates born with iron deficiency have a statistically significant increment in both cognitive and behavioral abnormalities that persist after repletion, highlighting the need for heightened awareness of the diagnosis. A smartphone application providing information on nutrition and treatment is provided. New formulations of intravenous iron with carbohydrate cores, which bind elemental iron more tightly, minimize the release of labile free iron to allow complete replacement doses of intravenous iron in 15 to 60 minutes, facilitating and simplifying care.

Treatment of Anemia of Chronic Disease with True Iron Deficiency in Pregnancy

Objective

We assess and compare the efficacy of anemia treatment in pregnant women with anemia of chronic disease with true iron deficiency and in women with iron deficiency anemia.

Study Design

Fifty patients with moderate anemia (hemoglobin 8.0–9.9 g/dl) and iron deficiency (ferritin < 15 μg/l) were treated in the Anemia Clinic at the Department of Obstetrics.

Results

All patients showed stimulation of erythropoiesis as evidenced by an increase in reticulocyte count at day eight of therapy and showed an increase in hemoglobin and hematocrit at the end of therapy (p < 0.001). The target hemoglobin (≥10.5 g/dl) was achieved in 45/50 women (90%). 12 patients showed anemia of chronic disease with true iron deficiency (12/50; 24%). Seven women (7/12; 59%) with anemia of chronic disease and iron deficiency responded well to anemia treatment. 50% of women with anemia of chronic disease and iron deficiency (3/6) responded well to intravenous iron, and 67% (4/6) responded well to the combination of intravenous iron and recombinant human erythropoietin.

Conclusion

Because of frequent true iron deficiency in pregnant women with anemia of chronic disease, anemia of chronic disease in pregnancy is often falsely diagnosed as iron deficiency anemia.

The Relationship between Iron Deficiency and Thyroid Function in Chinese Women during Early Pregnancy

Previous studies have identified an association between iron deficiency and thyroid function. We aimed to determine if there is a relationship between iron deficiency and thyroid function during the first trimester of pregnancy. Two thousand five hundred eighty-one pregnant women who presented for the first prenatal care were enrolled and divided into three groups, the mild iron deficiency (MID) group, iron deficiency anemia (IDA) group and normal control (NC) group, according to serum ferritin and hemoglobin levels. The former two groups can be merged into one iron deficiency (ID) group. Thyroid function parameters were compared among the three groups, including free thyroxine (FT4), thyroid stimulating hormone (TSH), total thyroxine (TT4) and thyroid peroxidase antibodies (TPOAb). Moreover, the rates of thyroid dysfunction were also compared. Our results show that pregnant women in the MID and IDA groups have higher TSH and lower FT4 status than those in the NC group (p<0.01), and the difference between the IDA group and MID group is significant (p<0.05). TPOAb in the IDA group is higher than in the MID group and NC group. Meanwhile, the rate of hypothyroidism or subclinical hypothyroidism in the IDA group was significantly higher than in the MID group and NC group (p<0.01). And the positive rate of TPOAb is also higher in the IDA group than MID group and NC group (p<0.05). Iron deficiency is related to thyroid function and could lead to hypothyroidism during early pregnancy, which could be explained by thyroid autoimmunity.

Iron Deficiency Anemia in Pregnancy

Anemia is a common problem in obstetrics and perinatal care. Any hemoglobin below 10.5 g/dL can be regarded as true anemia regardless of gestational age. Reasons for anemia in pregnancy are mainly nutritional deficiencies, parasitic and bacterial diseases, and inborn red blood cell disorders such as thalassemias. The main cause of anemia in obstetrics is iron deficiency, which has a worldwide prevalence between estimated 20%-80% and consists of a primarily female population. Stages of iron deficiency are depletion of iron stores, iron-deficient erythropoiesis without anemia, and iron deficiency anemia, the most pronounced form of iron deficiency. Pregnancy anemia can be aggravated by various conditions such as uterine or placental bleedings, gastrointestinal bleedings, and peripartum blood loss. In addition to the general consequences of anemia, there are specific risks during pregnancy for the mother and the fetus such as intrauterine growth retardation, prematurity, feto-placental miss ratio, and higher risk for peripartum blood transfusion. Besides the importance of prophylaxis of iron deficiency, the main therapy options for the treatment of pregnancy anemia are oral iron and intravenous iron preparations.

Is intravenous iron sucrose the treatment of choice for pregnant anemic women?

Anemia during pregnancy remains an important public health problem in developing countries like India. Anemia is the direct cause of 12-15% of maternal deaths. Iron deficiency is the commonest cause for anemia in the Indian subcontinent. Several preventive and therapeutic approaches are in practice. The available routes of iron supplementation are oral and intravenous. In spite of oral iron being least invasive, cheap and safe, the ineffectiveness of oral iron due to dietary inhibitors and poor compliance are well known. Intravenous iron sucrose can be a promising therapy for moderate to severely anemic pregnant women and has been in practice for quite some time in private and public health practices. In this article, we report the current evidence on the safety and efficacy of intravenous iron sucrose in anemic pregnant women on hematological and clinical outcomes. Though the evidence on its efficacy in improving hemoglobin and serum ferritin is convincing, its effect on maternal and fetal outcomes are unclear. This is primarily due to lack of well-designed and larger studies powered to detect difference in clinical outcomes. Hence, there is a need to gather evidence from a well-designed large randomized clinical trial conducted in a developing country. The results of such a study would feed into the national policy and would form the basis to frame guidelines for management of anemia in developing countries.

Severe Anaemia during Late Pregnancy

Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10-28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb) levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient's haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

Anaemia in the sow: a cohort study to assess factors with an impact on haemoglobin concentration, and the influence of haemoglobin concentration on the reproductive performance

The aim of this study was to conduct a descriptive study of haemoglobin concentration found on high-prolificacy sows, to study the relationship between the concentration of haemoglobin and body reserves, and to determine whether anaemia is a risk factor for reproductive performance. A cohort of 308 sows from seven farms was followed from the last third of gestation to the confirmation of the following gestation. Haemoglobin concentration was assessed at four stages of the reproductive cycle: seven and four weeks before farrowing, a few days and three weeks after farrowing. Backfat thickness (BFT) was measured at parturition. The results were analysed using linear mixed-effect models. The mean haemoglobin concentration was 108.4 g/l. The mean modellised haemoglobin concentration of parity 1 sows with a BFT of 16 mm, sampled seven weeks before farrowing, was 118 g/l. Haemoglobin concentration of sows of parity 6 or higher was 8.0 g/l lower than those of parity 1 sows (95% confidence interval -11.0 to -5.1). Haemoglobin concentration is lower in sows with a lower BFT, whatever parity rank. There is no evidence of a relation between haemoglobin concentration and the number of total born, stillborn or number of piglets alive at three weeks and the next breeding performance.

Daily versus intermittent iron supplementation in pregnant women

BACKGROUND

The purpose of this study was compare of daily iron supplementation in three time frames- daily, weekly and three time weekly supplementation in preventing anemia in healthy pregnant women.

METHOD

The present study was a prospective simply randomized clinical trial. During January 2006- January 2008, 150 healthy pregnant women without anemia, in their 16th week of pregnancy were randomly allocated into three equal groups. The first group (n = 50) received a 50 mg-ferrous sulfate tablet daily, second group (n = 50) received a 50 mg-ferrous sulfate tablet three times a week, and the third group (n = 50) received two 50 mg-ferrous sulfate tablets (100 mg) weekly, respectively for 12 consecutive weeks. Serum hemoglobin, ferritin, and iron were measured before and after the supplementation. Paired t and ANOVA tests were used as appropriated.

RESULTS

There were no significant differences between the pre- and post-treatment hemoglobin levels with iron supplementation in the three group (P = 0.518, P = 0.276, respectively). The mean serum iron level before and after treatment with iron supplementation in the three groups was not statistically significant (P = 0.962, P = 0.970, respectively). Although the mean serum ferritin level before and after treatment with iron supplementation was statistically significant in the three groups, no significant differences were found comparing the three groups (P = 0.827, P = 0.635 respectively).

CONCLUSIONS

This results suggested, three times a week or weekly iron supplementation is as effective as daily supplementation for healthy pregnant women without anemia.

TRIAL REGISTRATION

ISRCTN: IRCT201101093820N1.

Treatments for iron-deficiency anaemia in pregnancy

BACKGROUND

Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm.

OBJECTIVES

To assess the effects of different treatments for anaemia in pregnancy attributed to iron deficiency (defined as haemoglobin less than 11 g/dL or other equivalent parameters) on maternal and neonatal morbidity and mortality.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2011), CENTRAL (2011, Issue 5), PubMed (1966 to June 2011), the International Clinical Trials Registry Platform (ICTRP) (2 May 2011), Health Technology Assessment Program (HTA) (2 May 2011) and LATINREC (Colombia) (2 May 2011).

SELECTION CRITERIA

Randomised controlled trials comparing treatments for anaemia in pregnancy attributed to iron deficiency.

DATA COLLECTION AND ANALYSIS

We identified 23 trials, involving 3.198 women. We assessed their risk of bias. Three further studies identified are awaiting classification.

MAIN RESULTS

Many of the trials were from low-income countries; they were generally small and frequently methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (risk ratio 0.38, 95% confidence interval 0.26 to 0.55, one trial, 125 women) and better haematological indices than placebo (two trials). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. Most trials reported no clinically relevant outcomes nor adverse effects. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions. Daily low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with higher doses.

AUTHORS' CONCLUSIONS

Despite the high incidence and burden of disease associated with this condition, there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anaemia. Daily oral iron treatment improves haematological indices but causes frequent gastrointestinal adverse effects. Parenteral (intramuscular and intravenous) iron enhances haematological response, compared with oral iron, but there are concerns about possible important adverse effects (for intravenous treatment venous thrombosis and allergic reactions and for intramuscular treatment important pain, discolouration and allergic reactions). Large, good quality trials, assessing clinical outcomes (including adverse effects) as well as the effects of treatment by severity of anaemia are required.

Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region

Anemia during pregnancy and the postpartum period is commonly caused by iron deficiency and is a significant worldwide issue with severe consequences for both mother and developing fetus. From a worldwide perspective, iron-deficiency anemia (IDA) during pregnancy is highest in the Asia-Pacific region; however, there has been little guidance in this region for safe and effective treatment. An expert panel was convened to develop a concise and informative set of recommendations for the treatment of IDA in pregnant and postpartum women in the Asia-Pacific region. This manuscript provides these recommendations and aims to reduce the morbidity and mortality associated with IDA in pregnant and postpartum women in the Asia-Pacific region. The consensus recommendations define anemia as a hemoglobin (Hb) level <10.5 g/dL during pregnancy and <10 g/dL during the postpartum period, and provide cut-off Hb levels to initiate therapy with oral iron, intravenous iron or red blood cell transfusion.

Intravenous Iron Therapy versus Oral Iron in Postpartum Patients in Rural Area

Objectives

The aim of this study is to evaluate the efficiency and safety of intravenous iron sucrose complex and comparison with oral iron therapy in postpartum period in rural area.

Materials and methods

It is a prospective, randomized, hospital-based clinical study carried out in over 150 patients, having Hb < 8 mg/dl after 24 hours of delivery. 600 to 800 mg iron sucrose has been given in divided doses, 200 mg on alternate day in 100 ml of normal saline to half of the patients whereas rest of the patients given 200 mg bd dose of ferrous sulphate by oral route for one month. Data was collected after 1st, 2nd, 3rd and 4th week for the hemoglobin estimation and assessment of the impact of intravenous iron sucrose treatment on the postpartum parameters.

Results

The mean Hb was significantly increased in the intravenous iron sucrose group in 7 days (7.42 ± 1.04 gm/dl to 9.8 ± 0.76 gm/dl) of treatment but there was no change observed in mean Hb in the patients treated with oral ferrous sulphate. Women treated with intravenous iron sucrose has shown significantly higher Hb on day 7, day 15 and day 30 as compared to the women those were treated with oral iron (p < 0.0001).

Conclusion

Overall intravenous iron sucrose appears to be an effective mode of treatment in postpartum patients with no serious side effects and associated with faster recovery in shorter duration of hospital stay than oral iron treatment.

Mechanisms involved in the developmental programming of adulthood disease

There are many instances in life when the environment plays a critical role in the health outcomes of an individual, yet none more so than those experienced in fetal and neonatal life. One of the most detrimental environmental problems encountered during this critical growth period are changes in nutrition to the growing fetus and newborn. Disturbances in the supply of nutrients and oxygen to the fetus can not only lead to adverse fetal growth patterns, but they have also been associated with the development of features of metabolic syndrome in adult life. This fetal response has been termed developmental programming or the developmental origins of health and disease. The present review focuses on the epidemiological studies that identified this association and the importance that animal models have played in studying this concept. We also address the potential mechanisms that may underpin the developmental programming of future disease. It also highlights (i) how developmental plasticity, although beneficial for short-term survival, can subsequently programme glucose intolerance and insulin resistance in adult life by eliciting changes in key organ structures and the epigenome, and (ii) how aberrant mitochondrial function can potentially lead to the development of Type 2 diabetes and other features of metabolic syndrome.

Compliance to iron supplementation during pregnancy

Iron deficiency anaemia is the most common nutritional disorder in the world. Pregnant women are at especially high risk of iron deficiency and anaemia because of significantly increased iron requirements during pregnancy. Iron supplementation during pregnancy has been recommended for women in the developing world, since usually no basic changes occur in the composition of the diet. This is a retrospective cohort study carried out in Al-Yamamah Hospital, Riyadh, Saudi Arabia, comparing the outcome of haemoglobin levels in 308 pregnant women near term with compliance to iron supplementation during the preceding pregnancy stages. Data were collected using an interview-based questionnaire for assessment of supplementation compliance and the women were divided into three categories: strictly compliant; partially compliant; and non-compliant. Haemoglobin levels were extracted from the medical records for the first antenatal visit (before 13 weeks' gestation) and compared with the level at entrance to the study at 36 weeks' gestation. Both Epi-info 2002 version 3.2 and SPSS version 10 were used for data analysis. Our results show that 49.7% used iron supplements continuously during the second and third trimesters of pregnancy; 38.3% reported partial use and 12.0% used no iron supplements. Haemoglobin levels improved significantly only among strictly compliant pregnant women, by 0.3 g/dl; decreased among partially compliant women by, 0.36 g/dl and significantly decreased among non-compliant, by -1.4 g/dl. Factors associated with non-compliance were education with a simple linear protective effect from being non-compliant. The percentage of anaemic women increased from 29.6% in the first trimester to 34% in the third trimester. Anaemia was significantly associated with non-compliance with iron supplementation, the adjusted OR was 6.19 95% CI 2.55-15.02, p < 0.0001. Strategies to improve compliance and effective iron supplementation among pregnant women should be implemented.

Elevated serum erythropoietin concentration is associated with coordinated changes in red blood cell and reticulocyte indices of pregnant women at term

The aim of this study was to evaluate the relationship between the erythropoietin (EPO) concentration and both the advanced cellular indices reflecting the haemoglobin contents of red blood cells and reticulocytes and the serum markers of iron status. The study population comprised pregnant women at term (n = 210). The serum EPO, transferrin receptor (TfR), ferritin, the percentages of hypochromic red blood cells (%HYPOm) or reticulocytes (%HYPOr) and the cellular haemoglobin in mature red blood cells (CHm) or in reticulocytes (CHr) were measured in maternal blood before delivery. The EPO concentration was elevated above the reference limit (>31.5 mIU/mL) in 16 % of all pregnant women, and appeared to correlate in a linear fashion, especially with %HYPOm (r = 0.52, p<0.001), %HYPOr (r = 0.57, p<0.001) and CHr (r = -0.45, p<0.001). The significant (p<0.05) predictors of EPO in the multivariate stepwise regression analysis were %HYPOr, Hb, %HYPOm and MCV. In general, the lower the cellular haemoglobin content, the higher the overall maternal EPO production. In conclusion, elevated %HYPOm and %HYPOr reflecting iron-deficient erythropoiesis are associated with an increase in EPO concentration in maternal blood. This could be explained by subclinical iron deficiency being accompanied by a compensatory EPO response.

Evaluation of serum transferrin receptor for iron deficiency in women of child-bearing age

The objective was to study the evaluation of serum transferrin receptor (sTfR) for Fe deficiency in women of child-bearing age. Primary screening was performed in 942 women ranging in child-bearing age. Serum ferritin (SF), Zn protoporphyrin (ZPP) and Hb were determined. Then the subjects were divided into four groups: normal, Fe store depletion (IDs), Fe-deficiency erythropoiesis and Fe-deficiency anaemia. sTfR was determined and sTfR/SF (sTfR/logSF and log(sTfR/SF)) was calculated. Changes of sTfR in women of different Fe status were observed. A receiver-operating characteristic (ROC) curve was used to evaluate whether sTfR had proper diagnostic efficacy for functional Fe deficiency. The levels of sTfR increased significantly along with the aggravation of Fe deficiency. Increase of STfR/SF along with the aggravation of Fe deficiency was more significant than that of sTfR. STfR had a significant negative correlation with SF and Hb, while it had a significant positive correlation with ZPP. The ROC curve showed that the diagnostic effective rate of sTfR for Fe deficiency could reach 83 %. At this point, the sensitivity was 79 % and the specificity was 63 %. Log(sTfR/SF) could be considered to have the highest effective ratio in detecting IDs, since it reached 99 %. STfR and sTfR/SF could both reflect body Fe-deficiency status specifically. They could be used as reliable indicators for evaluating Fe status and diagnosing Fe deficiency in women of child-bearing age.

The responses of serum transferrin receptors to iron supplements in subjects with iron-deficiency erythropoiesis and iron-deficiency anaemia

We aimed to study the response of serum transferrin receptors (sTfR) to Fe supplementation in women of childbearing age with Fe-deficiency erythropoiesis (IDE) and Fe-deficiency anaemia (IDA). Primary screening was performed in 942 women ranging in age from 18 to 45 years. After Fe-related biochemical indices such as serum ferritin, Zn protoporphyrin and Hb were determined, the subjects were divided into four groups: normal, Fe store depletion, IDE and IDA. A total of 131 women were randomly selected from the normal, IDE and IDA groups. Subsequently, seventy-six women with IDE and IDA were given various doses of Fe (14 mg/d for IDE; 28 mg/d for IDA) with ferrousl-threonate capsules for twelve consecutive weeks. After receiving Fe supplements, the levels of Fe and sTfR were determined at weeks 0, 3, 6, 9 and 12.The levels of sTfR in women of childbearing age with IDE and IDA were significantly higher than those in the normal group. After receiving Fe supplements, the levels of sTfR were significantly decreased in women of childbearing age with IDE and IDA, while the levels of serum ferritin were significantly increased. In conclusion, STfR can be used as a reliable indicator for assessing the efficacy of Fe supplements.

Treatments for iron-deficiency anaemia in pregnancy

BACKGROUND

Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm.

OBJECTIVES

To assess the effects of different treatments for iron-deficiency anaemia in pregnancy (defined as haemoglobin less than 11 g/dl) on maternal and neonatal morbidity and mortality.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to December 2005), EMBASE (1976 to December 2005), LILACS (1982 to 40 edition), BIOSIS Previews (1980 to June 2002) and ongoing clinical trial registers.

SELECTION CRITERIA

Randomised controlled trials comparing treatments for iron-deficiency anaemia in pregnancy.

DATA COLLECTION AND ANALYSIS

We identified 17 trials, involving 2578 women. We assessed trial quality.

MAIN RESULTS

The trials were small and generally methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (one trial, 125 women; relative risk 0.38; 95% confidence interval 0.26 to 0.55). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. We found that most trials had no assessments on relevant clinical outcomes and a paucity of data on adverse effects, including some that are known to be associated with iron administration. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions.

AUTHORS' CONCLUSIONS

Despite the high incidence and burden of disease associated with this condition, there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anaemia. Daily oral iron treatment improves haematological indices but causes frequent gastrointestinal adverse effects. Parenteral (intramuscular and intravenous) iron enhances haematological response, compared with oral iron, but there are concerns about possible important adverse effects. Large, good quality trials, assessing clinical outcomes (including adverse effects) are required.

Iron deficiency: a concise review

Iron deficiency is a major worldwide health problem. There is recent evidence that the anemia is only the last manifestation of the syndrome and that symptoms occur before the anemia is manifest. Advances in outlining the physiology of iron deficiency have been made, gaps remain in the current understanding. While oral iron supplement remains the mainstay, some indications for the intravenous administration have developed. This review will highlight the epidemiology, physiology, clinical presentation, and treatment options.

Effect of administering recombinant erythropoietin to women with postpartum anemia: a meta-analysis

OBJECTIVES

Recombinant erythropoietin (rEpo) has been administered to women with postpartum anemia in an attempt to accelerate their increase in hemoglobin concentration and reduce postpartum transfusions. However, it is not clear whether such an approach can be supported by evidence and should be generally recommended.

STUDY DESIGN AND METHODS

Medical and scientific literature from January 1990 to December 2002 was searched and studies that reported the administration of rEpo to women with postpartum anemia were evaluated.

RESULTS

Eight evaluated studies reported an aggregate of 480 women; 300 rEpo recipients and 180 controls. Significant diversity in design was observed in rEpo dose, route of rEpo administration, iron supplementation, and baseline hemoglobin. No significant safety concerns were reported. In all five studies where it was reported, 4 to 7 days after beginning treatment, greater increases in hemoglobin concentration were observed among the rEpo recipients than among the controls. However, heterogeneity of results (Q-test statistic, p<0.01) indicated that it was not appropriate to apply summary statistics. The effect of rEpo on postpartum transfusion rate was not measurable by summary statistics because of the limited number of transfusions given (no transfusions among the 300 rEpo recipients vs two transfusions among the 180 controls).

CONCLUSION

Administration of rEpo to women with postpartum anemia appears to be safe, and is associated with a trend toward a faster increase in hemoglobin concentration. However, its efficacy in terms of diminishing postpartum transfusions is unproven.