Anaemia in pregnancy among Aboriginal and Torres Strait Islander women of Far North Queensland: A retrospective cohort study

Factors associated with anaemia in pregnancy: A retrospective cross-sectional study in the Bolgatanga Municipality, northern Ghana

BACKGROUND

Anaemia in pregnancy (AIP) remains a severe public health problem associated with adverse outcomes. This study assessed haemoglobin levels and the prevalence of anaemia during antenatal care (ANC) registration, at 28 weeks and 36 weeks of gestation as well as the factors associated with AIP at the different stages of pregnancy.

METHODS

A retrospective cross-sectional design was implemented. Using ANC registers as the sampling frame, 372 pregnant women, within 36 and 40 weeks of gestation were randomly sampled from 28 health facilities for the study. The participants were all receiving ANC in the Bolgatanga Municipality. Data were collected via clinical records review and a questionnaire-based survey between October and November, 2020. Using the Statistical Package for the Social Sciences (SPSS), descriptive analysis of haemoglobin levels and the prevalence of anaemia were performed. In addition, binary logistic regression was used to identify the factors associated with anaemia in pregnancy. AIP was determined using the national practice of 11.0g/dl haemoglobin cut-off point and the World Health Organisation's recommended adjustment for the 2nd trimester of pregnancy was made using the cut-off of 10.5g/dl to account for the effect of haemodilution.

RESULTS

At booking, AIP prevalence was 35.8% (95%CI:30.9, 40.9) using a cut-off of 11.0g/dl and 25.3% (95%CI:20.9, 30.0) using a cut-off of 10.5g/dl for those in the 2nd trimester. At 28 weeks, AIP prevalence was 53.1% (95%CI:45.8, 60.3) and 37.5 (95%CI:30.6, 44.8) using a cut-off of 11.0g/dl and 10.5g/dl for those in the 2nd trimester, respectively. At 36 weeks, AIP prevalence was 44.8% (95%CI:39.2, 50.4) using a cut-off of 11.0g/dl. At p<0.05, registering after the first trimester (AOR = 1.87, 95%CI: 1.17, 2.98, P = 0.009) and at a regional hospital (AOR = 2.25, 95%CI: 1.02, 4.98, P = 0.044) were associated with increased odds of AIP but registering at a private hospital (AOR = 0.32, 95%CI: 0.11, 0.92, P = 0.035) was associated with decreased odds of AIP at booking. At 28 weeks, age group 26-35 years (AOR = 0.46, 95%CI: 0.21, 0.98, P = 0.044), Christianity (AOR = 0.32, 95%CI: 0.31, 0.89, P = 0.028.), high wealth (AOR = 0.27, 95%CI: 0.09, 0.83, P = 0.022) and tertiary education (AOR = 0.09, 95%CI:0.02, 0.54, P = 0.009) were associated with decreased odds of AIP. At 36 weeks, booking after first trimester of pregnancy was associated with increased odds (AOR = 1.72, 95%CI: 1.05, 2.84, P = 0.033) whilst high wealth (AOR = 0.44, 95%CI: 0.20, 0.99, P = 0.049), higher age groups-26-35 (AOR = 0.38, 95%CI: 0.21, 0.68, P = 0.001) and 36-49 years (AOR = 0.35, 95%CI: 0.13, 0.90, P = 0.024) and secondary education of spouse were associated with reduced odds (AOR = 0.35, 95%CI: 0.14, 0.88, P = 0.026) of AIP.

CONCLUSION

AIP consistently increased from registration to 36 weeks of gestation. Given the observed correlates of AIP, we recommend that interventions geared towards early ANC registration, improved household wealth, and improved maternal education are required to reduce AIP.

A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia

Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015-2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05-6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01-1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.

Incidence of iron deficiency Anaemia during pregnancy in Far North Queensland

INTRODUCTION

The WHO estimates the incidence of iron deficiency anaemia in Australia is 25%. However there is considerable variation during pregnancy and in regional areas.

OBJECTIVE

The aim of this investigation is to quantify the incidence of iron deficiency anaemia during pregnancy within Far North Queensland.

DESIGN

This is a single-centre retrospective cohort study. Cairns Hospital is the main referral centre for complex maternity care in Far North Queensland with an estimated population of 280-000, which includes many people from rural and remote communities and a high proportion who identify as Aboriginal or Torres Strait Islander. This study included all births at the Cairns Hospital in 2018, a total of 2190 deliveries.

FINDINGS

The study randomly sampled 551 mothers from the cohort, and the incidence of iron deficiency anaemia was 34.9%. 48.7% of women who identified as Aboriginal or Torres Strait Islander within the region were anaemic. This was significantly higher than an incidence of 28.9% for the rest of the population. Other risk factors include booking appointment after 28-weeks, Asian ethnicity and age less than 25-years. A BMI greater than 35 was protective DISCUSSION: This study will inform antenatal care providers within the region and improve obstetric outcomes by increasing awareness. Identifying risk factors will also facilitate prompt treatment and improve maternity care for vulnerable patient groups. On a broader level, the study provides new data to inform population health estimates both nationally and internationally.

CONCLUSION

The incidence of iron deficiency anaemia during pregnancy in Far North Queensland is significantly higher than previous estimates.

Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis

BACKGROUND

Anemia is one of the most critical health conditions affecting people worldwide. The disease is silent, with a slow progression and a few physical symptoms. Anemia during pregnancy carries the risk of premature birth, low birth weight, and fetus malformations and can impose additional costs on society and families. Therefore, the aim of this study is to conduct a systematic review and meta-analysis on the prevalence of anemia in pregnant women worldwide.

METHODS

In this work, we have conducted a systematic review and meta-analysis of the studies that have examined the prevalence of anemia in pregnant women globally. The Google Scholar, Cochrane, ScienceDirect, Medline (PubMed), and Web of Science (WoS) databases were searched for articles published between 1991 and 2021. The search keywords were anemia, pregnancy, prevalence, and meta-analysis. In order to analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies was examined using the I² index. Data analysis was performed within the Comprehensive Meta-Analysis software (Version 2).

RESULTS

The search resulted in 338 deduplicated studies, of which 52 studies with a total sample size of 1,244,747 people were included in this review. According to the results of the meta-analysis, the overall prevalence of anemia in pregnant women is 36.8% (95% confidence interval: 31.5-42.4%). The highest prevalence of anemia is mild at 70.8 (95% CI 58.1-81) and highest in the third trimester of pregnancy with the prevalence of 48.8 (95% CI 38.7-58.9), while the highest prevalence of anemia in pregnant women was in Africa with the prevalence of 41.7 (95% CI 32.3-49.4).

CONCLUSION

The results of this study show a high prevalence of anemia among pregnant women worldwide, and the highest of this prevalence is mild anemia. The prevalence of anemia in the third trimester was higher than in the first and second trimesters. Anemia in pregnant women in developing countries is significantly higher than in developed countries due to pregnancy's economic, sociological, and health factors.

A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women - A narrative review

The unacceptable discrepancies in health outcomes between First Nations and non-Indigenous Australians begin at birth. Preterm birth (birth before 37 completed weeks of gestation) is a major contributor to adverse short- and long-term health outcomes and mortality. Australian First Nations infants are more commonly born too early. No tangible reductions in preterm births have been made in First Nations communities. Factors contributing to high preterm birth rates in Australian First Nations infants are reviewed and interventions to reduce preterm birth in Australian First Nations women are discussed. More must be done to ensure Australian First Nations infants get a better start to life. This can only be achieved with ongoing and improved research in partnership with Australian First Nations peoples.

Anaemia in chronic kidney disease pregnancy

AIM

To review the incidence and management of anaemia and outcomes in pregnancies in a cohort of Australian women with chronic kidney disease.

METHODS

A retrospective audit of 63 pregnancies in 52 women with chronic kidney disease.

RESULTS

Sixty-eight percent of chronic kidney disease pregnancies were complicated by haemoglobin less than 100 g/L. Iron stores were measured in only 62% of all pregnancies. Serum ferritin was less than 100 ng/ml in 95% of those tested. Erythropoietin-stimulating agents were used in 24 pregnancies (38%). Intravenous iron was used in only nine non-dialysis pregnancies.

CONCLUSION

Greater awareness of the importance of regular measurement of iron stores and appropriate levels for repletion in chronic kidney disease pregnancies amongst health professionals involved in obstetric care may result in earlier detection and treatment of iron deficiency, and potentially improve maternal and fetal outcomes.

Prediabetes and pregnancy: Early pregnancy HbA1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes

AIMS

To assess whether early pregnancy HbA1c can predict gestational diabetes mellitus (GDM) and adverse birth outcomes in Australian women.

METHODS

Prospective study of 466 women without diabetes, aged ≥16-years at first antenatal presentation. Recruitment was from 27 primary healthcare sites in rural and remote Australia from 9-January 2015 to 31-May 2018. HbA1c was measured with first antenatal investigations (<20-weeks gestation). Primary outcome measure was predictive value of HbA1c for GDM, by routine 75 g oral glucose tolerance test (OGTT; ≥24-weeks gestation), and for large-for-gestational-age (LGA) newborn.

RESULTS

Of 396 (129 Aboriginal) women with routine OGTT, 28.8% had GDM (24.0% Aboriginal). HbA1c ≥5.6% (≥38 mmol/mol) was highly predictive (71.4%, 95% CI; 47.8-88.7%) for GDM in Aboriginal women, and in the total cohort increased risk for LGA newborn (RR 2.04, 95% CI; 1.03-4.01, P = 0.040). There were clear differences between Aboriginal and non-Aboriginal women: 16.3% v 5.2% (P < 0.001) had elevated HbA1c whereas 12.4% v 29.6% (P < 0.001) developed hyperglycemia during pregnancy.

CONCLUSIONS

Early pregnancy HbA1c ≥5.6% (≥38 mmol/mol) identifies Aboriginal women with apparent prediabetes and elevated risk of having an LGA newborn. Universal HbA1c at first antenatal presentation could facilitate earlier management of hyperglycemia and improved perinatal outcome in this high-risk population.

Early childhood anaemia more than doubles the risk of developmental vulnerability at school-age among Aboriginal and Torres Strait Islander children of remote Far North Queensland: Findings of a retrospective cohort study

AIMS

Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school-age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland.

METHODS

The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development-physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland.

RESULTS

AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P < .001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P = .020) at school age.

CONCLUSIONS

Early childhood anaemia is a risk factor for developmental vulnerability at school-age in this setting. Interventions combining nutrition promotion and multi-micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement.