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Iriarte-Gahete M, Tarancon-Diez L, Garrido-Rodríguez V, Leal M, Pacheco YM. Absolute and functional iron deficiency: Biomarkers, impact on immune system, and therapy. Blood Rev 2024:101227. [PMID: 39142965 DOI: 10.1016/j.blre.2024.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
Iron is essential for numerous physiological processes and its deficiency often leads to anemia. Iron deficiency (ID) is a global problem, primarily affecting reproductive-age women and children, especially in developing countries. Diagnosis uses classical biomarkers like ferritin or transferrin saturation. Recent advancements include using soluble transferrin receptor (sTfR) or hepcidin for improved detection and classification of absolute and functional iron deficiencies, though mostly used in research. ID without anemia may present symptoms like asthenia and fatigue, even without relevant clinical consequences. ID impacts not only red-blood cells but also immune system cells, highlighting its importance in global health and immune-related comorbidities. Managing ID, requires addressing its cause and selecting appropriate iron supplementation. Various improved oral and intravenous products are available, but further research is needed to refine treatment strategies. This review updates on absolute and functional iron deficiencies, their relationships with the immune system and advancements in diagnosis and therapies.
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Affiliation(s)
- Marianela Iriarte-Gahete
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Laura Tarancon-Diez
- Group of Infections in the Pediatric Population, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Vanesa Garrido-Rodríguez
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Manuel Leal
- Internal Medicine Service, Viamed Santa Ángela de la Cruz Hospital, Seville, Spain
| | - Yolanda María Pacheco
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain; Universidad Loyola Andalucía, Facultad de Ciencias de la Salud, Campus Sevilla, 41704, Dos Hermanas, Sevilla, Spain.
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Morita A, Higeta D, Kitahara Y, Inoue M, Iwase A. Management of Mild Postpartum Anemia: Is Iron Administration Effective? Cureus 2024; 16:e65276. [PMID: 39184625 PMCID: PMC11343339 DOI: 10.7759/cureus.65276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background This study aimed to investigate the efficacy of iron therapy in the treatment of mild postpartum anemia. Methods We conducted a case-control study involving women who underwent cesarean section at our hospital between 2015 and 2020. Following propensity score matching, participants were categorized into two groups based on whether or not they received iron therapy. These patients were evaluated for mean hemoglobin (Hb) levels on the seventh postoperative day (POD 7), the percentage of subjects achieving Hb greater than 10 g/dL on POD 7, and the incidence of adverse events. The efficacy of iron administration was evaluated using a superiority test, and receiver operating characteristic analyses were employed to generate area under the receiver operating characteristic curves (AUROC). Results The mean Hb level on POD 7 was 10.12 g/dL in the iron group and 9.89 g/dL in the iron-free group (P = 0.206). The superiority test revealed that the percentage of subjects achieving Hb levels greater than 10 g/dL on POD 7 was 56.1% in the iron group and 48.8% in the iron-free group (P = 0.880), indicating that the iron group did not demonstrate superiority over the iron-free group. The incidence of adverse events was significantly higher in the iron group (P = 0.027). The highest AUROC was observed with preoperative mean corpuscular Hb, measuring 0.632 (95% CI: 0.509-0.755), with a cutoff point of 28.5 pg. Conclusion Consideration should be given to the uniform administration of iron for the management of mild postpartum anemia.
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Affiliation(s)
- Akihito Morita
- Obstetrics and Gynecology, Gunma University Hospital, Maebashi, JPN
| | - Daisuke Higeta
- Obstetrics and Gynecology, Gunma University Hospital, Maebashi, JPN
| | | | - Maki Inoue
- Obstetrics and Gynecology, Gunma University Hospital, Maebashi, JPN
| | - Akira Iwase
- Obstetrics and Gynecology, Gunma University Hospital, Maebashi, JPN
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Iolascon A, Andolfo I, Russo R, Sanchez M, Busti F, Swinkels D, Aguilar Martinez P, Bou-Fakhredin R, Muckenthaler MU, Unal S, Porto G, Ganz T, Kattamis A, De Franceschi L, Cappellini MD, Munro MG, Taher A. Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. Hemasphere 2024; 8:e108. [PMID: 39011129 PMCID: PMC11247274 DOI: 10.1002/hem3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.
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Affiliation(s)
- Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Mayka Sanchez
- Department of Basic Sciences, Iron metabolism: Regulation and Diseases Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine and Azienda Ospedaliera Universitaria Integrata of Verona, EuroBloodNEt Referral Center for Iron Disorders, Policlinico G.B. Rossi University of Verona Verona Italy
| | - Dorine Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory (TML 830) Radboud University Medical Center Nijmegen The Netherlands
| | - Patricia Aguilar Martinez
- Department of Hematological Biology, Reference Center on Rare Red Cell Disorders Montpellier University Hospital Montpellier France
| | - Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Martina U Muckenthaler
- Molecular Medicine Partnership Unit European Molecular Biology Laboratory Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg Heidelberg Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg Germany
| | - Sule Unal
- Department of Pediatric Hematology Hacettepe University Ankara Turkey
| | - Graça Porto
- HematologyServiço de Imuno-hemoterapia, CHUdSA-Centro Hospitalar Universitário de Santo António Porto Portugal
| | - Tomas Ganz
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National & Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Lucia De Franceschi
- Department of Medicine University of Verona & AOUI Verona, Policlinico GB Rossi Verona Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital Milan Italy
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology David Geffen School of Medicine Los Angeles California USA
| | - Ali Taher
- Division of Hematology-Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Armah A, Jackson C, Kolba N, Gracey PR, Shukla V, Padilla-Zakour OI, Warkentin T, Tako E. Effects of Pea ( Pisum sativum) Prebiotics on Intestinal Iron-Related Proteins and Microbial Populations In Vivo ( Gallus gallus). Nutrients 2024; 16:1856. [PMID: 38931211 PMCID: PMC11206367 DOI: 10.3390/nu16121856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Iron deficiency remains a public health challenge globally. Prebiotics have the potential to improve iron bioavailability by modulating intestinal bacterial population, increasing SCFA production, and stimulating expression of brush border membrane (BBM) iron transport proteins among iron-deficient populations. This study intended to investigate the potential effects of soluble extracts from the cotyledon and seed coat of three pea (Pisum sativum) varieties (CDC Striker, CDC Dakota, and CDC Meadow) on the expression of BBM iron-related proteins (DCYTB and DMT1) and populations of beneficial intestinal bacteria in vivo using the Gallus gallus model by oral gavage (one day old chicks) with 1 mL of 50 mg/mL pea soluble extract solutions. The seed coat treatment groups increased the relative abundance of Bifidobacterium compared to the cotyledon treatment groups, with CDC Dakota seed coat (dark brown pigmented) recording the highest relative abundance of Bifidobacterium. In contrast, CDC Striker Cotyledon (dark-green-pigmented) significantly increased the relative abundance of Lactobacillus (p < 0.05). Subsequently, the two dark-pigmented treatment groups (CDC Striker Cotyledon and CDC Dakota seed coats) recorded the highest expression of DCYTB. Our study suggests that soluble extracts from the pea seed coat and dark-pigmented pea cotyledon may improve iron bioavailability by affecting intestinal bacterial populations.
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Affiliation(s)
- Abigail Armah
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Cydney Jackson
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Nikolai Kolba
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Peter R. Gracey
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Viral Shukla
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Olga I. Padilla-Zakour
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
| | - Tom Warkentin
- Crop Development Centre, Department of Plant Sciences, University of Saskatchewan, 51 Campus Dr., Saskatoon, SK S7N 5A8, Canada;
| | - Elad Tako
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA; (A.A.); (C.J.); (N.K.); (P.R.G.); (V.S.); (O.I.P.-Z.)
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Katz D, Griffel A, Granozio S, Koenig G, Lin HM. Impact of cell salvage on hematocrit and post-partum anemia in low hemorrhage risk elective cesarean delivery. Transfus Apher Sci 2024; 63:103923. [PMID: 38637253 DOI: 10.1016/j.transci.2024.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Postpartum anemia is a significant contributor to peripartum morbidity. The utilization of cell salvage in low risk cases and its impact on postpartum anemia has not been investigated. We therefore aimed to examine the impact of autologous blood transfusion/cell salvage in routine cesarean delivery on postoperative hematocrit and anemia. STUDY DESIGN AND METHODS Retrospective cohort study from a perfusion database from a large academic center where cell salvage is performed at the discretion of the obstetrical team. Data from 99 patients was obtained. All patients were scheduled elective cesarean deliveries that took place on the labor and delivery floor. Thirty patients in the cohort had access to cell salvage where autologous blood was transfused after surgery. Pre-procedural hemoglobin/hematocrit measurements were obtained along will postpartum samples that were collected on post-partum day one. RESULTS The median amount of blood returned to cell salvage patients was 250 mL [206-250]. Hematocrit changes in cell salvage patients was significantly smaller than controls (-1.85 [-3.87, -0.925] vs -6.4 [-8.3, -4.75]; p < 0.001). The odds of developing new anemia following surgery were cut by 74% for the cell salvage treatment group, compared to the odds for the control group (OR = 0.26 (0.07-0.78); p = 0.028) DISCUSSION: Despite losing more blood on average, patients with access to cell salvage had higher postoperative HCT, less postpartum anemia, and no difference in complications related to transfusion. The utilization of cell salvage for routine cesarean delivery warrants further research.
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Affiliation(s)
- Daniel Katz
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, & Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Annalin Griffel
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Granozio
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gary Koenig
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, & Reproductive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, 06510, USA
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Neef V, Choorapoikayil S, Hof L, Meybohm P, Zacharowski K. Current concepts in postpartum anemia management. Curr Opin Anaesthesiol 2024; 37:234-238. [PMID: 38390913 PMCID: PMC11062600 DOI: 10.1097/aco.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Suma Choorapoikayil
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Lotta Hof
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
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Neef V. Strategies to increase patient safety in obstetric anesthesia. Curr Opin Anaesthesiol 2024; 37:205-206. [PMID: 38654544 DOI: 10.1097/aco.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
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Rao RB. Biomarkers of Brain Dysfunction in Perinatal Iron Deficiency. Nutrients 2024; 16:1092. [PMID: 38613125 PMCID: PMC11013337 DOI: 10.3390/nu16071092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Iron deficiency in the fetal and neonatal period (perinatal iron deficiency) bodes poorly for neurodevelopment. Given its common occurrence and the negative impact on brain development, a screening and treatment strategy that is focused on optimizing brain development in perinatal iron deficiency is necessary. Pediatric societies currently recommend a universal iron supplementation strategy for full-term and preterm infants that does not consider individual variation in body iron status and thus could lead to undertreatment or overtreatment. Moreover, the focus is on hematological normalcy and not optimal brain development. Several serum iron indices and hematological parameters in the perinatal period are associated with a risk of abnormal neurodevelopment, suggesting their potential use as biomarkers for screening and monitoring treatment in infants at risk for perinatal iron deficiency. A biomarker-based screening and treatment strategy that is focused on optimizing brain development will likely improve outcomes in perinatal iron deficiency.
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Affiliation(s)
- Raghavendra B. Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
- Masonic Institute for the Developing Brain, Minneapolis, MN 55414, USA
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Mikulska J, Pietrzak D, Rękawek P, Siudaj K, Walczak-Nowicka ŁJ, Herbet M. Celiac disease and depressive disorders as nutritional implications related to common factors - A comprehensive review. Behav Brain Res 2024; 462:114886. [PMID: 38309373 DOI: 10.1016/j.bbr.2024.114886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
Celiac disease (CD) is an immune-mediated disease affecting the small intestine. The only treatment strategy for CD is the gluten-free diet (GFD). One of the more common mental disorders in CD patients is major depressive disorder (MDD). The influence of GFD on the occurrence of MDD symptoms in patients with CD will be evaluated. This diet often reduces nutritional deficiencies in these patients and also helps to reduce depressive symptoms. Both disease entities are often dominated by the same deficiencies of nutrients such as iron, zinc, selenium, iodine, or B and D vitamins. Deficiencies of particular components in CD can favor MDD and vice versa. Gluten can adversely affect the mental state of patients without CD. Also, intestinal microbiota may play an important role in the described process. This work aims to comprehensively assess the common factors involved in the pathomechanisms of MDD and CD, with particular emphasis on nutrient imbalances. Given the complexity of both disease entities, and the many common links, more research related to improving mental health in these patients and the implementation of a GFD would need to be conducted, but it appears to be a viable pathway to improving the quality of life and health of people struggling with CD and MDD. Therefore, probiotics, micronutrients, macronutrients, and vitamin supplements are recommended to reduce the risk of MDD, given that they may alleviate the symptoms of both these disease entities. In turn, in patients with MDD, it is worth considering testing for CD.
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Affiliation(s)
- Joanna Mikulska
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Diana Pietrzak
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Paweł Rękawek
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Krystian Siudaj
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Łucja Justyna Walczak-Nowicka
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland.
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
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Caljé E, Oyston C, Wang Z, Bloomfield F, Marriott J, Dixon L, Groom K. The fatigue after infusion or transfusion pilot trial and feasibility study: A three-armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia. Transfusion 2024; 64:301-314. [PMID: 38149691 DOI: 10.1111/trf.17621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Evidence for the management of moderate-to-severe postpartum anemia is limited. A randomized trial is needed; recruitment may be challenging. STUDY DESIGN AND METHODS Randomized pilot trial with feasibility surveys. INCLUSION hemoglobin 65-79 g/L, ≤7 days of birth, hemodynamically stable. EXCLUSION ongoing heavy bleeding; already received, or contraindication to intravenous (IV)-iron or red blood cell transfusion (RBC-T). Intervention/control: IV-iron; RBC-T; or IV-iron and RBC-T. PRIMARY OUTCOME number of recruits; proportion of those approached; proportion considered potentially eligible. SECONDARY OUTCOMES fatigue, depression, baby-feeding, and hemoglobin at 1, 6 and 12 weeks; ferritin at 6 and 12 weeks. Surveys explored attitudes to trial participation. RESULTS Over 16 weeks and three sites, 26/34 (76%) women approached consented to trial participation, including eight (31%) Māori women. Of those potentially eligible, 26/167 (15.6%) consented to participate. Key participation enablers were altruism and study relevance. For clinicians and stakeholders the availability of research assistance was the key barrier/enabler. Between-group rates of fatigue and depression were similar. Although underpowered to address secondary outcomes, IV-iron and RBC-T compared with RBC-T were associated with higher hemoglobin concentrations at 6 (mean difference [MD] 11.7 g/L, 95% confidence interval [CI] 2.7-20.7) and 12 (MD 12.8 g/L, 95% CI 1.5-24.2) weeks, and higher ferritin concentrations at 6 weeks (MD 136.8 mcg/L, 95% CI 76.6-196.9). DISCUSSION Willingness to participate supports feasibility for a future trial assessing the effectiveness of IV-iron and RBC-T for postpartum anemia. Dedicated research assistance will be critical to the success of an appropriately powered trial including women-centered outcomes.
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Affiliation(s)
- Esther Caljé
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Zeke Wang
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Bombač Tavčar L, Hrobat H, Gornik L, Preložnik Zupan I, Vidmar Šimic M, Pečlin P, Kavšek G, Lučovnik M. Maternal Fatigue after Postpartum Anemia Treatment with Intravenous Ferric Carboxymaltose vs. Intravenous Ferric Derisomaltose vs. Oral Ferrous Sulphate: A Randomized Controlled Trial. J Clin Med 2024; 13:758. [PMID: 38337452 PMCID: PMC10856024 DOI: 10.3390/jcm13030758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Postpartum anemia is a common maternal complication and is recognized as a cause of impaired quality of life, reduced cognitive abilities, and fatigue. Efficient iron supplementation for the treatment of postpartum anemia is an essential component of high-quality maternal care. The optimal mode of iron supplementation has not been determined yet, whether oral or intravenous. The objective of this study was to compare postpartum anemia treatment with intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate. (2) Methods: A single-center, open-label, randomized controlled trial. Women with hemoglobin < 100 g/L within 48 h postpartum were randomly allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose, or oral ferrous sulfate. Intravenous iron was given in one or two doses, while ferrous sulfate was given as two 80 mg tablets once daily. The primary outcome was maternal fatigue measured by the Multidimensional Fatigue Inventory (MFI) six weeks postpartum. Hemoglobin, ferritin, and transferrin saturation levels were analyzed as secondary outcomes. A Kruskal-Wallis test was used for group comparison (p < 0.05 significant). (3) Results: Three hundred women were included. The MFI score at six weeks postpartum did not differ between groups (median 38 (inter-quartile range (IQR) 29-47) in the ferric carboxymaltose group, median 34 (IQR 26-42) in the ferric derisomaltose group, and median 36 (IQR 25-47) in the ferrous sulfate group; p = 0.26). Participants receiving oral iron had lower levels of hemoglobin (135 (131-139) vs. 134 (129-139) vs. 131 (125-137) g/L; p = 0.008), ferritin (273 (198-377) vs. 187 (155-246) vs. 24 (17-37) µg/L; p < 0.001) and transferrin saturation (34 (28-38) vs. 30 (23-37) vs. 24 (17-37) %; p < 0.001) than those receiving ferric carboxymaltose or ferric derisomaltose. (4) Conclusions: Intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate had similar impacts on maternal fatigue at six weeks postpartum despite improved laboratory parameters in the intravenous groups.
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Affiliation(s)
- Lea Bombač Tavčar
- Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; (M.V.Š.); (P.P.); (G.K.); (M.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (H.H.); (L.G.); (I.P.Z.)
| | - Hana Hrobat
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (H.H.); (L.G.); (I.P.Z.)
| | - Lea Gornik
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (H.H.); (L.G.); (I.P.Z.)
| | - Irena Preložnik Zupan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (H.H.); (L.G.); (I.P.Z.)
- Department of Hematology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Marijana Vidmar Šimic
- Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; (M.V.Š.); (P.P.); (G.K.); (M.L.)
| | - Polona Pečlin
- Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; (M.V.Š.); (P.P.); (G.K.); (M.L.)
| | - Gorazd Kavšek
- Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; (M.V.Š.); (P.P.); (G.K.); (M.L.)
| | - Miha Lučovnik
- Department of Perinatology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; (M.V.Š.); (P.P.); (G.K.); (M.L.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (H.H.); (L.G.); (I.P.Z.)
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Gundacker A, Glat M, Wais J, Stoehrmann P, Pollak A, Pollak DD. Early-life iron deficiency persistently disrupts affective behaviour in mice. Ann Med 2023; 55:1265-1277. [PMID: 37096819 PMCID: PMC10132221 DOI: 10.1080/07853890.2023.2191003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/09/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND/OBJECTIVE Iron deficiency (ID) is the most common nutrient deficiency, affecting two billion people worldwide, including about 30% of pregnant women. During gestation, the brain is particularly vulnerable to environmental insults, which can irrevocably impair critical developmental processes. Consequently, detrimental consequences of early-life ID for offspring brain structure and function have been described. Although early life ID has been associated with an increased long-term risk for several neuropsychiatric disorders, the effect on depressive disorders has remained unresolved. MATERIALS AND METHODS A mouse model of moderate foetal and neonatal ID was established by keeping pregnant dams on an iron-deficient diet throughout gestation until postnatal day 10. The ensuing significant decrease of iron content in the offspring brain, as well as the impact on maternal behaviour and offspring vocalization was determined in the first postnatal week. The consequences of early-life ID for depression- and anxiety-like behaviour in adulthood were revealed employing dedicated behavioural assays. miRNA sequencing of hippocampal tissue of offspring revealed specific miRNAs signatures accompanying the behavioural deficits of foetal and neonatal ID in the adult brain. RESULTS Mothers receiving iron-deficient food during pregnancy and lactation exhibited significantly less licking and grooming behaviour, while active pup retrieval and pup ultrasonic vocalizations were unaltered. Adult offspring with a history of foetal and neonatal ID showed an increase in depression- and anxiety-like behaviour, paralleled by a deranged miRNA expression profile in the hippocampus, specifically levels of miR200a and miR200b. CONCLUSION ID during the foetal and neonatal periods has life-long consequences for affective behaviour in mice and leaves a specific and persistent mark on the expression of miRNAs in the brain. Foetal and neonatal ID needs to be further considered as risk factor for the development of depression and anxiety disorders later in life.Key MessagesMarginal reduction of gestational alimentary iron intake decreases brain iron content of the juvenile offspring.Early-life ID is associated with increased depression- and anxiety-like behaviour in adulthood.Reduction of maternal alimentary iron intake during pregnancy is reflected in an alteration of miRNA signatures in the adult offspring brain.
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Affiliation(s)
- Anna Gundacker
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Micaela Glat
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonathan Wais
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Peter Stoehrmann
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Arnold Pollak
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniela D. Pollak
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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13
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Wu Q, Ren Q, Meng J, Gao WJ, Chang YZ. Brain Iron Homeostasis and Mental Disorders. Antioxidants (Basel) 2023; 12:1997. [PMID: 38001850 PMCID: PMC10669508 DOI: 10.3390/antiox12111997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Iron plays an essential role in various physiological processes. A disruption in iron homeostasis can lead to severe consequences, including impaired neurodevelopment, neurodegenerative disorders, stroke, and cancer. Interestingly, the link between mental health disorders and iron homeostasis has not received significant attention. Therefore, our understanding of iron metabolism in the context of psychological diseases is incomplete. In this review, we aim to discuss the pathologies and potential mechanisms that relate to iron homeostasis in associated mental disorders. We propose the hypothesis that maintaining brain iron homeostasis can support neuronal physiological functions by impacting key enzymatic activities during neurotransmission, redox balance, and myelination. In conclusion, our review highlights the importance of investigating the relationship between trace element nutrition and the pathological process of mental disorders, focusing on iron. This nutritional perspective can offer valuable insights for the clinical treatment of mental disorders.
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Affiliation(s)
- Qiong Wu
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, Hebei University of Chinese Medicine, Shijiazhuang 050200, China;
- Ministry of Education Key Laboratory of Molecular and Cellular Biology, The Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, No. 20 Nan’erhuan Eastern Road, Shijiazhuang 050024, China; (Q.R.); (J.M.)
| | - Qiuyang Ren
- Ministry of Education Key Laboratory of Molecular and Cellular Biology, The Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, No. 20 Nan’erhuan Eastern Road, Shijiazhuang 050024, China; (Q.R.); (J.M.)
| | - Jingsi Meng
- Ministry of Education Key Laboratory of Molecular and Cellular Biology, The Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, No. 20 Nan’erhuan Eastern Road, Shijiazhuang 050024, China; (Q.R.); (J.M.)
| | - Wei-Juan Gao
- Hebei Key Laboratory of Chinese Medicine Research on Cardio-Cerebrovascular Disease, Hebei University of Chinese Medicine, Shijiazhuang 050200, China;
| | - Yan-Zhong Chang
- Ministry of Education Key Laboratory of Molecular and Cellular Biology, The Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, No. 20 Nan’erhuan Eastern Road, Shijiazhuang 050024, China; (Q.R.); (J.M.)
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14
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Reid B, East P, Blanco E, Doom J, Burrows R, Correa-Burrows P, Lozoff B, Gahagan S. Early-life adversity is associated with poor iron status in infancy. Dev Psychopathol 2023; 35:1856-1867. [PMID: 35678178 PMCID: PMC9732147 DOI: 10.1017/s0954579422000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exposure to early-life adversity (ELA) and iron deficiency early in life are known risk factors for suboptimal brain and socioemotional development. Iron deficiency may arise from and co-occur with ELA, which could negatively affect development. In the present study, we investigated whether ELA is associated with iron deficiency in infants receiving no iron supplementation. This study is a secondary analysis of extant data collected in the 1990s; participants were healthy infants from working-class communities in Santiago, Chile (N = 534, 45.5% female). We measured stressful life events, maternal depression, and low home support for child development during infancy and assessed iron status when the infant was 12 months old. Slightly more than half of the infants were iron-deficient (51%), and 25.8% were iron-deficient anemic at 12 months. Results indicated that ELA was associated with lower iron levels and iron deficiency at 12 months. The findings are consistent with animal and human prenatal models of stress and iron status and provide evidence of the association between postnatal ELA and iron status in humans. The findings also highlight a nutritional pathway by which ELA may impact development and present a nutritionally-focused avenue for future research on ELA and psychopathology.
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Affiliation(s)
- B.M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - P. East
- Department of Pediatrics, University of California, San Diego
| | - E. Blanco
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile
| | - J.R. Doom
- Department of Psychology, University of Denver
| | - R.A. Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - P. Correa-Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - B. Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - S Gahagan
- Department of Pediatrics, University of California, San Diego
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15
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Serati M, Espuña-Pons M, Mouton-Puglisi A, Padoa A. Iron deficiency and sexual dysfunction in women. Sex Med Rev 2023; 11:342-348. [PMID: 37433756 DOI: 10.1093/sxmrev/qead028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. OBJECTIVES This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. METHODS The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. RESULTS Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. CONCLUSION IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.
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Affiliation(s)
- Maurizio Serati
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, University of Insubria, 21100 Varese, Italy
| | - Montserrat Espuña-Pons
- Department of Obstetrics and Gynecology, University of Barcelona, 08036 Barcelona, Spain
| | | | - Anna Padoa
- Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, 7033001 Tsrifin, Israel
- Sackler School of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
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16
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Yourkavitch J, Obara H, Usmanova G, Semrau KEA, Moller AB, Garcia-Casal MN, Daru J. A rapid landscape review of postpartum anaemia measurement: challenges and opportunities. BMC Public Health 2023; 23:1454. [PMID: 37518003 PMCID: PMC10388528 DOI: 10.1186/s12889-023-16383-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50-80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia. METHODS A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews. RESULTS In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases. CONCLUSIONS This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting.
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Affiliation(s)
| | - Hiromi Obara
- National Center for Global Health and Medicine, Bureau of International Health Cooperation, Tokyo, Japan
| | | | - Katherine E A Semrau
- Ariadne Labs | Brigham & Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ann-Beth Moller
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | | | - Jahnavi Daru
- Wolfson Institute of Population Health Science, Women's Health Research Unit, Queen Mary University of London, London, UK
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Rupanagunta GP, Nandave M, Rawat D, Upadhyay J, Rashid S, Ansari MN. Postpartum depression: aetiology, pathogenesis and the role of nutrients and dietary supplements in prevention and management. Saudi Pharm J 2023; 31:1274-1293. [PMID: 37304359 PMCID: PMC10250836 DOI: 10.1016/j.jsps.2023.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Postpartum depression (PPD) is a challenging psychological disorder faced by 10-30% of mothers across the globe. In India, it occurs among 22% of mothers. Its aetiology and pathophysiology aren't fully understood as of today but multiple theories on the interplay of hormones, neurotransmitters, genetics, epigenetics, nutrients, socio-environmental factors, etc. exist. Nutrients are not only essential for the synthesis of neurotransmitters, but they may also indirectly influence genomic pathways that methylate DNA, and there is evidence for molecular associations between nutritional quality and psychological well-being. Increased behavioural disorders have been attributed to macro- and micronutrient deficiencies, and dietary supplementation has been effective in treating several neuropsychiatric illnesses. Nutritional deficiencies occur frequently in women, especially during pregnancy and breastfeeding. The aim of this study was to perform a comprehensive literature review of evidence-based research in order to identify, gather and summarize existing knowledge on PPD's aetiology, pathophysiology, and the role of nutrients in its prevention as well as management. The possible mechanisms of action of nutrients are also presented here. Study findings show that the risk of depression increases when omega-3 fatty acid levels are low. Both fish oil and folic acid supplements have been used to effectively treat depression. Antidepressant efficacy is lowered by folate insufficiency. Folate, vitamin B12, iron, etc. deficiencies are more prevalent in depressed people than in non-depressed people. Serum cholesterol levels and plasma tryptophan levels are found to be inversely correlated with PPD. Serum vitamin D levels were associated inversely with perinatal depression. These findings highlight the importance of adequate nutrition in the antepartum period. Given that nutritional therapies can be affordable, safe, simple to use, and are typically well-accepted by patients, more focus should be placed on dietary variables in PPD.
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Affiliation(s)
- Gnana Prasoona Rupanagunta
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, University of Petroleum and Energy Studies, Energy Acres Campus, Bidholi, Dehradun 248007, Uttarakhand, India
| | - Mukesh Nandave
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), MB Road, Pushp Vihar, Sector 3, New Delhi 110017, India
| | - Divya Rawat
- Department of Allied Health Sciences, School of Health Sciences and Technology, University of Petroleum and Energy Studies, Energy Acres Campus, Bidholi, Dehradun 248007, Uttarakhand, India
| | - Jyoti Upadhyay
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, University of Petroleum and Energy Studies, Energy Acres Campus, Bidholi, Dehradun 248007, Uttarakhand, India
| | - Summya Rashid
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mohd Nazam Ansari
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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18
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Susič D, Bombač Tavčar L, Lučovnik M, Hrobat H, Gornik L, Gradišek A. Wellbeing Forecasting in Postpartum Anemia Patients. Healthcare (Basel) 2023; 11:1694. [PMID: 37372812 DOI: 10.3390/healthcare11121694] [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: 04/04/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Postpartum anemia is a very common maternal health problem and remains a persistent public health issue globally. It negatively affects maternal mood and could lead to depression, increased fatigue, and decreased cognitive abilities. It can and should be treated by restoring iron stores. However, in most health systems, there is typically a six-week gap between birth and the follow-up postpartum visit. Risks of postpartum maternal complications are usually assessed shortly after birth by clinicians intuitively, taking into account psychosocial and physical factors, such as the presence of anemia and the type of iron supplementation. In this paper, we investigate the possibility of using machine-learning algorithms to more reliably forecast three parameters related to patient wellbeing, namely depression (measured by Edinburgh Postnatal Depression Scale-EPDS), overall tiredness, and physical tiredness (both measured by Multidimensional Fatigue Inventory-MFI). Data from 261 patients were used to train the forecasting models for each of the three parameters, and they outperformed the baseline models that always predicted the mean values of the training data. The mean average error of the elastic net regression model for predicting the EPDS score (with values ranging from 0 to 19) was 2.3 and outperformed the baseline, which already hints at the clinical usefulness of using such a model. We further investigated what features are the most important for this prediction, where the EDPS score and both tiredness indexes at birth turned out to be by far the most prominent prediction features. Our study indicates that the machine-learning model approach has the potential for use in clinical practice to predict the onset of depression and severe fatigue in anemic patients postpartum and potentially improve the detection and management of postpartum depression and fatigue.
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Affiliation(s)
- David Susič
- Department of Intelligent Systems, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Lea Bombač Tavčar
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia
| | - Miha Lučovnik
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Hana Hrobat
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia
| | - Lea Gornik
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia
| | - Anton Gradišek
- Department of Intelligent Systems, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
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Saad AF, Stepanek R, Kothmann M, Wilson-Jimenez M, McCoy L, Aguillon B, Salazar A, Saade GR. Intravenous Iron Compared With Oral Iron Supplementation for the Treatment of Postpartum Anemia: A Randomized Controlled Trial. Obstet Gynecol 2023; 141:1052-1055. [PMID: 37486650 DOI: 10.1097/aog.0000000000005143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 07/25/2023]
Abstract
CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT05047211.
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Affiliation(s)
- Antonio F Saad
- Division of Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, Texas
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20
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Wemakor A, Kpewou DE, Wemah K. Correlates of haemoglobin level in mothers of children under two years in Nanton district: A cross-sectional study from Ghana. Heliyon 2023; 9:e16021. [PMID: 37215882 PMCID: PMC10192525 DOI: 10.1016/j.heliyon.2023.e16021] [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: 07/14/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives Anaemia, defined using haemoglobin level, is one of the most prevalent nutritional deficiency diseases among women of childbearing age. Whilst most studies of anaemia were conducted on pregnant women, data are lacking on the haemoglobin level and its correlates of mothers in Ghana. In this paper, we report data on the correlates of haemoglobin level among mothers in Nanton district, Northern Region, Ghana. Method A cross-sectional study design was used to study 420 mothers of children under 2 years selected randomly from the child welfare clinics (CWCs) of five health facilities in Nanton District, Ghana. Women were interviewed on their socio-demographic characteristics, dietary practices, reproductive history, and knowledge on anaemia using a structured questionnaire in health facilities. Haemoglobin values during pregnancy were retrieved from antenatal clinic files whilst finger-pricked blood test samples were obtained and used to determine haemoglobin levels during the survey. Multiple linear regression was used to identify the correlates of haemoglobin level of the mothers. Results The mean age (±SD) and parity of the subjects were 29.4 (±6.36) years, and 3.36 (±1.78) respectively. The mean haemoglobin (±SD) was 10.35 (±2.17) g/dl and 56.0% of the subjects had anaemia. Multivariable regression analysis identified 12 haemoglobin correlates, but based on standardized regression coefficients, the seven most important correlates of haemoglobin were: parity (β = -0.396), age (β = 0.352), having malaria infection postpartum (β = - 0.340), frequency of fruit consumption (once weekly, β = 0.322), frequency of vegetable consumption (twice weekly, β = 0.296), overall index of anaemia knowledge (richest tertile, β = 0.125), and CWC attendance (β = 0.110). It is recommended to strengthen family planning and malaria prevention programmes, and to intensify education on fruit and vegetable consumption, and anaemia.
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Affiliation(s)
- Anthony Wemakor
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box TL 1883, Tamale, Ghana
| | - Daniel Edem Kpewou
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P O Box TL 1883, Tamale, Ghana
| | - Khadidjah Wemah
- Department of Global and International Health, School of Public Health, University for Development Studies, P O Box TL 1883, Tamale, Ghana
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21
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Tsai Z, Shah N, Tahir U, Mortaji N, Owais S, Perreault M, Van Lieshout RJ. Dietary interventions for perinatal depression and anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2023:S0002-9165(23)46315-0. [PMID: 37019362 DOI: 10.1016/j.ajcnut.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Dietary interventions are a widely available intervention for depression and anxiety among pregnant and/or postpartum (i.e., perinatal) persons but their effectiveness is not well known. OBJECTIVE We performed a systematic review and meta-analysis to assess the effectiveness of dietary interventions for the treatment of perinatal depression and/or anxiety. DESIGN We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inception to November 2, 2022. Studies were included if they were available in English and examined the effectiveness of a dietary intervention for perinatal depression and/or anxiety in a randomized controlled trial. RESULTS Our search identified 4,246 articles, 36 of which were included and 28 were eligible for meta-analysis. Random effects meta-analyses were performed. Polyunsaturated fatty acids (PUFAs) were not found to improve symptoms of perinatal depression compared to control conditions (SMD -0.11; 95% CI -0.26 to 0.04). These results did not change when examined during pregnancy or the postpartum period separately, nor did they vary according to fatty acid ratio. Elemental metals (iron, zinc, and magnesium) were also not found to be superior to placebo (SMD, -0.42; 95% CI, -1.05 to 0.21), though, vitamin D yielded a small to medium effect size improvements (SMD, -0.52; 95% CI, -0.84 to -0.20) in postpartum depression. Iron may help in those with confirmed iron deficiency. Narrative synthesis was performed for studies ineligible for meta-analyses. CONCLUSIONS Despite their widespread popularity, PUFAs and elemental metals do not appear to effectively reduce perinatal depression. Vitamin D taken in doses of 1800 to 3500 International Units (IU) per day may have some promise. Additional high-quality, large-scale randomized controlled trials (RCTs) are needed to determine the true effectiveness of dietary interventions on perinatal depression and/or anxiety. PROSPERO REGISTRATION DATE AND NUMBER July 5th 2020, CRD42020208830.
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Affiliation(s)
- Zoe Tsai
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Nirmay Shah
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Umair Tahir
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Neda Mortaji
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sawayra Owais
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maude Perreault
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Calje E, Marriott J, Oyston C, Dixon L, Bloomfield F, Groom K. Postpartum anaemia in three New Zealand district health board regions: An observational study of incidence and management. Aust N Z J Obstet Gynaecol 2023; 63:178-186. [PMID: 35851951 DOI: 10.1111/ajo.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of postpartum anaemia (PPA) in New Zealand, and the extent of intravenous iron (IV-iron) use in its treatment, are unknown. AIMS To report the incidence of PPA in three district health board (DHB) regions and describe current management of moderate to severe PPA, including by ethnicity. MATERIALS AND METHODS Retrospective observational study of PPA (haemoglobin (Hb) <100 g/L) in three DHBs from July-December 2019. Cases with moderate to severe PPA (Hb <90 g/L) were reviewed and management compared to local and national guidance. Logistic regression examined demographic associations of PPA. RESULTS There were 8849 women who gave birth during the study period: 4076 (46%) had postpartum Hb testing and 1544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% CI 0.37-0.57, P < 0.01). Of 681 women with Hb <90 g/L, 278 (41%) received IV-iron only, 66 (10%) red blood cell transfusion (RBC-T) only and 155 (23%) both. Of those receiving RBC-T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90 g/L had the highest incidence of IV-iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding. CONCLUSION The incidence and management of PPA differs by ethnicity but fewer than half of the women had Hb testing, making precise determination of incidence impossible. The majority of women with Hb <90 g/L received IV-iron, with or without RBC-T.
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Affiliation(s)
- Esther Calje
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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23
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Abbas M, Gandy K, Salas R, Devaraj S, Calarge CA. Iron deficiency and internalizing symptom severity in unmedicated adolescents: a pilot study. Psychol Med 2023; 53:2274-2284. [PMID: 34911595 DOI: 10.1017/s0033291721004098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Iron plays a key role in a broad set of metabolic processes. Iron deficiency is the most common nutritional deficiency in the world, but its neuropsychiatric implications in adolescents have not been examined. METHODS Twelve- to 17-year-old unmedicated females with major depressive or anxiety disorders or with no psychopathology underwent a comprehensive psychiatric assessment for this pilot study. A T1-weighted magnetic resonance imaging scan was obtained, segmented using Freesurfer. Serum ferritin concentration (sF) was measured. Correlational analyses examined the association between body iron stores, psychiatric symptom severity, and basal ganglia volumes, accounting for confounding variables. RESULTS Forty females were enrolled, 73% having a major depressive and/or anxiety disorder, 35% with sF < 15 ng/mL, and 50% with sF < 20 ng/mL. Serum ferritin was inversely correlated with both anxiety and depressive symptom severity (r = -0.34, p < 0.04 and r = -0.30, p < 0.06, respectively). Participants with sF < 15 ng/mL exhibited more severe depressive and anxiety symptoms as did those with sF < 20 ng/mL. Moreover, after adjusting for age and total intracranial volume, sF was inversely associated with left caudate (Spearman's r = -0.46, p < 0.04), left putamen (r = -0.58, p < 0.005), and right putamen (r = -0.53, p < 0.01) volume. CONCLUSIONS Brain iron may become depleted at a sF concentration higher than the established threshold to diagnose iron deficiency (i.e. 15 ng/mL), potentially disrupting brain maturation and contributing to the emergence of internalizing disorders in adolescents.
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Affiliation(s)
- Malak Abbas
- The Rockefeller University, New York, NY 10065, USA
| | - Kellen Gandy
- St. Jude Children's Research Hospital, Houston, Texas 77027, USA
| | - Ramiro Salas
- Baylor College of Medicine - Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, Texas 77030, USA
| | | | - Chadi A Calarge
- Baylor College of Medicine - The Menninger Department of Psychiatry and Behavioral Sciences, 1102 Bates Ave, Suite 790, Houston, Texas 77030, USA
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24
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Cozzi GD, Blanchard CT, Edwards JT, Szychowski JM, Subramaniam A, Battarbee AN. Optimal predelivery hemoglobin to reduce transfusion and adverse perinatal outcomes. Am J Obstet Gynecol MFM 2023; 5:100810. [PMID: 36379441 PMCID: PMC10559786 DOI: 10.1016/j.ajogmf.2022.100810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Maternal anemia has been associated with poor obstetrical outcomes; however, the optimal hemoglobin level for reducing blood transfusion at delivery has not been well-defined. OBJECTIVE This study aimed to measure the association of maternal anemia immediately before delivery with peripartum transfusion and other adverse perinatal outcomes. We also sought to identify the optimal hemoglobin level for predicting transfusion. STUDY DESIGN This was a retrospective cohort study of patients who had hemoglobin or hematocrit collected before delivery of live, nonanomalous neonates at ≥23 weeks' gestation at a single center (2013-2018). Patients were excluded if they had sickle cell disease or were receiving anticoagulation. Patients were categorized as having anemia or no anemia on the basis of predelivery hemoglobin or hematocrit levels using criteria set by the American College of Obstetricians and Gynecologists. The primary outcome was transfusion of ≥1 unit of packed red blood cells during the delivery admission. Secondary outcomes included select adverse perinatal outcomes. Bivariable analyses compared baseline characteristics and outcomes between the anemia and no-anemia groups. Multivariable logistic regression estimated the association between anemia and outcomes. The hemoglobin cutoff optimizing sensitivity and specificity for transfusion was identified by the Liu method. RESULTS Of the 18,357 patients included in the analysis, 5444 (30%) had predelivery anemia (mean hemoglobin, 10.0±0.8 g/dL) vs 12,913 (70%) who did not (mean hemoglobin, 12.3±1.1 g/dL). Patients with anemia were more likely to be non-Hispanic Black and publicly insured and less likely to be nulliparous. Anemia was associated with 5-fold higher odds of packed red blood cell transfusion (6.0% vs 1.3%; adjusted odds ratio, 5.23 [95% confidence interval, 4.09-6.69]) compared with no anemia. For each 1 g/dL increase in predelivery hemoglobin, the odds of transfusion were 56% lower (adjusted odds ratio, 0.44 [confidence interval, 0.40-0.48]). The optimal hemoglobin for prediction of transfusion was 10.6 g/dL (sensitivity: 80%, specificity: 86%). There was no association between anemia and composite maternal or neonatal morbidity after adjustment for covariates, but anemia was associated with higher odds of postpartum readmission (adjusted odds ratio, 1.35 [1.11-1.64]). CONCLUSION Maternal anemia before delivery was associated with 5-fold higher odds of packed red blood cell transfusion and postpartum readmission, but not other perinatal morbidity. Optimizing predelivery hemoglobin, particularly ≥10.6 g/dL, may reduce peripartum transfusion.
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Affiliation(s)
- Gabriella D Cozzi
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee).
| | - Christina T Blanchard
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Joseph T Edwards
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Jeff M Szychowski
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Dr Szychowski)
| | - Akila Subramaniam
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
| | - Ashley N Battarbee
- From the Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Blanchard, and Drs Edwards, Szychowski, Subramaniam, and Battarbee); Departments of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Edwards, Szychowski, Subramaniam, and Battarbee)
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25
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Prokopowicz A, Stańczykiewicz B, Uchmanowicz I, Zimmer M. How to Improve the Care of Women after Childbirth in the Rooming-in Unit: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16117. [PMID: 36498191 PMCID: PMC9736068 DOI: 10.3390/ijerph192316117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Rooming-in is the WHO-recommended care system for mothers in the puerperium and their babies. This system allows the newborn to stay with the mother in the same room, 24 h a day. We aimed to investigate the need to entrust a newborn (NEN) in the care of maternity rooming-in staff during the COVID-19 pandemic, and its relationship to pain, anxiety, and blood loss after delivery. A prospective study of 200 adult women in the maternity ward operating in the rooming-in system focussed on NEN in the care of maternity rooming-in staff on the first (T1) and the second day of puerperium (T2). Women who declared having NEN were compared with women without NEN for anxiety, pain, and a drop in haemoglobin in the blood after delivery. In T1, 34% and in T2, 27% of women felt NEN in the care of maternity rooming-in staff. The NEN of women after a cesarean section was higher on both days than the NEN of women after vaginal delivery. Women with NEN had higher levels of pain, state anxiety, and higher levels of postpartum anxiety than women without NEN. Further research should be warranted to investigate whether women who give birth in hospitals that satisfy the NEN in the care of maternity rooming-in staff in their rooming-in units experience less pain and anxiety in comparison to those who give birth in hospital units without such a possibility and whether this factor is an important element in reducing anxiety and pain during puerperium.
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Affiliation(s)
- Anna Prokopowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | | | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Mariusz Zimmer
- 2nd Department of Gynaecology and Obstetrics, Wroclaw Medical University, 50-556 Wroclaw, Poland
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26
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Benson AE, Shatzel JJ, Ryan KS, Hedges MA, Martens K, Aslan JE, Lo JO. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109:633-642. [PMID: 36153674 PMCID: PMC9669178 DOI: 10.1111/ejh.13870] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
Iron deficiency and/or iron deficiency anemia (IDA) complicate nearly 50% of pregnancies globally, negatively impacting both maternal and fetal outcomes. Iron deficiency can cause a range of symptoms that range from aggravating to debilitating including fatigue, poor quality of life, pagophagia, and restless leg syndrome. Iron deficiency and IDA are also associated with maternal complications including preterm labor, increased rates of cesarean delivery, postpartum hemorrhage, and maternal death. Fetal complications include increased rates of low birth weight and small for gestational age newborns. Prenatal maternal anemia has also been associated with autism spectrum disorders in the neonate, although causation is not established. Deficiency in the newborn is associated with compromised memory, processing, and bonding, with some of these deficits persisting into adulthood. Despite the prevalence and consequences associated with iron deficiency in pregnancy, data show that it is routinely undertreated. Due to the physiologic changes of pregnancy, all pregnant individuals should receive oral iron supplementation. However, the bioavailability of oral iron is poor and it is often ineffective at preventing and treating iron deficiency. Likewise, it frequently causes gastrointestinal symptoms that can worsen the quality of life in pregnancy. Intravenous iron formulations administered in a single or multiple dose series are now available. There is increasing data suggesting that newer intravenous formulations are safe and effective in the second and third trimesters and should be strongly considered in pregnant individuals without optimal response to oral iron repletion.
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Affiliation(s)
- Ashley E Benson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
| | - Kim S Ryan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Madeline A Hedges
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph E Aslan
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Jamie O Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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27
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Ortiz-Serrano R, Leal-Bernal J, López-Acevedo AV, Martínez-Maldonado EG, Mejía-Rodríguez PA. Beneficios del uso del hierro parenteral como alternativa eficaz en el manejo de la anemia gestacional en Colombia. MEDUNAB 2022. [DOI: 10.29375/01237047.3966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada “anemia dilucional”, existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.
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28
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Bai Y, Abulitifu R, Wang D. Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11392. [PMID: 36141665 PMCID: PMC9516973 DOI: 10.3390/ijerph191811392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers' mental health is one of the most important factors influencing children's development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the "Integrated Program for Early Childhood Development" on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5-25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent's age, parent's education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child's age, the grandmother's rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.
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Affiliation(s)
- Yu Bai
- School of Economics, Minzu University of China, Beijing 100081, China
- China Institute for Vitalizing Border Areas and Enriching the People, Beijing 100081, China
| | - Reyila Abulitifu
- School of Economics, Minzu University of China, Beijing 100081, China
| | - Dan Wang
- School of Economics, Minzu University of China, Beijing 100081, China
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29
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Wemakor A, Ziyaaba A, Yiripuo F. Risk factors of anaemia among postpartum women in Bolgatanga Municipality, Ghana. BMC Nutr 2022; 8:58. [PMID: 35751125 PMCID: PMC9229867 DOI: 10.1186/s40795-022-00550-7] [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: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Anaemia is a major public health problem affecting women of reproductive age globally. This study was conducted to assess the prevalence and determinants of anaemia among postpartum women in Bolgatanga Municipality, Ghana. METHODS The study employed an analytical cross-sectional study design to recruit 405 women who delivered in the last 6 weeks from 9 health facilities in the Municipality. Data were collected on socio-demographic characteristics, obstetric characteristics, dietary diversity, knowledge on iron-folic acid (IFA), iron and anaemia, and haemoglobin level of the women. Postpartum anaemia (PPA) was defined as hemoglobin < 12 g/dl. Chi-square and logistic regression analysis were used to identify the determinants of PPA. RESULTS The mean age of the participants was 27.4 ± 5.3 years and 46.70% of them had PPA. The risk factors of PPA were not meeting dietary diversity [Adjusted Odds Ratio (AOR) = 2.96; 95% Confidence Interval (CI): 1.67-5.25], low knowledge on IFA, iron and anaemia (AOR = 3.03; 95% CI: 1.67-5.25), and first trimester pregnancy anaemia (AOR = 10.39; 95% CI: 1.32-6.95). Kusasi ethnicity was protective of PPA (AOR = 0.35; CI: 0.16-0.75). CONCLUSION Anaemia is prevalent in postpartum women in Bolgatanga Municipality and its risk factors are dietary diversity, knowledge on IFA, iron and anaemia, pregnancy anaemia and ethnicity. Nutrition counselling and intervention in pregnancy and after delivery are warranted to reduce the burden of anaemia in this population.
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Affiliation(s)
- Anthony Wemakor
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana.
| | - Alice Ziyaaba
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Felix Yiripuo
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
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30
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Kukuia KKE, Torbi J, Amoateng P, Adutwum-Ofosu KK, Koomson AE, Appiah F, Tagoe TA, Mensah JA, Ameyaw EO, Adi-Dako O, Amponsah SK. Gestational iron supplementation reverses depressive-like behavior in post-partum Sprague Dawley rats: Evidence from behavioral and neurohistological studies. IBRO Neurosci Rep 2022; 12:280-296. [PMID: 35746978 PMCID: PMC9210498 DOI: 10.1016/j.ibneur.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Postpartum depression is a mood disorder that affects about 9–20% of women after child birth. Reports suggest that gestational iron deficiency can cause a deficit in behavioral, cognitive and affective functions and can precipitate depressive symptoms in mothers during the postpartum period. The present study examined the effect of iron supplementation on depressive behavior during postpartum period in a rat model. Method Female Sprague-Dawley rats were crossed. Pregnant rats received iron, fluoxetine, desferrioxamine or vehicle throughout the period of gestation. During the postpartum period, mothers from all groups were taken through the open field test (OFT), forced swim test (FST), novelty-induced hypophagia (NIH) and sacrificed for histological examination of the brains. Results Results showed that rats treated with iron-chelating agent, desferrioxamine, and vehicle during gestation exhibited increased immobility scores in the FST, increased latency to feed and reduced feeding in the NIH with corresponding decreased number of neurons and dendritic branches in the cortex of the brain. These depression-related effects were attenuated by perinatal iron supplementation which showed decreased immobility scores in the FST comparable to rats treated with fluoxetine, a clinically effective antidepressant. Iron treatment also decreased latency to feeding while increasing feeding behavior in the NIH. Iron-treated dams had a higher number of neurons with dendritic connections in the frontal cortex compared to vehicle- and desferrioxamine-treated groups. Conclusion The results suggest that, iron supplementation during gestation exerts an antidepressant-like effect in postpartum Sprague-Dawley rats, attenuates neuronal loss associated with depression and increases dendritic spine density. Iron supplementation during gestation exerts an antidepressant-like effect in postpartum Sprague-Dawley rats. Iron supplementation during gestation attenuates neuronal loss associated with depression. Iron-treated dams had a higher number of neurons with dendritic connections in the frontal cortex.
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Is iron deficiency a risk factor for postpartum depression? A case-control study in the Gaza Strip, Palestine. Public Health Nutr 2022; 25:1631-1638. [PMID: 34462043 PMCID: PMC9991634 DOI: 10.1017/s1368980021003761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aims to investigate the association between iron body status and postpartum depression (PPD) among mothers during the postpartum period. DESIGN This is a case-control study. SETTING Governmental primary health care centres in the Gaza Strip, Palestine. PARTICIPANTS This study involved 300 mothers a month after delivery, with one 150 mothers that were recruited in the cases group who were diagnosed with PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥ 10. The control group included 150 mothers did not have PPD (EPDS < 10). Body iron status is represented by the index of sTfR/log ferritin. RESULTS Among PPD mothers, 43·3 % had low ferritin level v. 15·3 % for controls (P < 0·001) and cases v. controls difference in mean Hb level was -0·61 (95 % CI -0·86, -0·35). The results of the multiple logistic regression reported that there is a statistically significant association between PPD and the body iron status existed, as mothers who suffered from iron deficiency (ID) were three times more likely to have PPD (ORadj 3·25; P = 0·015). Furthermore, the results of the final regression model showed that the other factors that can lead to PPD are absence of psychological guidance services (ORadj 8·54; P = 0·001), suffering from undesired feeling in the last pregnancy (ORadj 1·77; P = 0·034), in addition to having one of the mental health disorders in the last pregnancy (P = 0·001). CONCLUSION Body iron status might be a risk factor for postpartum depression and other possibilities of reverse causality may worsen the condition.
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Wang K, Qiu J, Meng L, Lai X, Yao Z, Peng S. Postpartum hemorrhage and postpartum depressive symptoms: A retrospective cohort study. Depress Anxiety 2022; 39:246-253. [PMID: 35167153 DOI: 10.1002/da.23245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Many psychological and obstetrical factors contribute to the development of postpartum depression. However, little is known about how postpartum hemorrhage (PPH) influences postpartum depressive symptoms. This study explored the relationship between PPH and postpartum depressive symptoms in the Chinese population. METHODS A retrospective cohort study was conducted at the Baoan Maternal and Child Health Hospital in Shenzhen, China, from January 2016 to June 2020. The Edinburgh Postnatal Depression Scale was used to assess postpartum depressive symptoms. A multivariate logistic regression model was used to estimate the odds ratios (ORs) with 95% confidence intervals (95% CIs) between PPH and risk of postpartum depressive symptoms. RESULTS Of the 7734 respondents, 293 (3.8%) and 7441 were in the PPH and control groups, respectively. Puerperal women with PPH were more likely to screen positive for postpartum depressive symptoms than those without PPH (16.4% vs. 11.7%, p = .016). Adjusting for other covariates, women with PPH still had higher risk of postpartum depressive symptoms (OR = 1.68, 95% CI: 1.16-2.42). Stratification analyses revealed no interaction between PPH and maternal age, prepregnancy body mass index, mode of delivery, and fetal sex in developing depressive symptoms (p for interaction > .05). CONCLUSIONS PPH may increase the risk of postpartum depressive symptoms. Therefore, women with PPH should be actively screened for depressive symptoms in the immediate postpartum period.
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Affiliation(s)
- Kewei Wang
- Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China
| | - Jun Qiu
- Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China
| | - Liping Meng
- Department of Public Health, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, China
| | - Xin Lai
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenzhen Yao
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Songxu Peng
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
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Moya E, Phiri N, Choko AT, Mwangi MN, Phiri KS. Effect of postpartum anaemia on maternal health-related quality of life: a systematic review and meta-analysis. BMC Public Health 2022; 22:364. [PMID: 35189871 PMCID: PMC8862508 DOI: 10.1186/s12889-022-12710-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/31/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Postpartum anaemia remains a persistent and severe public health issue in many parts of the world. Studies have reported mixed findings on the effects of anaemia during the postpartum period on maternal health-related quality of life (HRQoL). We conducted this systematic review to summarise available evidence to inform public health practitioners on whether 1) anaemia negatively impact maternal health-related quality of life and 2) whether iron supplementation in anaemic women can improve maternal HRQoL during the postpartum period. METHODS This review's protocol was registered online with PROSPERO (CRD42020206618). We extensively searched Embase, PubMed, Cochrane and Scopus through the HINARI website to identify studies that reported either association or effect of postpartum anaemia on fatigue, depression and mother-child interaction. We restricted our search to studies of human females published in English language from databases inception until August 2020. We followed a Cochrane guideline for reporting systematic reviews and meta-analysis to synthesise data. RESULTS Twenty-seven studies were included in this systematic review, with some reporting all three domains (fatigue, depression and mother-child interaction) of HRQoL. Seven observational studies with pooled dichotomous outcomes showed that iron deficient or anaemic women were 1.66 times more likely to experience symptoms of depression than non-anaemic or iron-replete women [RR = 1.66 (95% CI: 1.28; 2.16), I2 = 67.0%, P < 0.01]. In three randomized controlled trials (RCTs), pooled continuous data showed statistically significant reduction in fatigue scores in women who received iron supplementation than the control group [MD: -1.85 (95% CI: -3.04; -0.67), I2 = 65.0%, p < 0.06]. Two of the four included studies showed that anaemic mothers were less responsive and had negative feelings towards their children than non-anaemic mothers. CONCLUSION Evidence from this review suggests that postpartum anaemia negatively affects health-related quality of life and that iron replenishment improves both symptoms of fatigue and depression. Nevertheless, it remains unclear whether postpartum anaemia affects mother-child interaction.
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Affiliation(s)
- Ernest Moya
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, Chichiri, BT3, PO Box 30538, Blantyre, Malawi.
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi.
| | - Nomsa Phiri
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, Chichiri, BT3, PO Box 30538, Blantyre, Malawi
| | - Augustine T Choko
- College of Medicine, Malawi-Liverpool Wellcome Trust Queen Elizabeth Central Hospital, PO Box 30096, Chichiri, Blantyre, Malawi
| | - Martin N Mwangi
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, Chichiri, BT3, PO Box 30538, Blantyre, Malawi
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi
| | - Kamija S Phiri
- Training and Research Unit of Excellence (TRUE), 1 Kufa Road, Chichiri, BT3, PO Box 30538, Blantyre, Malawi
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, BT3, Blantyre, Malawi
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Purcell S, Beckmann M. The utility of routine screening for anaemia at 36 weeks gestation. Aust N Z J Obstet Gynaecol 2022; 62:610-613. [PMID: 35170017 DOI: 10.1111/ajo.13495] [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: 11/26/2022]
Abstract
Anaemia is a global disease, affecting over 1 billion people worldwide; 12% of Australian women experience anaemia in pregnancy. Professional bodies/institutions recommend screening for and treating anaemia in pregnancy but there is inconsistency in recommendations for when to screen. A ten-year retrospective analysis was undertaken of 10 518 pregnancies where there was not a specific indication for repeat blood tests. Using a 28-week haemoglobin (Hb) threshold of ≥110 g/L, seven out of ten could safely forego a routine 36-week full blood count. Less than 2.5% would then be anaemic at 36 weeks, none of whom would have had a Hb < 90 g/L.
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Affiliation(s)
- Samuel Purcell
- Mater Mother's Hospital, Brisbane, Queensland, Australia
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Berthou C, Iliou JP, Barba D. Iron, neuro‐bioavailability and depression. EJHAEM 2022; 3:263-275. [PMID: 35846210 PMCID: PMC9175715 DOI: 10.1002/jha2.321] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/14/2022]
Abstract
Medical management of iron deficiency (ID) requires to consider its consequences in biochemical and physiological plural functions, beyond heme/hemoglobin disrupted synthesis. Fatigue, muscle weakness, reduced exercise capacity, changes in thymia and modified emotional behaviors are the commonest symptoms integrated in the history of ID, dependent or not of the hemoglobin concentration. The relationship between depression and absolute ID (AID) is a condition which is often unrecognized. Neuro‐bioavailability and brain capture of blood iron are necessary for an appropriate synthesis of neurotransmitters (serotonin, dopamine, noradrenaline). These neurotransmitters, involved in emotional behaviors, depend on neuron aromatic hydoxylases functioning with iron as essential cofactor. Noradrenaline also has impact on neuroplasticity via brain‐derived neurotrophic factor (BDNF), which is key for prefrontal and hippocampus neurons playing a role in depression. Establishing the formal relationship between depression and AID remains difficult. Intracerebral reduced iron is still hard to quantify by neuroimaging and single‐photon emission computed tomography (SPECT) now tends to explore the neurotransmission pathways. AID has to be looked for and identified in the context of depression, major episode or resistant to conventional treatment such as serotonin reuptake inhibitor, and even in the absence of anemia, microcytosis or hypochromia (non‐anemic ID). Confronted to brain imaging, blood iron status evaluation is indicated, especially in depressed, treatment‐resistant, iron‐deficient young women. In patients suffering from depression, increase in the prevalence of AID should be considered, in order to deliver a suitable treatment, considering both anti‐depressive program and iron supplementation if AID.
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Affiliation(s)
- Christian Berthou
- Department of Immuno‐Hematology INSERM UMR 12 27 LBAI University Brest Brest France
| | | | - Denis Barba
- Health and Medical Center Le Guilvinec France
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Chawla S, Tangri M, Srivastava A, Bhardwaj D, Indu, Mishra R. Randomized controlled trial to compare injection ferric carboxymaltose and oral iron in reducing postpartum anemia: A multicenter, pilot study. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_157_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Natural history of postpartum hematocrit recovery in an urban, safety-net population. Am J Obstet Gynecol MFM 2021; 4:100541. [PMID: 34875414 DOI: 10.1016/j.ajogmf.2021.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Postpartum anemia is common after delivery, and postpartum blood transfusion is the leading indicator of severe maternal morbidity in the United States. Although hematologic changes during the antepartum period are well understood, little is known about postpartum hematologic changes. Therefore, we investigated the hematologic changes in the postpartum period in a large, contemporary cohort. OBJECTIVE This study aimed to characterize hematologic recovery in the postpartum period and evaluate the effect of demographics, medical conditions, and pregnancy characteristics on the recovery. STUDY DESIGN In a contemporary cohort of deliveries in 2019 at a single institution, the hematocrit of postpartum women before hospital discharge was compared with the hematocrit of women at the postpartum follow-up. Our population was composed of a predominantly Hispanic population at an urban, safety-net hospital. All women received a complete blood count on postpartum day 1 and a spun hematocrit at their postpartum follow-up visit in our hospital system. All women were scheduled for a routine postpartum visit 2 to 3 weeks after delivery. All deliveries of a live-born infant with available postpartum hematocrit before hospital discharge and at postpartum follow-up were included. Demographics and pregnancy characteristics, along with medical conditions, were evaluated. To evaluate an uncomplicated cohort, those with multiple gestation, preeclampsia with severe features, chronic hypertension, and diabetes mellitus were excluded in the secondary analysis. Statistical analysis included chi-square, paired Student t test, Student t test for independent groups, and analysis of variance. RESULTS Of 12,456 deliveries, 9003 met the inclusion criteria. The average number of days from discharge to follow-up was 21.73±10.39 days. The average hematocrit levels were 30.77±3.61 before discharge and 38.70±3.61 at postpartum follow-up. From discharge to postpartum follow-up, the hematocrit levels increased by an average of 7.93±3.24. In the cohort without complications, the average increase in hematocrit levels was 8.19±3.09. The rise in hematocrit levels was significantly lower for those with chronic hypertension (6.9±3.6), diabetes mellitus (7.3±3.3), and preeclampsia with severe features (6.9±3.7). The severity of anemia influenced the rise in hematocrit levels in the postpartum period. In women with postpartum anemia (hematocrit<30%), the rise in hematocrit levels was 9.49±2.97 in the uncomplicated cohort. Postpartum hemorrhage did not influence the rise in postpartum hematocrit levels; women receiving blood transfusion had a greater rise in hematocrit levels (9.01±3.29). CONCLUSION Our study establishes the natural course of hematologic recovery in the postpartum period, and we found that women with asymptomatic postpartum anemia may have a hematocrit level of 37% to 39% at their postpartum follow-up approximately 3 weeks after hospital discharge. Women with preexisting and obstetrical complications experienced less hematologic recovery and adapted more slowly to postpartum physiological changes.
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Iancu AM, Buckstein J, Melamed N, Lin Y. Examining prescribing practices with respect to oral iron supplementation for post-partum anemia: a retrospective review. J Matern Fetal Neonatal Med 2021; 35:8982-8988. [PMID: 34844500 DOI: 10.1080/14767058.2021.2008897] [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: 10/19/2022]
Abstract
PURPOSE Treatment for post-partum anemia frequently entails oral iron supplementation, but questions remain regarding optimal dosing, frequency, and efficacy. The objective of this study was to describe oral iron prescribing practices in post-partum women delivered via Cesarean section, and identify factors associated with iron supplementation. METHODS A retrospective review of Cesarean section deliveries at a single tertiary center between May 2019 and April 2020 was undertaken. Patient demographics, hematological indices, indication for Cesarean section and discharge prescriptions were collected. Univariate and multivariable analyses were performed to identify factors associated with oral iron prescription at discharge. RESULTS During the study period, 1470 women were eligible for inclusion. The mean age at delivery was 34.4 ± 4.9 years and mean gestational age was 37.2 ± 3.6 weeks. Most pregnancies (92%) were singleton. Ninety-six total patients (6.5%) received intravenous iron post-partum. Fourteen percent of women (210/1470) received prescriptions for oral iron at discharge, most commonly ferrous fumarate (61.9%, 130/210). The most common dose provided was 300 mg (145/210). Ante-partum ferritin was available for most patients (64.3%, 945/1470), but only for 17 post-partum patients (1.2%). Factors significantly associated with oral iron prescription were earlier gestational age at birth (aOR 0.93, 95% CI 0.89-0.97), history of complications during pregnancy or labor (aOR 1.92, 95% CI 1.26-2.98), higher blood loss (aOR 2.66, 95% CI 1.36-5.44), post-partum anemia (aOR 6.28, 95%-CI 4.41-8.96), blood transfusion (aOR 5.43, 95%-CI 1.81-18.19) and antenatal iron supplementation (aOR 5.70, 95%-CI 4.02-8.17). CONCLUSIONS In summary, a relatively small proportion of women following Cesarean section were prescribed oral iron at discharge. We identified several factors associated with post-partum iron supplementation. This information will inform future prospective studies investigating the efficacy of iron supplementation in the treatment of post-partum anemia.
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Affiliation(s)
- Ana-Maria Iancu
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | | | - Nir Melamed
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.,Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Canada
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BXD Recombinant Inbred Mice as a Model to Study Neurotoxicity. Biomolecules 2021; 11:biom11121762. [PMID: 34944406 PMCID: PMC8698863 DOI: 10.3390/biom11121762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
BXD recombinant inbred (RI) lines represent a genetic reference population derived from a cross between C57BL/6J mice (B6) and DBA/2J mice (D2), which through meiotic recombination events possesses recombinant chromosomes containing B6 or D2 haplotype segments. The quantitative trait loci (QTLs) are the locations of segregating genetic polymorphisms and are fundamental to understanding genetic diversity in human disease susceptibility and severity. QTL mapping represents the typical approach for identifying naturally occurring polymorphisms that influence complex phenotypes. In this process, genotypic values at markers of known genomic locations are associated with phenotypic values measured in a segregating population. Indeed, BXD RI strains provide a powerful tool to study neurotoxicity induced by different substances. In this review, we describe the use of BXD RI lines to understand the underlying mechanisms of neurotoxicity in response to ethanol and cocaine, as well as metals and pesticide exposures.
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Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv 2021; 5:4666-4673. [PMID: 34459878 PMCID: PMC8759118 DOI: 10.1182/bloodadvances.2021004352] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/31/2021] [Indexed: 12/16/2022] Open
Abstract
Iron deficiency (ID) anemia in pregnancy is associated with poor maternal and childhood outcomes, yet ferritin testing, the standard test for ID, is not considered part of routine prenatal bloodwork in Canada. We conducted a retrospective cohort study of 44 552 pregnant patients with prenatal testing at community laboratories in Ontario, Canada, to determine the prevalence of ferritin testing over 5 years. Secondary objectives were to determine the prevalence and severity of ID and to identify clinical and demographic variables that influence the likelihood of ID screening. A total of 59.4% of patients had a ferritin checked during pregnancy; 71.4% were ordered in the first trimester, when the risk of ID is lowest. Excluding patients with abnormally elevated ferritins, 25.2% were iron insufficient (30-44 µg/L) and 52.8% were iron deficient (≤29 µg/L) at least once in pregnancy. A total of 8.3% were anemic (hemoglobin <105 g/L). The proportion of anemic patients with a subsequent ferritin test in pregnancy ranged from 22% to 67% in the lowest and highest anemia severity categories, respectively. Lower annual household income was negatively associated with the odds of a ferritin test; compared with those in the fifth (ie, highest) income quintile, the odds of ferritin testing for patients in the first, second, and fourth quintiles were 0.83 (95% confidence interval [CI], 0.74-0.91), 0.82 (95% CI, 0.74-0.91), and 0.86 (95% CI, 0.77-0.97), respectively. These data highlight gaps in prenatal care and issues of health equity that warrant harmonization of obstetrical guidelines to recommend routine ferritin testing in pregnancy.
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Ruiz de Viñaspre-Hernández R, García-Erce JA, Rodríguez-Velasco FJ, Gea-Caballero V, Sufrate-Sorzano T, Garrote-Cámara ME, Urra-Martínez R, Juárez-Vela R, Czapla M, Santolalla-Arnedo I. Variability in Oral Iron Prescription and the Effect on Spanish Mothers' Health: A Prospective Longitudinal Study. J Clin Med 2021; 10:jcm10215212. [PMID: 34768732 PMCID: PMC8584634 DOI: 10.3390/jcm10215212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: No consensus exists regarding the hemoglobin (Hb) values that define postpartum anemia. Knowledge is currently lacking regarding prescription and consumption practices, which prevents evaluating the rational use of iron supplementation postpartum. Aim: In this study, our objective was to describe this practice and analyze its association with maternal health outcomes. Methods: A prospective observational study was conducted with 1010 women aged between 18 and 50. The hemoglobin value on the first postpartum day; the prescription schedule at hospital discharge; iron consumption; and data on hemoglobin, serum ferritin, maternal fatigue, type of breastfeeding, and perceived health six weeks after delivery were collected. Findings: Oral iron was prescribed to 98.1% of mothers with anemia and 75.8% without anemia. At the same Hb value, the maximum amount of total iron prescribed was between 8 and 10 times greater than the minimum amount. Iron intake was significantly lower than prescribed (p < 0.01). At six weeks, anemic mothers who took iron presented a 3.6-, 3-, and 2.4-times lower probability of iron deficiency, anemia, and abandoning breastfeeding, respectively. Discussion: Postpartum iron intake shows a protective effect on iron deficiency and anemia at six weeks, but not on fatigue or self-perceived health level. Conclusion: We conclude that there is wide variability in the prescription regimen. Oral iron supplementation can benefit mothers with anemia and harm those without. Subsequent studies should further explore the Hb figure that better discriminates the need for postpartum iron.
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Affiliation(s)
- Regina Ruiz de Viñaspre-Hernández
- Centro de Salud “Cascajos”, Servicio Riojano de Salud, Government of La Rioja, 26002 Logroño, Spain;
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - José Antonio García-Erce
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Hematologist, Bank of Blood and Tissue, Government of Navarra, 31015 Pamplona, Spain
| | | | - Vicente Gea-Caballero
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Faculty of Health Sciences, International University of Valencia, 46010 Valencia, Spain
- Correspondence: (V.G.-C.); (R.J.-V.)
| | - Teresa Sufrate-Sorzano
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - María Elena Garrote-Cámara
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - Raquel Urra-Martínez
- Servicio Riojano de Salud, Hospital San Pedro, Government of La Rioja, 26006 Logroño, Spain;
| | - Raúl Juárez-Vela
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Correspondence: (V.G.-C.); (R.J.-V.)
| | - Michał Czapla
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-516 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Iván Santolalla-Arnedo
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
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Shah HE, Bhawnani N, Ethirajulu A, Alkasabera A, Onyali CB, Anim-Koranteng C, Mostafa JA. Iron Deficiency-Induced Changes in the Hippocampus, Corpus Striatum, and Monoamines Levels That Lead to Anxiety, Depression, Sleep Disorders, and Psychotic Disorders. Cureus 2021; 13:e18138. [PMID: 34692346 PMCID: PMC8525689 DOI: 10.7759/cureus.18138] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/20/2021] [Indexed: 01/09/2023] Open
Abstract
Iron deficiency anemia caused by severe iron deficiency in infancy is associated with poor health and severe neurological impairment such as mental, motor, social, emotional, neurophysiological, and neurocognitive dysfunction. The behavioral effects of iron deficiency can present themselves in infancy, but they are also found in adulthood. Some behaviors can start in childhood but persist throughout adulthood. The behaviors that are particularly often seen in infants and children include wariness and hesitance, lack of positive affect, and diminished social engagement. The affected behaviors in adults include anxiety, depression, higher complex cogitative tasks, and other psychological disorders. The mechanisms of how iron deficiency affects behavior include affecting the hippocampus, the corpus striatum, and certain neurotransmitters. The hippocampus is a brain region that is essential for memory, learning, and other purposes. The hippocampus is very sensitive to lack of Iron during early development. The corpus striatum dispatches dopamine-rich projects to the prefrontal cortex, and it is involved in controlling executive activities such as planning, inhibitory control, sustained attention, working memory, regulation of emotion, memory storage and retrieval, motivation, and reward. Iron deficiency has been known to cause changes in behavioral and developmental aspects by affecting neurotransmitters such as serotonin, noradrenaline, and dopamine. Iron deficiency causes behavior changes that can present in infancy and, even if corrected postnatally, it can have long-lasting effects well into adulthood.
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Affiliation(s)
- Hira E Shah
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nitin Bhawnani
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aarthi Ethirajulu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Almothana Alkasabera
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chike B Onyali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Tasnim R, Sujan MSH, Islam MS, Ferdous MZ, Hasan MM, Koly KN, Potenza MN. Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh. Acta Psychol (Amst) 2021; 220:103426. [PMID: 34619554 PMCID: PMC8486640 DOI: 10.1016/j.actpsy.2021.103426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh. METHODS Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively. RESULTS Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking. CONCLUSIONS Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.
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Affiliation(s)
- Rafia Tasnim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Safaet Hossain Sujan
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Most Zannatul Ferdous
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh.
| | | | - Kamrun Nahar Koly
- Health System and Population Studies Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA.
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44
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Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management. Nutrients 2021; 13:nu13103437. [PMID: 34684433 PMCID: PMC8537360 DOI: 10.3390/nu13103437] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023] Open
Abstract
Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.
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de Vena Franks PL, Pan AY, Gill MK, Cross AMK, Konrad KL, Lightfoot NJ. Incidence and predictors of iron deficiency anaemia in parturients undergoing elective caesarean section at a tertiary hospital in New Zealand: a retrospective, observational cohort study. BMC Pregnancy Childbirth 2021; 21:645. [PMID: 34551736 PMCID: PMC8459509 DOI: 10.1186/s12884-021-04121-9] [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: 03/23/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Worldwide, iron deficiency anaemia in pregnancy is a significant problem which can be especially problematic when delivery is by caesarean section, a procedure associated with significant blood loss. Optimising iron stores pre-delivery remains an overarching goal. We aim to measure the incidence of iron deficiency anaemia in patients undergoing elective caesarean section at our institution and determine any associated predictors, as well as adverse outcomes. Methods A retrospective, observational cohort study of patients presenting for elective caesarean section over a two-year period. Patient data was collected from hospital electronic records. Iron deficiency anaemia was defined a haemoglobin < 110 g/L and a ferritin < 30 μg/L in the three-month period prior to delivery. The primary aim was to establish the incidence of iron deficiency anaemia at the time of delivery and any associated predictors. Secondary outcomes included any association between the primary outcome and complications defined by the hospital discharge complication coding system, as well as an evaluation of the number of blood tests carried out antenatally per trimester. Results One thousand and ninety-three women underwent caesarean section over the study period and 16.2% had iron deficiency anaemia. Patients with iron deficiency anaemia were more likely to be of Māori and Pacific Island ethnicity, have a greater booking body mass index, be younger and have a greater parity. Pre-operative anaemia was associated with a greater likelihood of post-operative blood transfusion. Conclusions There remains potential for optimisation of iron deficiency anaemia in our local population undergoing elective caesarean section. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04121-9.
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Affiliation(s)
- Pablo L de Vena Franks
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, 2025, New Zealand.
| | - Andrew Y Pan
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, 2025, New Zealand
| | - Manpreet K Gill
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, 2025, New Zealand
| | - Angela M K Cross
- Department of Obstetrics and Gynaecology, Counties Manukau Health, Auckland, 2025, New Zealand
| | - Katy L Konrad
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, 2025, New Zealand
| | - Nicholas J Lightfoot
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, 2025, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, 1142, New Zealand
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Nurhasanah C, Idiana A, Santi P, Yushida Y. Comparative Analysis of Beet Juice and Red Guava Juice against Erythrocyte and Hematocrit Levels in Post-partum Women. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Post-partum physiological bleeding can cause post-partum mothers to experience anemia; often, post-partum mothers are limited by nutrient and fluid intake to keep the body strong and have ideal body weight.
AIM: The aim of the study is to knowing the difference between beet juice and Guava juice on erythrocyte and hematocrit (HTC) levels in post-partum mothers at Darul Imarah Health Center, Darul Imarah District, Aceh Besar District.
METHODS: This was a quasi-experimental study with a pre-post test design using a randomized controlled trial. The population of post-partum mothers in the Darul Imarah Health Center, Darul Imarah District, Aceh Besar District. The sample selection is purposive sampling with inclusion and exclusion criteria; the sample is 45 people.
RESULTS: The results showed differences in erythrocyte and HTC levels between before and after giving guava and iron (Fe) juices with a p-value of 0.00 <0.05. Beet juice increases the average erythrocytes and HTC levels higher than guava juice. There were significant differences in erythrocyte levels in the guava + Fe, beet + Fe, and control (Fe) treatment groups with a p-value of 0.001 <0.05. the difference in the average difference in erythrocyte levels between the guava and beet treatment groups was 0.03. The treatment group Bit + Fe had a higher mean erythrocyte level different than the guava + the treatment group and the control group (Fe). There was a significant difference in HTC levels in the guava + Fe, beet + Fe, and control (Fe) treatment groups with a p-value of 0.001 <0.05. the difference in the average difference in erythrocyte levels between the guava and beet treatment groups was 0.03. The treatment group Bit + Fe had a higher mean difference in HTC levels than the guava + the treatment group and the control group (Fe).
CONCLUSION: There is a significant difference in erythrocytes and HTC levels between before and after giving guava juice and beet juice to post-partum mothers with a p-value of 0.00 <0.05. Beet juice increases the average level of erythrocytes and HTC, which is higher than guava juice in post-partum mothers at the Darul Imarah Health Center.
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47
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Zeitoun T, Dehghan Noudeh N, Garcia-Bailo B, El-Sohemy A. Genetics of Iron Metabolism and Premenstrual Symptoms: A Mendelian Randomization Study. J Nutr 2021; 151:1747-1754. [PMID: 33758941 DOI: 10.1093/jn/nxab048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many women of reproductive age experience adverse psychological and physiological premenstrual symptoms. These symptoms may last for most of the reproductive years and can negatively affect the quality of life of many women. Some studies have examined the role of micronutrients in premenstrual symptoms, but the research on iron has been limited. OBJECTIVES The objective of this study was to evaluate the effects of genetic predictors of iron overload and low iron status on premenstrual symptoms using Mendelian randomization. METHODS We examined 254 White females aged 20-29 y from the Toronto Nutrigenomics and Health Study. DNA was isolated from peripheral white blood cells and genotyped for the homeostatic regulatory iron gene (HFE; rs1800562 and rs1799945), transmembrane protease serine 6 (TMPRSS6; rs482026), transferrin receptor 2 (TFR2; rs3811647), and transferrin (TF; rs738584) polymorphisms. Risk of iron overload or low iron status was determined based on combined genotypes. Binomial logistic regressions were carried out to examine the association between genetic risk of iron overload or low iron status and the presence of premenstrual symptoms. RESULTS Compared with participants with typical risk of iron overload, those with an elevated risk of iron overload were less likely to experience premenstrual symptoms of confusion (OR: 0.13; 95% CI: 0.02, 1.00), headaches (OR: 0.28; 95% CI: 0.08, 0.98), and nausea (OR: 0.13; 95% CI: 0.02, 0.99) after adjusting for BMI, age, and vitamin C and calcium intake. No associations were seen with the other symptoms. There were also no associations between low iron status genotypes and premenstrual symptoms. CONCLUSIONS This Mendelian randomization study demonstrates that women with an elevated risk of iron overload may have a lower risk of experiencing some premenstrual symptoms (headache, confusion, and nausea), suggesting that iron status could impact the risk of certain premenstrual symptoms.
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Affiliation(s)
- Tara Zeitoun
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Negar Dehghan Noudeh
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bibiana Garcia-Bailo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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48
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Benson CS, Shah A, Frise MC, Frise CJ. Iron deficiency anaemia in pregnancy: A contemporary review. Obstet Med 2021; 14:67-76. [PMID: 34394714 PMCID: PMC8358243 DOI: 10.1177/1753495x20932426] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023] Open
Abstract
Iron deficiency anaemia is a global health problem, which particularly affects pregnant women. Iron deficiency anaemia during pregnancy is associated with increased maternal and perinatal morbidity and mortality. Maternal iron deficiency may also be associated with neurocognitive deficits in infants. Iron requirements increase during pregnancy and are influenced by hepcidin, the master regulator of iron homeostasis. The enduring global burden of maternal anaemia suggests that currently employed iron supplementation strategies are suboptimal. Recent developments in our understanding of systemic and placental iron homeostasis may improve therapeutic effectiveness by altering the dose and frequency of oral iron. Intravenous iron appears to be a safe treatment to correct maternal anaemia rapidly but research on patient-centred outcomes and cost-effectiveness is needed. Future trials should be adequately powered to assess outcomes relevant to pregnant women.
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Affiliation(s)
- Charlotte S Benson
- Department of Obstetrics, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Akshay Shah
- Department of Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Matthew C Frise
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Intensive Care Unit, Royal Berkshire Hospital, NHS Foundation Trust, Reading, UK
| | - Charlotte J Frise
- Fetal Maternal Medicine Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
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Gosdin L, Sharma AJ, Tripp K, Amoaful EF, Mahama AB, Selenje L, Jefferds ME, Martorell R, Ramakrishnan U, Addo OY. A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls. J Nutr 2021; 151:1646-1655. [PMID: 33758915 PMCID: PMC8172428 DOI: 10.1093/jn/nxab024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND School-based iron and folic acid (IFA) supplementation is recommended for adolescent girls in countries with high burdens of anemia. OBJECTIVES We aimed to evaluate the context-specific effectiveness of a school-based, integrated anemia control program with IFA supplementation in Ghana. METHODS Using data from a pre-post, longitudinal program evaluation, we evaluated the effectiveness of school-based weekly IFA supplementation in reducing the burden of anemia and increasing hemoglobin concentrations (Hb; primary outcomes) in 2 regions of Ghana. Generalized linear mixed effects models with schools (clusters) as random effects were used to quantify the change in the anemia prevalence and the mean Hb associated with cumulative IFA tablet consumption over 1 school year (30-36 weeks), controlling for participant-level potential confounders. A cut point for minimum effective cumulative IFA consumption that is reflective of adequate Hb was derived following logistic regression. This cut point was verified by a restricted cubic spline model of IFA consumption and Hb. RESULTS The analytical sample included 60 schools and 1387 girls ages 10-19 years. The prevalence of anemia declined during 1 school year of the intervention, from 25.1% to 19.6% (P = 0.001). Students consumed a mean of 16.4 IFA tablets (range, 0-36). IFA consumption was positively associated with Hb and negatively associated with anemia. Each additional IFA tablet consumed over the school year was associated with a 5% (95% CI, 1-10%) reduction in the adjusted odds of anemia at follow-up, though the relationship is nonlinear. The cut point for minimum effective consumption was 26.7 tablets over a 30-36-week school year, with tablets provided weekly. CONCLUSIONS School-based weekly IFA supplementation is effective in improving Hb and reducing the anemia prevalence among schoolgirls in Ghana, though most participants consumed fewer than the minimum effective number of IFA tablets. Increasing intake adherence may further improve anemia outcomes in this population.
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Affiliation(s)
- Lucas Gosdin
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA,Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea J Sharma
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,US Public Health Service Commissioned Corps, Atlanta, Georgia, USA
| | - Katie Tripp
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - O Yaw Addo
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA,Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Emory Global Health Institute, Atlanta, Georgia, USA
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50
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Valladão Júnior JBR, Suemoto CK, Goulart AC, Schmidt MI, Passos VMA, Barreto SM, Lotufo PA, Bensenor IM, Santos IS. Anemia and Cognitive Performance in the ELSA-Brasil Cohort Baseline. J Neuropsychiatry Clin Neurosci 2021; 32:227-234. [PMID: 31795805 DOI: 10.1176/appi.neuropsych.19040088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of individuals from six Brazilian cities. METHODS A total of 13,624 participants (mean age=51.6 years [SD=9.0]) were included in this cross-sectional study. Cognitive performance was evaluated by using standardized scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B). The association between anemia and cognitive performance was examined by using linear regression models adjusted for sociodemographic characteristics and cardiovascular risk factors. RESULTS Anemia was diagnosed in 713 (5.2%) participants. No association was found between anemia and worse cognitive performance for the main models. Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (β=-0.004; 95% CI=-0.052, 0.044) or for men (β=0.047; 95% CI=-0.053, 0.146) and women (β=-0.015; 95% CI=-0.070, 0.040) separately. In addition, hemoglobin levels (in quintile groups) were not associated with global cognitive scores. Similarly, no significant associations with anemia or hemoglobin levels were observed when each cognitive performance test was evaluated separately. CONCLUSIONS Anemia and hemoglobin levels were not associated with worse cognitive performance in this large cohort.
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Affiliation(s)
- José Benedito R Valladão Júnior
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Claudia K Suemoto
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Alessandra C Goulart
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Maria Ines Schmidt
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Valéria M A Passos
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Sandhi M Barreto
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Paulo A Lotufo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Isabela M Bensenor
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
| | - Itamar S Santos
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Valladão, Suemoto, Lotufo, Bensenor, Santos); Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil (Suemoto, Goulart, Lotufo, Bensenor, Santos); Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (Schmidt); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Passos, Barreto)
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