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Hassen JY, Debella A, Eyeberu A, Mussa I. Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis. Int Health 2024:ihae015. [PMID: 38339961 DOI: 10.1093/inthealth/ihae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context. METHODS Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot. RESULTS This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth. CONCLUSIONS The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.
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Affiliation(s)
- Jemal Y Hassen
- School of Rural Development and Agricultural Innovation, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Abdullahi AS, Suliman A, Khan MAB, Khair H, Ghazal-Aswad S, Elbarazi I, Al-Maskari F, Loney T, Al-Rifai RH, Ahmed LA. Temporal trends of hemoglobin among pregnant women: The Mutaba'ah study. PLoS One 2023; 18:e0295549. [PMID: 38064469 PMCID: PMC10707684 DOI: 10.1371/journal.pone.0295549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Low hemoglobin (Hb) level is a leading cause of many adverse pregnancy outcomes. Patterns of changes in Hb levels during pregnancy are not well understood. AIM This study estimated Hb levels, described its changing patterns across gestational trimesters, and identified factors associated with these changes among pregnant women. MATERIALS AND METHODS Data from the ongoing maternal and child health cohort study-The Mutaba'ah Study, was used (N = 1,120). KML machine learning algorithm was applied to identify three distinct cluster trajectories of Hb levels between the first and the third trimesters. Descriptive statistics were used to profile the study participants. Multinomial multivariable logistic regression was employed to identify factors associated with change patterns in Hb levels. RESULTS The three identified clusters-A, B and C-had, respectively, median Hb levels (g/L) of 123, 118, and 104 in the first trimester and 119, 100, and 108 in the third trimester. Cluster 'A' maintained average normal Hb levels in both trimesters. Cluster 'B', on average, experienced a decrease in Hb levels below the normal range during the third trimester. Cluster 'C' showed increased Hb levels in the third trimester but remained, on average, below the normal range in both trimesters. Pregnant women with higher gravida, diabetes mellitus (type 1 or 2), nulliparity or lower level of education were more likely to be in cluster 'B' than the normal cluster 'A'. Pregnant women who reported using iron supplements before pregnancy or those with low levels of education. were more likely to be in cluster 'C' than the normal cluster 'A'. CONCLUSION The majority of pregnant women experienced low Hb levels during pregnancy. Changes in Hb levels during pregnancy were associated with parity, gravida, use of iron before pregnancy, and the presence of diabetes mellitus (type 1 or 2).
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Affiliation(s)
- Aminu S. Abdullahi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Abubaker Suliman
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Moien AB Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Howaida Khair
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Saad Ghazal-Aswad
- Obstetrics and Gynecology Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatima Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Gestational Anemia and its effects on neonatal outcome, in the population of Hyderabad, Sindh, Pakistan. Saudi J Biol Sci 2022; 29:83-87. [PMID: 35002396 PMCID: PMC8716886 DOI: 10.1016/j.sjbs.2021.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Anemia in pregnancy is a globally health-related issue, that affects both mothers and their newborn. Anemia during pregnancy across the world involves approximately 38% of the world population. To evaluate the effect of gestational anemia on perinatal outcome in the population. The aim of present study is to evaluate the effect of gestational anemia on perinatal outcome in the population of Hyderabad, Sindh, Pakistan. Methods A cross-sectional comparative analysis was conducted among pregnant mothers who were listed to give birth at Liaquat University of medical and health sciences Jamshoro/Hyderabad during the period of September 2018 to September 2019. The study population 400 were selected by convenient random sampling, and grouped into 2 on the basis of their Hb levels, with Hb < 11 gm% they were classified as anemic mothers, Hb ≥ 11 gm% were termed as non-anemic mothers, data was collected on the preformed questionnaire, and was analyzed on SPSS 21. Results The prevalence of anemia was 51.5% in in total population out of which, the incidence of normocytic normochromic anemia was highest 52.4 %microcytic hypochromic anemia was found in 19.4%, Overall, extremely low Apgar was found in 53 anemics, and 8 non. anemic mother’s infants, LBW incidence was 47.5 %; in anemic mothers, and 15.4 % in non-anemic group, the term, small for gestational age infants were 14.5% in anemic mothers, and 3.6% in non-anemic mothers, there were 36 preterm births to anemic mothers and 10 in non-anemic mothers. The incidence of caesarian section is 53.3% in anemic mothers compared to 30.9% in non-anemic mothers. Conclusions Anemia in pregnancy significantly increases risks of low Apgar, LBW, term SGA, preterm birth, and an increase incidence of caesarian section.
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Ogunsakin RE, Akinyemi O, Babalola BT, Adetoro G. Spatial pattern and determinants of anemia among women of childbearing age in Nigeria. Spat Spatiotemporal Epidemiol 2021; 36:100396. [PMID: 33509424 DOI: 10.1016/j.sste.2020.100396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The risk of anemia in Nigeria is of public health importance, with an increasing number of women of reproductive age being anemic. This study sought to identify the spatial distribution and examine the geographical variation of anemia risk at a regional level while accounting for risk factors associated with anemia among women of childbearing age in Nigeria. The significant interest in spatial statistics lies in identifying associated risk factors that enhance the risk of infection. However, most studies make no or limited use of the data's spatial structure and possible non-linear effects of the risk factors. METHODS The data used in this study were extracted from the 2015 Nigeria Demographic and Health Survey (NDHS). A full Bayesian semi-parametric regression model was fitted to data to accomplish the aims of the study. Model estimation and the inference was fully Bayesian approach via integrated nested Laplace approximations (INLA). The fixed effects were modeled parametrically; non-linear effects were modeled non-parametrically using second-order random walk priors. RESULTS Wealth index, level of education, type of residence, and unprotected drinking water source were found to be the risk factors associated with anemia. The risk of anemia was found to vary across different regions, with North Central, North East, and North West regions having the highest number of cases and South East with the least number of cases. The spatial analysis result indicated that statistically high hot-spots of anemia were observed in all the northern parts of the country. CONCLUSION The study revealed associations between anemia risk and women residing in rural settlements, wealth index, women with no formal education, and unprotected drinking water sources. Community and household-related change interventions should, therefore, be pertinent to the prevention of anemia. The spatial analysis further revealed a significant anemia risk towards the Northern areas of Nigeria. We propose that interventions targeting women of reproductive age should initially focus on these regions and subsequently spread across Nigeria.
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Affiliation(s)
- Ropo Ebenezer Ogunsakin
- Discipline of Public Health Medicine (Bio-Statistics Unit), University of KwaZulu Natal, South Africa.
| | - Oluwadare Akinyemi
- Department of Statistics, Faculty of Science, Ekiti State University, Nigeria
| | | | - Gbemisola Adetoro
- Department of Demography and Social Statistics, Covenant University, Nigeria
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Rahman MA, Khan MN, Rahman MM. Maternal anaemia and risk of adverse obstetric and neonatal outcomes in South Asian countries: A systematic review and meta-analysis. PUBLIC HEALTH IN PRACTICE 2020; 1:100021. [PMID: 36101702 PMCID: PMC9461600 DOI: 10.1016/j.puhip.2020.100021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/20/2023] Open
Abstract
Background The occurrence of maternal anaemia is common in South Asian countries which increase the risk of adverse maternal obstetric and birth outcomes. This may adversely affect the achievement of the Sustainable Development Goals’ (SDG) targets of reducing maternal and under-five deaths by 2030. Objectives To summarize the evidence on the association of maternal anaemia with adverse birth and maternal obstetric outcomes. Methods We adopted the PRISMA consensus statement. PubMed, CINAHL and Web of Science databases were searched on February 20, 2020. A total of 38 studies was included, of which 25 articles were included in the quantitative synthesis and meta-analysis. Results Maternal anaemia was associated with a significantly higher risk of low birth weight (OR, 1.90; 95% CI, 1.06-2.60, p < 0.05), preterm birth (OR, 1.96; 95% CI, 1.20-2.41, p < 0.05) and perinatal mortality (OR, 2.90; 1.97-3.78, p < 0.05). Non-significant associations were seen with neonatal mortality (OR, 1.80; 95% CI, 0.90-27.77, p = 0.7), miscarriage (OR, 1.68; 95% CI, 0.48-3.20, p = 0.08), preeclampsia (OR, 2.66; 95% CI, 0.61-11.52, p = 0.6) and caesarean delivery (OR, 1.18; 95% CI, 0.36-2.80, p = 0.07). Conclusion Maternal anaemia increases the risk of low birth weight, preterm birth and perinatal mortality. Improving maternal nutritional status and iron supplementation during pregnancy are important for reducing these adverse outcomes.
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Affiliation(s)
- Md Aminur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
- Corresponding author.
| | - Md Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Gurung A, Wrammert J, Sunny AK, Gurung R, Rana N, Basaula YN, Paudel P, Pokhrel A, Kc A. Incidence, risk factors and consequences of preterm birth - findings from a multi-centric observational study for 14 months in Nepal. ACTA ACUST UNITED AC 2020; 78:64. [PMID: 32695337 PMCID: PMC7368758 DOI: 10.1186/s13690-020-00446-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023]
Abstract
Background Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. Methods This was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted. Results The incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22–1.64), literate mothers (aOR 1.21; 1.08–1.35) and mothers having basic level of education (aOR 1.17; 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01–1.26), use of polluted fuel (aOR 1.26; 1.17–1.35) and sex of baby (aOR 1.18; 1.11–1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20–1.48), multiple delivery (aOR 6.63; 5.16–8.52), severe anemia during pregnancy (aOR 3.27; 2.21–4.84), antenatal visit during second trimester (aOR 1.13; 1.05–1.22) and third trimester (aOR 1.24; 1.12–1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28–12.10). Conclusion In this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities. Trial registration ISRCTN30829654.
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Affiliation(s)
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
| | | | | | - Netra Rana
- Lumbini Provincial Hospital, Government of Nepal, Butwal, Nepal
| | | | - Prajwal Paudel
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Amrit Pokhrel
- Syangya District Hospital, Government of Nepal, Syangya, Nepal
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
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K. C. A, Basel PL, Singh S. Low birth weight and its associated risk factors: Health facility-based case-control study. PLoS One 2020; 15:e0234907. [PMID: 32569281 PMCID: PMC7307746 DOI: 10.1371/journal.pone.0234907] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background Low birth weight is a preventable public health problem. It is an important determinant of child survival and development, as well as long-term consequences like the onset of non-communicable disease in the life course. A large number of mortality and morbidity can be prevented by addressing the factors associated with low birth weight. The main objective of this study was to identify associated risk factors of low birth weight. Methodology A health facility-based unmatched case-control study was carried out from July 2018 to March 2019 among the mothers who delivered in health facilities of Dang district of Nepal from 17th August to 16th November 2018. The total sample size for the study was 369; 123 cases and 246 controls. Cases and controls were randomly selected independent of the exposure status in the ratio of 1:2. Information regarding exposure status was assessed through interviews and medical records. Mothers who delivered outside Dang districts were excluded from the study. Ethical clearance was obtained from the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University and written consent was taken from each participant after explaining the objectives of the study. Results Multivariate logistic regression found that having the kitchen in the same living house (AOR 2.7, CI: 1.5–4.8), iron intake less than 180 tablets (AOR 3.2, CI: 1.7–5.7), maternal weight gain during second and third trimester less than 6.53 kg (AOR 2.6, CI: 1.5–4.7), co-morbidity during pregnancy (AOR 2.4, CI: 1.3–4.5), preterm birth (AOR 2.9, CI: 1.4–6.1) were the risk factors associated with low birth weight. Conclusion Having the kitchen in the same living house, iron intake less than 180 tablets during pregnancy, maternal weight gain less than 6.53 kg during the second and third trimester, co-morbidity during pregnancy and preterm birth were the risk factors associated with low birth weight.
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Affiliation(s)
- Anil K. C.
- Health Foundation Nepal, Patan, Nepal
- * E-mail:
| | - Prem Lal Basel
- Department of Community Medicine and Public Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sarswoti Singh
- Department of Community Medicine and Public Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Ahammed B, Maniruzzaman M, Ferdausi F, Abedin M, Hossain M. Socioeconomic and demographic factors associated with low birth weight in Nepal: Data from 2016 Nepal demographic and health survey. SOCIAL HEALTH AND BEHAVIOR 2020. [DOI: 10.4103/shb.shb_46_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jung J, Rahman MM, Rahman MS, Swe KT, Islam MR, Rahman MO, Akter S. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta‐analysis. Ann N Y Acad Sci 2019; 1450:69-82. [DOI: 10.1111/nyas.14112] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/07/2019] [Accepted: 04/05/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Jenny Jung
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Shafiur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Khin Thet Swe
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
| | - Md. Rashedul Islam
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | | | - Shamima Akter
- Global Public Health Research Foundation Dhaka Bangladesh
- Department of Epidemiology and Prevention, Center for Clinical SciencesNational Center for Global Health and Medicine Tokyo Japan
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Ardic C, Usta O, Omar E, Yıldız C, Memis E, Zeren Öztürk G. Relationship between anaemia during pregnancy and preterm delivery. J OBSTET GYNAECOL 2019; 39:903-906. [PMID: 31064297 DOI: 10.1080/01443615.2019.1572726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to analyse the relationship between preterm delivery and maternal anaemia. This retrospective cohort study was completed with 483 women; 294 of them had a normal delivery and 189 had a preterm delivery. The haemoglobin (Hb) values of all the women participating in the study were measured in the first and second trimesters, and the average Hb values were calculated. The pregnant women participating in the study were divided into three groups, according to their Hb level: those with Hb level <10 g/dl, those with Hb level between 10 and 11 g/dl and those with Hb level >11 g/dl. In crude analysis, women with low Hb levels had an increased rate of preterm delivery (odds ratio, 2.42; 95% CI, 1.07-5.49). Our study provides data that low Hb level is effective in preterm delivery. Impact statement What is already known on this subject? Serum Hb levels have inconsistent associations with a risk of preterm delivery. What the results of this study add? Compared with term delivery Hb levels are lower in preterm delivery. It is necessary to take into account the Hb levels of both the first and second trimester of the pregnancy when describing the pregnancy anaemia. What the implications are of these findings for clinical practice and/or further research? Given these results, physicians should take into account anaemia in pregnancy when considering the risk of a preterm delivery.
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Affiliation(s)
- Cuneyt Ardic
- Department of Family Medicine, Faculty of Medicine, Recep Tayyip Erdoğan University , Rize , Turkey
| | - Oguzer Usta
- Department of Family Medicine, Faculty of Medicine, Recep Tayyip Erdoğan University , Rize , Turkey
| | - Esma Omar
- Department of Family Medicine, Faculty of Medicine, Recep Tayyip Erdoğan University , Rize , Turkey
| | - Cihangir Yıldız
- Department of Family Medicine, Faculty of Medicine, Recep Tayyip Erdoğan University , Rize , Turkey
| | - Erdem Memis
- Department of Family Medicine, Faculty of Medicine, Recep Tayyip Erdoğan University , Rize , Turkey
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Ejigu BA, Wencheko E, Berhane K. Spatial pattern and determinants of anaemia in Ethiopia. PLoS One 2018; 13:e0197171. [PMID: 29775472 PMCID: PMC5959194 DOI: 10.1371/journal.pone.0197171] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 04/27/2018] [Indexed: 12/27/2022] Open
Abstract
Anaemia is a condition in which the haemoglobin concentration falls below an established cut-off value due to a decrease in the number and size of red blood cells. The current study aimed (i) to assess the spatial pattern and (ii) to identify determinants related to anaemia using the third Ethiopian demographic health survey. To achieve these objectives, this study took into account the sampling weight and the clustered nature of the data. As a result, multilevel modeling has been used in the statistical analysis. The analysis included complete cases from 15,909 females, and 13,903 males. Among all subjects who agreed for hemeoglobin test, 5.22% males, and 16.60% females were anemic. In both binary and ordinal outcome modeling approaches, educational level, age, wealth index, BMI and HIV status were found to be significant predictors of anaemia prevalence. Furthermore, this study applied spatial methods to generate maps at regional level which could be useful for policy makers where great efforts should be concentrated to reduce the prevalence of anaemia. As revealed by Moran's I test, significant spatial autocorrelation were noted across clusters. The risk of anaemia was found to vary across different regions, and higher prevalences were observed in Somali and Affar regions.
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Affiliation(s)
- Bedilu Alamirie Ejigu
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Wencheko
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kiros Berhane
- Division of Biostatistics, Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
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Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAFD, Lyrio AO, Souza ES, Cruz SS, Pereira MG. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10050601. [PMID: 29757207 PMCID: PMC5986481 DOI: 10.3390/nu10050601] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 01/14/2023] Open
Abstract
Objective: To systematically analyze the relationship between maternal anemia and low birth weight. Methods: A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. Results: A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06–1.43) and I2: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. Conclusions: Maternal anemia was considered a risk factor for low birth weight.
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Affiliation(s)
- Ana C M G Figueiredo
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil.
| | - Roberta B Silva
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Priscilla P S Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Fabiana A F Da Mata
- Faculty of Medical Sciences, University of Brasilia; Brasília 70910-900, Distrito Federal, Brazil.
| | - Amanda O Lyrio
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Elivan S Souza
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Simone S Cruz
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Mauricio G Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
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Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAFD, Lyrio AO, Souza ES, Cruz SS, Pereira MG. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10050601. [PMID: 29757207 DOI: 10.3390/nu10050601.pmid:29757207;pmcid:pmc5986481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To systematically analyze the relationship between maternal anemia and low birth weight. METHODS A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. RESULTS A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06⁻1.43) and I²: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. CONCLUSIONS Maternal anemia was considered a risk factor for low birth weight.
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Affiliation(s)
- Ana C M G Figueiredo
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil.
| | - Roberta B Silva
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Priscilla P S Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Fabiana A F Da Mata
- Faculty of Medical Sciences, University of Brasilia; Brasília 70910-900, Distrito Federal, Brazil.
| | - Amanda O Lyrio
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Elivan S Souza
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Simone S Cruz
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Mauricio G Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
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Abay A, Yalew HW, Tariku A, Gebeye E. Determinants of prenatal anemia in Ethiopia. ACTA ACUST UNITED AC 2017; 75:51. [PMID: 29142745 PMCID: PMC5674228 DOI: 10.1186/s13690-017-0215-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
Background Anemia is responsible for 20% of maternal mortality worldwide, and it is associated with premature birth, low birth weight, and infant mortality. In Ethiopia, about 22% of pregnant women are anemic. However, literatures are limited, therefore, this study aimed to investigate the prevalence and associated factors of anemia among pregnant women attending antenatal care (ANC) in Asossa Zone Public Health Institutions, northwest Ethiopia. Methods A facility based cross-sectional study was conducted from February to March 2016. Data were collected by interviewer administered, pretested and structured questionnaires. A multi-stage sampling technique was used to select 762 pregnant women. The hemoglobin level was determined by taking 5 ml of venous blood using Sahli's method. A multivariate binary logistic regression model was fitted to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was computed to show the strength of association and statistical significance was determined at a P-value of <0.05. Results The prevalence of anemia was 31.8% [95% CI: 28.9, 35.5]. In the adjusted analysis, maternal age of 30-34 years [AOR = 0.34, 95% CI: 0.14, 0.86], household size of ≥6 [AOR = 4.27, 95% CI: 1.58, 11.45], dietary diversity [AOR = 0.58, 95% CI: 0.38, 0.93], no meat consumption [AOR = 1.80, 95% CI: 1.11, 2.91], not drinking soft beverages [AOR =1.96, 95% CI: 1.19, 3.23], undernutrition [AOR = 7.38, 95% CI: 4.22, 12.91], not consuming fruits [AOR = 3.29, 95% CI: 1.59, 6.82], inter-pregnancy interval of ≥2 years [AOR = 0.59, 95% CI: 0.34, 0.99], and third trimester of pregnancy [AOR = 0.33, 95% CI: 0.20, 0.57] were significantly associated with anemia. Conclusions The prevalence of prenatal anemia is high in the Asossa Zone; suggesting a moderate public health concern. Socio-demographic and dietary intake characteristics were significantly associated with anemia. Therefore, improving dietary diversity and animal food consumption are the key to reduce the high burden of anemia. It is also important to strengthen interventions aiming to reduce closed birth interval and teenage pregnancy.
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Affiliation(s)
- Abera Abay
- Maternal and Child Health Core Process, Asossa Zonal Health Department, Asossa, Ethiopia
| | - Haile Woldie Yalew
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Almberg KS, Turyk ME, Jones RM, Rankin K, Freels S, Graber JM, Stayner LT. Arsenic in drinking water and adverse birth outcomes in Ohio. ENVIRONMENTAL RESEARCH 2017; 157:52-59. [PMID: 28521257 DOI: 10.1016/j.envres.2017.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/08/2017] [Accepted: 05/08/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Arsenic in drinking water has been associated with adverse reproductive outcomes in areas with high levels of naturally occurring arsenic. Less is known about the reproductive effects of arsenic at lower levels. OBJECTIVES This research examined the association between low-level arsenic in drinking water and small for gestational age (SGA), term low birth weight (term LBW), very low birth weight (VLBW), preterm birth (PTB), and very preterm birth (VPTB) in the state of Ohio. METHODS Exposure was defined as the mean annual arsenic concentration in drinking water in each county in Ohio from 2006 to 2008 using Safe Drinking Water Information System data. Birth outcomes were ascertained from the birth certificate records of 428,804 births in Ohio from the same time period. Multivariable generalized estimating equation logistic regression models were used to assess the relationship between arsenic and each birth outcome separately. Sensitivity analyses were performed to examine the roles of private well use and prenatal care utilization in these associations. RESULTS Arsenic in drinking water was associated with increased odds of VLBW (AOR 1.14 per µg/L increase; 95% CI 1.04, 1.24) and PTB (AOR 1.10; 95% CI 1.06, 1.15) among singleton births in counties where <10% of the population used private wells. No significant association was observed between arsenic and SGA, or VPTB, but a suggestive association was observed between arsenic and term LBW. CONCLUSIONS Arsenic in drinking water was positively associated with VLBW and PTB in a population where nearly all (>99%) of the population was exposed under the current maximum contaminant level of 10µg/L. Current regulatory standards may not be protective against reproductive effects of prenatal exposure to arsenic.
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Affiliation(s)
- Kirsten S Almberg
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA.
| | - Mary E Turyk
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA.
| | - Rachael M Jones
- Environmental and Occupational Health Sciences Division, University of Illinois at Chicago, School of Public Health, 2121 W. Taylor Street, Chicago, IL 60612, USA.
| | - Kristin Rankin
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA.
| | - Sally Freels
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA.
| | - Judith M Graber
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA; Epidemiology Department, Rutgers the State University of New Jersey, School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States.
| | - Leslie T Stayner
- Epidemiology and Biostatistics Division, University of Illinois at Chicago, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60607, USA.
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Smith LE, Prendergast AJ, Turner PC, Humphrey JH, Stoltzfus RJ. Aflatoxin Exposure During Pregnancy, Maternal Anemia, and Adverse Birth Outcomes. Am J Trop Med Hyg 2017; 96:770-776. [PMID: 28500823 PMCID: PMC5392618 DOI: 10.4269/ajtmh.16-0730] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnant women and their developing fetuses are vulnerable to multiple environmental insults, including exposure to aflatoxin, a mycotoxin that may contaminate as much as 25% of the world food supply. We reviewed and integrated findings from studies of aflatoxin exposure during pregnancy and evaluated potential links to adverse pregnancy outcomes. We identified 27 studies (10 human cross-sectional studies and 17 animal studies) assessing the relationship between aflatoxin exposure and adverse birth outcomes or anemia. Findings suggest that aflatoxin exposure during pregnancy may impair fetal growth. Only one human study investigated aflatoxin exposure and prematurity, and no studies investigated its relationship with pregnancy loss, but animal studies suggest aflatoxin exposure may increase risk for prematurity and pregnancy loss. The fetus could be affected by maternal aflatoxin exposure through direct toxicity as well as indirect toxicity, via maternal systemic inflammation, impaired placental growth, or elevation of placental cytokines. The cytotoxic and systemic effects of aflatoxin could plausibly mediate maternal anemia, intrauterine growth restriction, fetal loss, and preterm birth. Given the widespread exposure to this toxin in developing countries, longitudinal studies in pregnant women are needed to provide stronger evidence for the role of aflatoxin in adverse pregnancy outcomes, and to explore biological mechanisms. Potential pathways for intervention to reduce aflatoxin exposure are urgently needed, and this might reduce the global burden of stillbirth, preterm birth, and low birthweight.
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Affiliation(s)
- Laura E Smith
- Division of Nutritional Sciences, Cornell University, Ithaca, New York.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J Prendergast
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Blizard Institute, Queen Mary University of London, London, United Kingdom.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Paul C Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Jean H Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Blizard Institute, Queen Mary University of London, London, United Kingdom
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Rahmati S, Delpishe A, Azami M, Hafezi Ahmadi MR, Sayehmiri K. Maternal Anemia during pregnancy and infant low birth weight: A systematic review and Meta-analysis. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.3.125] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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Miller EM. The reproductive ecology of iron in women. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 159:S172-95. [PMID: 26808104 DOI: 10.1002/ajpa.22907] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Reproductive ecology focuses on the sensitivity of human reproduction to environmental variation. While reproductive ecology has historically focused on the relationship between energy status and reproductive outcomes, iron status is equally critical to women's reproductive health, given the wide-ranging detrimental effects of iron-deficiency anemia on maternal and infant well-being. This review interprets the vast literature on iron status and women's reproduction through an evolutionary framework. First, it will critique the evidence for iron deficiency caused by blood loss during menstruation, reinterpreting the available data as ecological variation in menses within and between populations of women. Second, it will highlight the scant but growing evidence that iron status is implicated in fertility, a relationship that has deep evolutionary roots. Third, this review proposes a new hypothesis for the transfer of iron from mother to infant via pregnancy and breastfeeding: reproductive iron withholding. In this hypothesis, mothers transfer iron to infants in a manner that helps infants avoid iron-mediated infection and oxidative stress, but trades off with potential risk of maternal and infant iron deficiency. Finally, this review explores two main factors that can modify the relationship between iron status and the gestation-lactation cycle: (1) the relationship between long-term reproductive effort (parity) and iron status and (2) supplementation schemes before and during pregnancy. The review concludes by suggesting continued research into iron homeostasis in women using evolutionary, ecological, and biocultural frameworks.
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Affiliation(s)
- Elizabeth M Miller
- Department of Anthropology, University of South Florida, Tampa, FL, 33620
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Cordina M, Bhatti S, Fernandez M, Syngelaki A, Nicolaides KH, Kametas NA. Association between maternal haemoglobin at 27–29weeks gestation and intrauterine growth restriction. Pregnancy Hypertens 2015; 5:339-45. [DOI: 10.1016/j.preghy.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/24/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
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Maternal iron status in early pregnancy and birth outcomes: insights from the Baby's Vascular health and Iron in Pregnancy study. Br J Nutr 2015; 113:1985-92. [PMID: 25946517 PMCID: PMC4498461 DOI: 10.1017/s0007114515001166] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Fe deficiency anaemia during early pregnancy has been linked with low birth
weight and preterm birth. However, this evidence comes mostly from studies
measuring Hb levels rather than specific measures of Fe deficiency. The present
study aimed to examine the association between maternal Fe status during the
first trimester of pregnancy, as assessed by serum ferritin, transferrin
receptor and their ratio, with size at birth and preterm birth. In the Baby VIP
(Baby's Vascular health and Iron in Pregnancy) study, we recruited 362
infants and their mothers after delivery in Leeds, UK. Biomarkers were measured
in maternal serum samples previously obtained in the first trimester of
pregnancy. The cohort included sixty-four (18 %) small for gestational
age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34
and 37 weeks). First trimester maternal Fe depletion was associated with a
higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1,
4·1). This relationship was attenuated when including early pregnancy Hb
in the model, suggesting it as a mediator (adjusted OR 1·6, 95 %
CI 0·8, 3·2). For every 10 g/l increase in maternal Hb
level in the first half of pregnancy the risk of SGA was reduced by 30 %
(adjusted 95 % CI 0, 40 %); levels below 110 g/l were
associated with a 3-fold increase in the risk of SGA (95 % CI 1·0,
9·0). There was no evidence of association between maternal Fe depletion
and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8).
The present study shows that depleted Fe stores in early pregnancy are
associated with higher risk of SGA.
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21
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Neggers YH. The relationship between preterm birth and underweight in Asian women. Reprod Toxicol 2015; 56:170-4. [PMID: 25801177 DOI: 10.1016/j.reprotox.2015.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
Abstract
Although vast improvements have been made in the survival of preterm infants, the toll of preterm birth (PTB) is particularly severe in Asia, with the Indian subcontinent leading the preterm birth rate. Despite the obesity epidemic, maternal underweight remains a common occurrence in developing countries. An association between maternal underweight and preterm birth has been reported in developed countries. A review of epidemiological studies in Asian women in whom association between maternal body mass index (BMI) and risk of PTB was measured, indicated no significant association between low maternal BMI and preterm birth. A hindrance in comparison of these studies is the use of different cut-off point for BMI in defining maternal underweight. As a commentary on published studies it is proposed that that country-specific BMI cut points should be applied for defining underweight for Asian women for the purpose of evaluating the association between maternal underweight and preterm birth.
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Affiliation(s)
- Yasmin H Neggers
- Department of Human Nutrition, University of Alabama, Box 870311, 504 University Blvd, Tuscaloosa, AL 35487, United States.
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22
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Malhotra N, Upadhyay RP, Bhilwar M, Choy N, Green T. The role of maternal diet and iron-folic acid supplements in influencing birth weight: evidence from India's National Family Health Survey. J Trop Pediatr 2014; 60:454-60. [PMID: 25266114 DOI: 10.1093/tropej/fmu051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To examine the role of maternal diet in determining low birth weight (LBW) in Indian infants. METHODS Data from the National Family Health Survey (2005-06) were used. Multivariate regression analysis was used to analyse the effect of maternal diet on infant birth weight. RESULTS Infants whose mothers consumed milk and curd daily [odds ratio (OR), 1.17; 95% confidence interval (CI), 1.06-1.29]; fruits daily (OR, 1.20; 95% CI, 1.07-1.36) or weekly (OR, 1.13; 95% CI, 1.02-1.24) had higher odds of not having a low birth weight baby. The daily consumption of pulses and beans (OR, 1.18; 95% CI, 1.02-1.36) increased the odds while weekly consumption of fish (OR, 0.79; 95% CI, 0.70-0.89) decreased the odds of not having a LBW infant. Intake of iron-folic acid supplements during pregnancy increased birth weight by 6.46 g per month. CONCLUSION Improved intake of micronutrient-rich foods can increase birth weight.
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Affiliation(s)
- Nisha Malhotra
- Vancouver School of Economics, Faculty of Arts, University of British Columbia, Vancouver, V6T1Z1, Canada
| | - Ravi Prakash Upadhyay
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - Meenakshi Bhilwar
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - Nicholas Choy
- Market Research Analyst, iData Research, Vancouver, V5Z4J7, Canada
| | - Timothy Green
- Faculty of Land & Food Systems, University of British Columbia, Vancouver, V6T1Z4, Canada
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Mild anemia and pregnancy outcome in a Swiss collective. J Pregnancy 2014; 2014:307535. [PMID: 25478229 PMCID: PMC4247945 DOI: 10.1155/2014/307535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Over half of all women in the world experience anemia during their pregnancy. Our aim was to investigate the relation between hemoglobin and iron status examined in second trimester and pregnancy outcome. Methods. In a prospective longitudinal study, 382 pregnant women were included. Blood samples were examined for hematological status and serum ferritin between 16 and 20 weeks and for hemoglobin before delivery. The adverse maternal and perinatal outcomes were determined. Regression analysis was performed to establish if anemia and low serum ferritin are risk factors for pregnancy complications. Results. There was no increase of complications in women with mild anemia and in women with depleted iron stores. The finding showed that mild iron deficiency anemia and depleted iron stores are not risk factors for adverse outcomes in iron supplemented women. Conclusions. Mild anemia and depleted iron stores detected early in pregnancy were not associated with adverse maternal and perinatal outcomes in iron supplemented women.
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Han Z, Lutsiv O, Mulla S, McDonald SD. Maternal height and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:721-746. [PMID: 22947405 DOI: 10.1016/s1701-2163(16)35337-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Preterm birth (PTB) and low birth weight (LBW) are the leading causes of neonatal morbidity and mortality, but the effect of maternal height on these outcomes continues to be debated. Our objective was to determine the relationships between maternal height and PTB and LBW. DATA SOURCES Medline and EMBASE were searched from their inceptions. STUDY SELECTION Studies with a reference group that assessed the effect of maternal height on PTB (< 37 weeks) and LBW (< 2500 grams) in singletons were included. DATA EXTRACTION Data were extracted independently by two reviewers. DATA SYNTHESIS Fifty-six studies were included involving 333 505 women. In the cohort studies, the unadjusted risk of PTB in short-statured women was increased (relative risk [RR] 1.23; 95% CI 1.11 to 1.37), as was the unadjusted risk of LBW (RR 1.81; 95% CI 1.47 to 2.23), although not all of the studies with adjusted data found the same association. Maternal tall stature was not associated with PTB (unadjusted RR 0.97; 95% CI 0.82 to 1.14), although LBW was decreased (unadjusted RR 0.56; 95% CI 0.46 to 0.69), but not in the adjusted data. CONCLUSION From our complete systematic review and meta-analyses, to our knowledge the first in this area, we conclude that short-statured women have higher unadjusted risks of PTB and LBW and tall women have approximately one half the unadjusted risk of LBW of women of reference height.
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Affiliation(s)
- Zhen Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Olha Lutsiv
- Faculty of Health Sciences, McMaster University, Hamilton ON
| | - Sohail Mulla
- Faculty of Health Sciences, McMaster University, Hamilton ON
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Diagnostic Imaging, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON
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Savajols E, Burguet A, Grimaldi M, Godoy F, Sagot P, Semama DS. Maternal haemoglobin and short-term neonatal outcome in preterm neonates. PLoS One 2014; 9:e89530. [PMID: 24586850 PMCID: PMC3934893 DOI: 10.1371/journal.pone.0089530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/22/2014] [Indexed: 12/05/2022] Open
Abstract
Objective To determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates. Study design We included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1st 2009 and December 31st 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt. Results The global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36–6.47]). There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values. Conclusion We show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.
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Affiliation(s)
- Elodie Savajols
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Antoine Burguet
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Marianne Grimaldi
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Florence Godoy
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Paul Sagot
- Department of Obstetrics, Centre Hospitalier Universitaire, Dijon, France
| | - Denis S. Semama
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
- * E-mail:
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Khanal V, Sauer K, Karkee R, Zhao Y. Factors associated with small size at birth in Nepal: further analysis of Nepal Demographic and Health Survey 2011. BMC Pregnancy Childbirth 2014; 14:32. [PMID: 24438693 PMCID: PMC3898999 DOI: 10.1186/1471-2393-14-32] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background The global Low Birth Weight (LBW) rate is reported to be 15.5% with more than 95% of these LBW infants being from developing countries. LBW is a major factor associated with neonatal deaths in developing countries. The determinants of low birth weight in Nepal have rarely been studied. This study aimed to identify the factors associated with small size at birth among under-five children. Methods Data from the 2011 Nepal Demographic and Health Survey (NDHS) were used. The association between small size at birth and explanatory variables were analysed using Chi-square tests (χ2) followed by logistic regression. Complex Sample Analysis was used to adjust for study design and sampling. Results A total of 5240 mother- singleton under five child pairs were included in the analysis, of which 936 (16.0%) children were reported as small size at birth. Of 1922 infants whose birth weight was recorded, 235 (11.5%) infants had low birth weight (<2500 grams). The mean birth weight was 3030 grams (standard deviation: 648.249 grams). The mothers who had no antenatal visits were more likely (odds ratio (OR) 1.315; 95% confidence interval (CI) (1.042-1.661)) to have small size infants than those who had attended four or more antenatal visits. Mothers who lived in the Far-western development region were more likely to have (OR 1.698; 95% CI (1.228-2.349)) small size infants as compared to mothers from the Eastern development region. Female infants were more likely (OR 1.530; 95% CI (1.245-1.880)) to be at risk of being small than males. Conclusion One in every six infants was reported to be small at birth. Attendance of antenatal care programs appeared to have a significant impact on birth size. Adequate antenatal care visits combined with counselling and nutritional supplementation should be a focus to reduce adverse birth outcomes such as small size at birth, especially in the geographically and economically disadvantaged areas such as Far-western region of Nepal.
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Affiliation(s)
- Vishnu Khanal
- School of Public Health, Curtin University, Perth, Australia.
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Messina JP, Mwandagalirwa K, Taylor SM, Emch M, Meshnick SR. Spatial and social factors drive anemia in Congolese women. Health Place 2013; 24:54-64. [PMID: 24042090 PMCID: PMC4801186 DOI: 10.1016/j.healthplace.2013.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
Anemia is common in women of child-bearing age in the Democratic Republic of the Congo (DRC). As part of the 2007 DRC Demographic and Health Survey (DHS), 4638 women of childbearing age (including 526 pregnant women) were tested for HIV and had the hemoglobin content of their blood recorded. We used the leftover dried blood spots to assess malaria prevalence using PCR assays. The DHS provided extensive information on individuals, as well as the geographic coordinates of household clusters which enabled us to derive several variables that characterize the spatial context of these clusters. Multilevel analyses were conducted to determine individual and contextual risk factors for anemia. Prevalence varied geographically; the odds of anemia were associated with both one's ethnic group and the amount and type of nearby agriculture. The odds were not affected by HIV or malaria status.
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Affiliation(s)
- Jane P Messina
- Department of Zoology, University of Oxford, Oxford, UK.
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Tzur T, Weintraub AY, Sergienko R, Sheiner E. Can anemia in the first trimester predict obstetrical complications later in pregnancy? J Matern Fetal Neonatal Med 2012; 25:2454-7. [PMID: 22708721 DOI: 10.3109/14767058.2012.703723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The present study examines whether there is an association between anemia during the first trimester and the risk to develop preterm delivery (PTD), intrauterine growth restriction, and other obstetrical complications. METHODS The study population included all registered births between 2000 and 2010. Anemia was defined as hemoglobin <10 g/dl. A comparison of obstetrical characteristics and perinatal outcomes was performed between women with and without anemia. Multiple logistic regression models were used to control for confounders. RESULTS The study population included 33,888 deliveries, of these 5.1% (1718) were with anemia during the first trimester. Women with anemia were significantly older, delivered earlier, and were more likely to be grand multiparous. There were significantly higher rates of PTD and low birth weight (LBW; <2500 g) among patients with anemia (12.3% vs. 9.3%; p < 0.001 and 11.7% vs. 9.0%; p < 0.001, respectively). On the contrary, no significant differences between the groups were noted regarding the rate of intrauterine growth restriction. Using a multivariable analysis, the significant association between anemia and PTD persisted (OR = 1.35; 95% CI 1.2-1.6, p < 0.01). CONCLUSIONS Anemia during the first trimester is significantly and independently associated with an increased risk for subsequent PTD.
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Affiliation(s)
- Tamar Tzur
- Department of Obstetrics & Gynecology, Be'er-Sheva, Israel.
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Bodeau-Livinec F, Briand V, Berger J, Xiong X, Massougbodji A, Day KP, Cot M. Maternal anemia in Benin: prevalence, risk factors, and association with low birth weight. Am J Trop Med Hyg 2011; 85:414-20. [PMID: 21896797 DOI: 10.4269/ajtmh.2011.10-0599] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied the prevalence of anemia during pregnancy and its relationship with low birth weight (LBW; birth weight < 2,500 g) in Benin. We analyzed 1,508 observations from a randomized controlled trial conducted from 2005 to 2008 showing equivalence on the risk of LBW between two drugs for Intermittent Preventive Treatment of malaria during pregnancy (IPTp). Despite IPTp, helminth prophylaxis, and iron and folic acid supplementations, the proportions of women with severe anemia (hemoglobin [Hb] concentration < 80 g/L) and anemia (Hb < 110 g/L) were high throughout pregnancy: 3.9% and 64.7% during the second and 3.7% and 64.1% during the third trimester, but 2.5% and 39.6% at the onset of labor, respectively. Compared with women without anemia (Hb ≥ 110 g/L) during the third trimester, women with severe anemia (Hb < 80 g/L) were at higher risk of LBW after adjustment for potential confounding factors (prevalence ratio [PR] = 2.8; 95% confidence interval [1.4-5.6]).
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Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev 2011; 69 Suppl 1:S23-9. [PMID: 22043878 PMCID: PMC3227006 DOI: 10.1111/j.1753-4887.2011.00429.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Anemia prevalence is highest in preschool children, women of reproductive age, and women who are pregnant. While the etiology of anemia is multifactorial, iron deficiency is the most commonly recognized nutritional cause. Observational studies imply that supplementation with iron or iron-folic acid should be started early in pregnancy, if not before, in order to prevent low-birth-weight and preterm delivery. Despite this, findings from clinical trials, even those conducted during early pregnancy, are equivocal. Recent follow-up studies of children born to women supplemented with iron-folic acid suggest that mortality is decreased and that the infant's iron endowment reflects the mother's iron status during pregnancy.
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Affiliation(s)
- Theresa O Scholl
- Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey 08104, USA.
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Ali AA, Rayis DA, Abdallah TM, Elbashir MI, Adam I. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan. BMC Res Notes 2011; 4:311. [PMID: 21867566 PMCID: PMC3224576 DOI: 10.1186/1756-0500-4-311] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/26/2011] [Indexed: 11/24/2022] Open
Abstract
Background Anaemia during pregnancy is major health problem. There is conflicting literature regarding the association between anaemia and its severity and maternal and perinatal outcomes. Methods This is a retrospective case-control study conducted at Kassala hospital, eastern Sudan. Medical files of pregnant women with severe anaemia (haemoglobin (Hb) < 7 g/dl, n = 303) who delivered from January 2008 to December 2010 were reviewed. Socio-demographic and obstetric data were analysed and compared with a similar number of women with mild/moderate anaemia (Hb = 7-10.9 g/dl, n = 303) and with no anaemia (Hb > 11 g/dl, n = 303). Logistic regression analysis was performed separately for each of the outcome measures: preeclampsia, eclampsia, preterm birth, low birth weight (LBW) and stillbirth. Results There were 9578 deliveries at Kassala hospital, 4012 (41.8%) women had anaemia and 303 (3.2%) had severe anaemia. The corrected risk for preeclampsia increased only in severe anaemia (OR = 3.6, 95% CI: 1.4-9.1, P = 0.007). Compared with women with no anaemia, the risk of LBW was 2.5 times higher in women with mild/moderate anaemia (95% CI: 1.1-5.7), and 8.0 times higher in women with severe anaemia (95% CI: 3.8-16.0). The risk of preterm delivery increased significantly with the severity of anaemia (OR = 3.2 for women with mild/moderate anaemia and OR = 6.6 for women with severe anaemia, compared with women with no anaemia). The corrected risk for stillbirth increased only in severe anaemia (OR = 4.3, 95% CI: 1.9-9.1, P < 0.001). Conclusions The greater the severity of the anaemia during pregnancy, the greater the risk of preeclampsia, preterm delivery, LBW and stillbirth. Preventive measures should be undertaken to decrease the prevalence of anaemia in pregnancy.
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Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2010; 40:65-101. [PMID: 21097954 DOI: 10.1093/ije/dyq195] [Citation(s) in RCA: 305] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite the current obesity epidemic, maternal underweight remains a common occurrence with potential adverse perinatal outcomes. Our objective was to determine the relationship between maternal underweight and preterm birth (PTB) and low birth weight (LBW) in singleton pregnancies in developing and developed countries. METHODS We followed the MOOSE consensus statement. We searched MEDLINE and EMBASE from their inceptions. We included studies that assessed the effect of maternal underweight compared with normal weight according to body mass index in singleton gestations on our two primary outcomes: PTB (<37 weeks) and LBW (<2500 g). Two assessors independently reviewed citations, extracted data and assessed quality. RESULTS A total of 78 studies were included involving 1 025 794 women. The overall risk of PTB was increased in the cohort studies of underweight women [adjusted relative risk (RR) 1.29, 95% confidence interval (CI) 1.15-1.46], as were the risks of spontaneous PTB (adjusted RR 1.32, 95% CI 1.10-1.57) and induced PTB (adjusted RR 1.21, 95% CI 1.07-1.36). Underweight women had an increased risk of an LBW infant (adjusted RR 1.64, 95% CI 1.38-1.94). In developed countries, underweight women had an increased risk of PTB (RR 1.22, 95% CI 1.15-1.30) but not in developing countries (RR 0.99, 95% CI 0.67-1.45). In both developed and developing countries, underweight women were at increased risk of having an LBW infant (RR 1.48, 95% CI 1.29-1.68, and RR 1.52, 95% CI 1.25-1.85, respectively). CONCLUSIONS In this systematic review and meta-analyses, we determined that singletons born to underweight women have higher risks of PTB (overall, spontaneous and induced) and LBW than those born to women with normal weight.
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Affiliation(s)
- Zhen Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiao Tong University, Shaanxi Province, PR China
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Hwang HS, Kim YH, Kwon JY, Park YW. Uterine and umbilical artery Doppler velocimetry as a predictor for adverse pregnancy outcomes in pregnant women with anemia. J Perinat Med 2010; 38:467-71. [PMID: 20443671 DOI: 10.1515/jpm.2010.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this study was to investigate the significance of Doppler ultrasound as a predictor for adverse pregnancy outcomes in Korean women with anemia during the third trimester of pregnancy. METHODS A retrospective study comparing women with (n=377) and without (n=3183) anemia was performed. Maternal anemia was defined as hemoglobin concentration <10 g/dL. Umbilical artery Doppler (UmA) and uterine artery Doppler (UtA) velocimetry was performed before delivery. RESULTS There were higher rates of small for gestational age, cesareans for fetal distress, and preterm birth among the anemic compared to non-anemic women. When maternal anemia was combined with abnormal Doppler, the odds ratio (OR) of adverse pregnancy outcome was further increased. Both abnormal UtA and UmA to predict adverse pregnancy outcome showed sensitivity, specificity, positive and negative predictive values of 41.2%, 97.4%, 85.9%, and 51.2%, respectively (OR 2.0; 95% confidence interval 1.2-2.3). CONCLUSIONS Doppler ultrasound examination could be used as a predictor for adverse pregnancy outcomes in women with anemia during the third trimester.
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Affiliation(s)
- Han Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Republic of Korea
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Chumak EL, Grjibovski AM. Anemia in pregnancy and its association with pregnancy outcomes in the Arctic Russian town of Monchegorsk, 1973-2002. Int J Circumpolar Health 2010; 69:265-77. [PMID: 20492761 DOI: 10.3402/ijch.v69i3.17603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the prevalence of anemia in pregnancy in Monchegorsk, north-west Russia, and to analyse its association with birth weight and the risk of stillbirth and preterm birth. STUDY DESIGN A registry study based on the Kola Birth Registry. METHODS A total of 24,525 women who gave birth in Monchegorsk between 1973 and 2002 and who had data on anemia in pregnancy in the Kola Birth Registry (KBR) were included in the study. For these women, data on maternal anemia, age, occupation, marital status, parity, smoking, alcohol, gestational age, birth weight, stillbirth and year of delivery were obtained from the KBR. Linear regression was used to study the effect of maternal anemia on birth weight. Logistic regression was used to estimate the effect of anemia on the risks of stillbirth and preterm birth, with adjustment for the above-mentioned characteristics. Crude and adjusted odds ratios (OR) were calculated. RESULTS The prevalence of anemia increased from 43.7% in the 1970s to 89.8% in the beginning of the 2000s. Infants born to women with anemia were 48 grams (95% CI 36, 59) heavier than infants of non-anemic women. Women with anemia in pregnancy were less likely to have stillbirths (OR=0.68; 95% CI 0.52, 0.89) and preterm births (OR=0.66; 95% CI 0.58, 0.75) after adjustment for potential confounders. CONCLUSION The prevalence of anemia in pregnant women as defined by the KBR more than doubled during the 30-year period. Positive associations with birth weight and negative associations with the risk of stillbirth and live preterm birth were observed.
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Affiliation(s)
- Elena L Chumak
- International School of Public Health, Northern State Medical University, Hospital No. 4, Arkhangelsk, Russia
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Iron deficiency anemia: pregnancy outcomes with or without iron supplementation. Nutrition 2010; 27:65-72. [PMID: 20381313 DOI: 10.1016/j.nut.2009.12.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 12/07/2009] [Accepted: 12/07/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes. METHODS Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. RESULTS Of 22,843 cases with congenital abnormalities, 3242 (14.2%), while of 38,151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation. CONCLUSION A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements.
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Shumpert MN, Salihu HM, Kirby RS. Impact of maternal anaemia on birth outcomes of teen twin pregnancies: a comparative analysis with mature young mothers. J OBSTET GYNAECOL 2009; 24:16-21. [PMID: 14675974 DOI: 10.1080/01443610310001620224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We investigated the impact of maternal anaemia on birth outcomes among adolescent twin pregnancies in the United States using the vital statistics records for matched multiple births covering the years 1995-1997 inclusive. The study group consisted of mothers aged 19 years or younger who had a twin pregnancy. A cohort of women aged 20-29 years with twin pregnancies served as the comparison group. The main birth outcomes of interest were: low and very low birth weight, preterm and very preterm delivery, small-for-gestational age, stillbirth, neonatal and perinatal mortality. Crude and adjusted odds ratios for the above outcomes were calculated using the generalised estimating equation framework (GEE) that captured both intra- and intercluster sources of heterogeneity. Although not statistically significant, we detected an elevated risk for stillbirth among anaemic women (20-30%) in either age cohort, a magnitude that is substantial at the population level as well as warranting further aetiological investigations.
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Affiliation(s)
- M Nicole Shumpert
- Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham 35294, USA
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Gao T, Zablith NR, Burns DH, Skinner CD, Koski KG. Second trimester amniotic fluid transferrin and uric acid predict infant birth outcomes. Prenat Diagn 2008; 28:810-4. [DOI: 10.1002/pd.1981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Thame M, Lewis J, Trotman H, Hambleton I, Serjeant G. The mechanisms of low birth weight in infants of mothers with homozygous sickle cell disease. Pediatrics 2007; 120:e686-93. [PMID: 17766509 DOI: 10.1542/peds.2006-2768] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A low mean birth weight is a constant finding in pregnancies of women with homozygous sickle cell disease. The factors responsible are largely unknown and have now been investigated in an 11-year retrospective analysis. METHODS Records for 126 pregnancies of mothers with homozygous sickle cell disease and 126 pregnancies of control women with an AA phenotype, matched according to age and date of delivery, were examined. Events during pregnancy and outcomes of pregnancy were recorded. RESULTS Pregnancy outcomes for mothers with homozygous sickle cell disease confirmed the lower birth weight, gestational age, and placental weight. A low birth weight in infants of mothers with homozygous sickle cell disease was strongly related to gestational age and placental weight and weakly related to reticulocyte counts and a history of preeclampsia in univariate analyses, but only gestational age and placental weight remained significant in multivariate analyses. No relationships were seen with maternal age, parity, anthropometric features, other hematologic features (hemoglobin levels, fetal hemoglobin levels, mean cell volume, and alpha-thalassemia), pregnancy-induced hypertension, or prepartum hospital admissions (expressed as number or total days). Compared with Jamaican standards, birth weight was affected more than head circumference or length in infants of mothers with homozygous sickle cell disease, indicating asymmetric growth retardation, which occurred for 27% of boys and 38% of girls (compared with 4% and 9%, respectively, among infants of control mothers). CONCLUSIONS A chronic condition such as homozygous sickle cell disease might have been expected to cause symmetric growth retardation throughout pregnancy. The finding of asymmetric retardation might indicate adverse factors emerging late in pregnancy and might have relevance for the poor pregnancy outcomes in such mothers.
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Affiliation(s)
- Minerva Thame
- Department of Obstetrics, Gynaecology, and Child Health, University of the West Indies, Mona, Kingston 7, Jamaica, West Indies.
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Ren A, Wang J, Ye RW, Li S, Liu JM, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. Int J Gynaecol Obstet 2007; 98:124-8. [PMID: 17585914 DOI: 10.1016/j.ijgo.2007.05.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 05/11/2007] [Accepted: 05/16/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between first-trimester hemoglobin (Hb) concentration and risk of low birth weight (LBW), preterm birth and small for gestational age (SGA). METHODS Data were obtained from a population-based prenatal care program in China. A total of 88,149 women who delivered during 1995-2000 and had their Hb measured in the first trimester were selected as study subjects. RESULTS The prevalence of anemia (Hb<110 g/L) was 22.1% in the first trimester. The risk of LBW, preterm birth and SGA was increased steadily with the decrease of first-trimester Hb concentration. After controlling for confounding factors, women with Hb 80-99 g/L had significantly higher risk for LBW (OR=1.44, 95% CI 1.17-1.78), preterm birth (OR=1.34, 95% CI 1.16-1.55) and SGA (OR=1.13, 95% CI 0.98-1.31) than women with Hb 100-119 g/L. No elevated risk was noted for women with Hb> or =120 g/L. CONCLUSION Low first-trimester Hb concentration increases the risk of LBW, preterm birth and SGA.
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Affiliation(s)
- A Ren
- Institute of Reproductive and Child Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100083, China.
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Hopenhayn C, Bush HM, Bingcang A, Hertz-Picciotto I. Association between arsenic exposure from drinking water and anemia during pregnancy. J Occup Environ Med 2006; 48:635-43. [PMID: 16766928 DOI: 10.1097/01.jom.0000205457.44750.9f] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Arsenic is associated with numerous health effects. We investigated the association between arsenic exposure from drinking water and anemia during pregnancy. METHODS We conducted a prospective cohort pregnancy study in two Chilean cities with contrasting drinking water arsenic levels: 40 microg/L versus <1 microg/L. This analysis included 810 women who gave birth to live, singleton infants and had at least one hemoglobin determination during pregnancy. RESULTS Arsenic exposed women were more likely to be anemic during pregnancy after adjusting for other factors. Furthermore, as pregnancy progressed, the prevalence of anemia rose more sharply among those in the exposed versus unexposed city: 49% versus 17%. CONCLUSION This study suggests an association between moderate arsenic in drinking water and anemia during pregnancy. Further research is needed to identify the specific types of anemia underlying the association.
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Affiliation(s)
- Claudia Hopenhayn
- College of Public Health, University of Kentucky, Lexington, Kentucky 40504, USA.
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Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2006; 122:182-6. [PMID: 16219519 DOI: 10.1016/j.ejogrb.2005.02.015] [Citation(s) in RCA: 223] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2004] [Revised: 12/14/2004] [Accepted: 02/19/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. METHODS A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. RESULTS During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (<37 weeks gestation) and low birthweight (<2500 g) were found among patients with anemia as compared to the non-anemic women (10.7% versus 9.0%, p < 0.001 and 10.5% versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4% versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95% CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95% CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95% CI 1.1-1.2, p = 0.001). CONCLUSION Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.
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Affiliation(s)
- Amalia Levy
- Department of Epidemiology and Health Services Evaluation, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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El Guindi W, Pronost J, Carles G, Largeaud M, El Gareh N, Montoya Y, Arbeille P. [Severe maternal anemia and pregnancy outcome]. ACTA ACUST UNITED AC 2005; 33:506-9. [PMID: 15567966 DOI: 10.1016/s0368-2315(04)96563-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effects of severe antenatal maternal anemia on pregnancy outcome. MATERIAL and methods. A retrospective study comparing 2 groups of pregnant women: 111 (pregnant women) with anemia (Hb < 8 g/dl), 111 non- anemic pregnant women (Hb >10 g/dl). Clinical and biological characteristics for both groups were compared. Data on the newborn babies were collected. RESULTS In the anemic group: iron deficiency was the most common cause of anemia (92.7%). There was no significant difference between the 2 groups with respect to age or parity. Maternal anemia was found to be significantly associated with more frequent preterm birth (29.2% vs 9.2%) and increased low birth weight (2933 g vs 3159 g). DISCUSSION The literature is not conclusive on the influence of anemia in pregnant women. More frequent preterm birth and low birth weight have been reported in the majority of studies considering mild to moderate maternal anemia (in contrast to our study where the mothers had severe anemia). Many studies indicated that routine iron supplementation during pregnancy may have beneficial effects on pregnancy outcome. Severe anemia in pregnancy may have adverse effects for the newborn and should be treated or prevented early in pregnancy.
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Affiliation(s)
- W El Guindi
- Service de Gynécologie-Obstétrique, Centre Hospitalier Franck Joly, 97320 Saint-Laurent-du-Maroni, Guyane, France
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Abrams ET, Milner DA, Kwiek J, Mwapasa V, Kamwendo DD, Zeng D, Tadesse E, Lema VM, Molyneux ME, Rogerson SJ, Meshnick SR. Risk factors and mechanisms of preterm delivery in Malawi. Am J Reprod Immunol 2005; 52:174-83. [PMID: 15274659 DOI: 10.1111/j.1600-0897.2004.00186.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM We examined risk factors and mechanisms of preterm delivery (PTD) in malaria-exposed pregnant women in Blantyre, Malawi. METHOD OF STUDY The human immunodeficiency virus (HIV), malaria, syphilis, and anemia were assessed in a cross-sectional study of 572 pregnant women. In a nested case-control study, chorioamnionitis (CAM) was examined; tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, macrophage inflammatory protein (MIP)-1alpha, monocyte chemotactic protein (MCP)-1, transforming growth factor (TGF)-beta, cortisol, and corticotropin-releasing hormone were measured in placental, maternal and/or cord blood. RESULTS HIV, infrequent antenatal clinic attendance, low-maternal weight, no intermittent preventive malaria therapy (IPT), and CAM were associated with PTD, while malaria was not. Of the 18 compartmental cytokine measurements, elevations in placental and/or cord IL-6 and IL-8 were associated with both CAM and PTD. In contrast, there was no overlap between the cytokines affected by malaria and those associated with PTD. CONCLUSIONS The HIV and CAM were the major infections associated with PTD in this study. CAM, but not malaria, causes PTD via its effect on proinflammatory cytokines.
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Marín G, Fazio P, Rubbo S, Baistrocchi A, Sager G, Gelemur A. [Prevalence of anaemia in pregnancy and analysis of the underlying factors]. Aten Primaria 2002; 29:158-63. [PMID: 11879602 PMCID: PMC7684053 DOI: 10.1016/s0212-6567(02)70528-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2001] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of anaemia and to evaluate the factors that condition its occurrence.Setting. Out-patient clinics in the La Plata area, Buenos Aires, Argentina. DESIGN Observational and prospective study. PARTICIPANTS All the pregnant women consulting for the first time, excluding those with prior pathology or regular use of medical drugs. MEASUREMENTS Anaemia was defined at values of Hb < 11 g/dl. Questionnaires were administered for general data and the type of nutrition, and a complete haematological report was compiled. RESULTS 1218 pregnant women started the study. Anaemia was detected in 196 of them (16%), with average Hb 9.88 g/dl. Between normal and anaemic pregnant women, the following differences were found between the first and second consultations: weight (64.44 vs 59.50, p < 0.00001), family income (US$744.36 vs 568.28, p < 0.0001), kilocalories ingested (2,488.44 vs 2,204.28, p = 0.01), percentage of proteins in diet (15.73 vs 13.69, p = 0.002), and weekly iron consumption (15.24 mg vs 13.04, p < 0.0001). CONCLUSIONS Pregnant women run a greater risk of suffering anaemia if they have diets of < 1800 kcal, < 13% proteins, less than 7 mg of iron per week, and haemic iron < 10%; and family income below US$400. Ensuring a proper diet and improving the social and economic conditions of this population group will reduce the risk of anaemia during pregnancy and its perinatal consequences.
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Affiliation(s)
- G.H. Marín
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
| | - P. Fazio
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
| | - S. Rubbo
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
| | - A. Baistrocchi
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
| | - G. Sager
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
| | - A. Gelemur
- Hospital San Martín. Ministerio de Salud de la Provincia de Buenos Aires-La Plata (Argentina)
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Current Awareness. Prenat Diagn 2001. [DOI: 10.1002/pd.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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