1
|
Oulerich Z, Sferruzzi-Perri AN. Early-life exposures and long-term health: adverse gestational environments and the programming of offspring renal and vascular disease. Am J Physiol Renal Physiol 2024; 327:F21-F36. [PMID: 38695077 DOI: 10.1152/ajprenal.00383.2023] [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: 11/30/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 06/21/2024] Open
Abstract
According to the Developmental Origins of Health and Disease hypothesis, exposure to certain environmental influences during early life may be a key determinant of fetal development and short- and long-term offspring health. Indeed, adverse conditions encountered during the fetal, perinatal, and early childhood stages can alter normal development and growth, as well as put the offspring at elevated risk of developing long-term health conditions in adulthood, including chronic kidney disease and cardiovascular diseases. Of relevance in understanding the mechanistic basis of these long-term health conditions are previous findings showing low glomerular number in human intrauterine growth restriction and low birth weight-indicators of a suboptimal intrauterine environment. In different animal models, the main suboptimal intrauterine conditions studied relate to maternal dietary manipulations, poor micronutrient intake, prenatal ethanol exposure, maternal diabetes, glucocorticoid and chemical exposure, hypoxia, and placental insufficiency. These studies have demonstrated changes in kidney structure, glomerular endowment, and expression of key genes and signaling pathways controlling endocrine, excretion, and filtration function of the offspring. This review aims to summarize those studies to uncover the effects and mechanisms by which adverse gestational environments impact offspring renal and vascular health in adulthood. This is important for identifying agents and interventions that can prevent and mitigate the long-term consequences of an adverse intrauterine environment on the subsequent generation.NEW & NOTEWORTHY Human data and experimental animal data show that suboptimal environments during fetal development increase the risk of renal and vascular diseases in adult-life. This is related to permanent changes in kidney structure, function, and expression of genes and signaling pathways controlling filtration, excretion, and endocrine function. Uncovering the mechanisms by which offspring renal development and function is impacted is important for identifying ways to mitigate the development of diseases that strain health care services worldwide.
Collapse
Affiliation(s)
- Zoé Oulerich
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
- Agro Paris Tech, Université Paris-Saclay, Paris, France
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
2
|
Zou JC, Jia XL, Wang HX, Su YJ, Zhu JY. Comparative efficacy and safety of Chinese patent medicines of iron deficiency anemia during pregnancy: A network meta-analysis. World J Clin Cases 2024; 12:3515-3528. [DOI: 10.12998/wjcc.v12.i18.3515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a prevalent nutritional disorder during pregnancy. Clinical studies indicate that incorporating Chinese patent medicines (CPMs) with oral iron (OI) in treating IDA in pregnancy can reduce adverse effects and improve clinical outcomes. Nonetheless, the comparative efficacy of different CPMs remains unclear.
AIM To assess the safety and effectiveness of different CPMs for treating IDA during pregnancy using network meta-analysis.
METHODS We conducted a search for randomized controlled trials (RCTs) that combined CPM and OI for IDA treatment in pregnancy, spanning from 2013 to the present. Data analysis was performed using Rev Man 5.3 and Stata 14.0 on literature that satisfied the quality criteria.
RESULTS The analysis included 45 RCTs, encompassing 4422 pregnant patients with IDA. Six CPMs were examined, including Shengxuebao Mixture, Shengxuening Tablets (SXN), Yiqi Weixue CPMs (YQWX), Jianpi Shengxue CPMs (JPSX), Yiqi Buxue Tablets, and Compound Hongyi Buxue Oral Liquid (FFHY). Findings indicated that FFHY + OI significantly improved the clinical effective rate. SXN + OI was most effective in boosting red blood cells counts and hemoglobin levels. YQWX + OI showed superior results in improving serum ferritin, and SXN + OI was most effective in increasing serum iron levels. JPSX + OI was optimal in reducing adverse pregnancy outcomes, while YQBX + OI effectively minimized adverse events. A cluster analysis suggested that SXN + OI could be the potentially optimal therapeutic regimen for IDA in pregnancy.
CONCLUSION This study demonstrates that the combination of OI with CPMs offers better outcomes than OI alone. Based on clinical efficacy and other measured outcomes, SXN + OI emerges as the most effective treatment modality for improving the health of pregnant patients with IDA.
Collapse
Affiliation(s)
- Jia-Chen Zou
- School of Chinese Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Xian-Ling Jia
- School of Chinese Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
| | - Hai-Xia Wang
- Traditional Chinese Medicine Department, Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Ying-Jie Su
- Traditional Chinese Medicine Department, Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Jing-Yu Zhu
- Traditional Chinese Medicine Department, Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| |
Collapse
|
3
|
Jin Q, Shimizu M, Sugiura M, Akashi Y, Iwase K, Tsuzuki H, Suzuki N, Tanaka T, Kitamura Y, Yamakawa M. Effectiveness of non-pharmacological interventions to prevent anemia in pregnant women: a quantitative systematic review protocol. JBI Evid Synth 2024; 22:1122-1128. [PMID: 38084098 PMCID: PMC11163888 DOI: 10.11124/jbies-23-00081] [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: 06/12/2024]
Abstract
OBJECTIVE This review will identify the effectiveness of non-pharmacological interventions in preventing iron deficiency anemia in pregnant women with a normal course of pregnancy. INTRODUCTION The global prevalence of anemia among pregnant women is 36.5%, posing risks to women and fetuses. This underscores the need for effective prevention; however, the effectiveness of non-pharmacological approaches in preventing pregnancy anemia remains unclear. INCLUSION CRITERIA This review will encompass experimental and quasi-experimental studies on the following approaches to prevent anemia during pregnancy: recommendations for dietary supplements, oral iron supplements (over the counter), provision of supplements to promote iron absorption, participation in anemia prevention education, and provision of information. There will be no restrictions on the duration or frequency of intervention, and longitudinal intervention studies will be included. In studies with a control group, the comparator may be usual care or pharmacological interventions; in studies without, it may involve no intervention, temporal comparisons, or baseline periods without non-pharmacological interventions. Evaluation of hemoglobin, hematocrit, and ferritin will be included as primary outcomes. Low birth weight, preterm birth, amount of blood loss at delivery, small for gestational age, and Apgar scores will be included as secondary outcomes. METHODS A search will be conducted in MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), Scopus, Australian New Zealand Clinical Trials Registry, Cochrane Central Register of Controlled Trials, and ICHUSHI-Web. Researchers will screen studies, extract data, assess the quality of studies, and analyze the data in accordance with the JBI guidance for systematic reviews of effectiveness. The Grading of Recommendations, Assessment, Development and Evaluation approach will be used to assess the certainty of the findings. REVIEW REGISTRATION PROSPERO CRD42022344155.
Collapse
Affiliation(s)
- Qiongai Jin
- Faculty of Nursing, Fujita Health University, Aichi, Japan
| | - Mikiko Shimizu
- Faculty of Nursing, Fujita Health University, Aichi, Japan
| | - Masato Sugiura
- Faculty of Nursing, Fujita Health University, Aichi, Japan
| | - Yumi Akashi
- Faculty of Nursing, Fujita Health University, Aichi, Japan
| | - Keisuke Iwase
- Faculty of Nursing, Fujita Health University, Aichi, Japan
| | | | - Noriko Suzuki
- Faculty of Health Care and Nursing, Juntendo University, Tokyo, Japan
| | - Tomoko Tanaka
- Faculty of Health Care and Nursing, Juntendo University, Tokyo, Japan
| | - Yukie Kitamura
- Faculty of Health Care and Nursing, Juntendo University, Tokyo, Japan
| | - Miyae Yamakawa
- The Japan Centre for Evidence Based Practice: A JBI Centre of Excellence, Osaka, Japan
- Department of Evidence-Based Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Suliburska J, Cholik R, Kocyłowski R, Bakinowska E. Relationship between prepregnancy BMI and the concentrations of iron, calcium, and magnesium in serum and hair during the first trimester of pregnancy in women. J Trace Elem Med Biol 2024; 83:127388. [PMID: 38262193 DOI: 10.1016/j.jtemb.2024.127388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND In women of childbearing age, a low dietary supply of iron, calcium, and magnesium is often observed. Minerals deficiency in pregnant women is often associated with abnormal body weight and may impact fetal development disorders. The aim of this study is to determine the relationship between prepregnancy body mass index (BMI) and the dietary intake of iron, calcium and magnesium and their concentrations in serum and hair in pregnant women. METHOD The study involved 97 Caucasian/white low-risk pregnant women at 12 weeks of gestation. The analysis of minerals in serum and hair samples was performed using atomic absorption spectrometry. Pre-pregnancy BMI was calculated based on self-reported weight. The study used a validated questionnaire and a 24-h recall nutrition interview, which were analyzed using Aliant software. RESULTS It was found that overweight and obese women exhibited higher magnesium concentration in serum, while iron content in serum and hair was markedly lower compared to women with normal body weight. The average total supply of iron was below the recommendation in pregnant women. Moreover, an inverse significant relationship was observed between BMI and iron concentration in hair and serum in the whole population. CONCLUSION In conclusion, being overweight or obese before pregnancy is associated with low dietary iron intake and low iron concentration in serum and hair during the first trimester of pregnancy in women.
Collapse
Affiliation(s)
- Joanna Suliburska
- Department of Human Nutrition and Dietetics, Poznan University of Life Science, ul. Wojska Polskiego 31, 60-624 Poznan, Poland.
| | - Rafsan Cholik
- Department of Human Nutrition and Dietetics, Poznan University of Life Science, ul. Wojska Polskiego 31, 60-624 Poznan, Poland
| | - Rafał Kocyłowski
- PreMediCAre NewMed Medical Centre, ul. Drużbickiego 13, 61-693 Poznań, Poland
| | - Ewa Bakinowska
- Institute of Mathematics, Poznan University of Technology, ul. Piotrowo 3A, 60-965 Poznan, Poland
| |
Collapse
|
6
|
Abu Shqara R, Chole S, Sgayer I, Rozano Gorelick A, Lowensetin L, Frank Wolf M. The utility of inpatient anemia workup in hemoglobin < 10 g/dL diagnosed randomly in the third trimester: a retrospective study. Arch Gynecol Obstet 2024; 309:1893-1901. [PMID: 37162561 DOI: 10.1007/s00404-023-07069-7] [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: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE About 40% of pregnant women are anemic and at an increased risk for complications. We examined the efficacy of inpatient anemia workup and treatment in pregnant women diagnosed with moderate-severe anemia (hemoglobin < 10 mg/dL), during hospitalization in the late second-trimester and third-trimester. METHODS This retrospective study, conducted between March 2020 and November 2022, included women at ≥ 24 gestational weeks who were hospitalized due to various indications and diagnosed with anemia (hemoglobin < 10 mg/dL). The study group comprised women who underwent an inpatient anemia workup and initiation of anemia treatment. The comparison group comprised women who did not undergo an inpatient anemia investigation. The primary outcome was the rate of pre-delivery hemoglobin > 11 g/dL. RESULTS The most frequent etiology of anemia in the study group (n = 188) was iron-deficiency anemia (30.2%), followed by mixed anemia of iron, folate and vitamin-B12 deficiencies (20.7%). In the study vs. the comparison group (n = 179), the rate of pre-delivery hemoglobin > 11 g/dL was higher, and the increase in hemoglobin from intervention to delivery was greater. The ideal timing for anemia intervention for maximizing the increase in pre-delivery hemoglobin was 6-weeks or more prior to delivery. The rates of postpartum hemorrhage and blood transfusions were similar. The rate of postpartum hemoglobin < 10 g/dL was lower in the study than the comparison group. CONCLUSION Inpatient anemia investigation and treatment resulted in higher peri-delivery hemoglobin. In women randomly diagnosed with anemia at hospitalization, the rate of pre-delivery hemoglobin > 11 g/dL was increased among those who underwent a simple anemia investigation and treatment initiation.
Collapse
Affiliation(s)
- Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Samuel Chole
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Lior Lowensetin
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| |
Collapse
|
7
|
Tirore LL, Areba AS, Tamrat H, Habte A, Abame DE. Determinants of severity levels of anemia among pregnant women in Sub-Saharan Africa: multilevel analysis. Front Glob Womens Health 2024; 5:1367426. [PMID: 38655396 PMCID: PMC11035794 DOI: 10.3389/fgwh.2024.1367426] [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] [Received: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
Background Anemia is a severe public health problem affecting 54% of pregnant women in SSA Yet, only a limited number of studies have provided a partial assessment of the pooled prevalence and related determinants of the severity levels of anemia in pregnant women in SSA. Therefore, this study provides the most recent estimates of anemia severity levels and related determinants. Methods The most recent Demographic Health Survey (DHS) dataset of 21 Sub-Saharan African countries which were collected between 2015 and 2022 were used. A total of 14,098 pregnant women were included. Multilevel ordinal logistic regression was used. Results The pooled prevalence of anemia was 51.26%. Pregnant women who were in the old age groups, and who have attended secondary and higher education were less likely to be at higher levels of anemia. Those women who have given birth to >1 children in the last 5 years, pregnant women in second and third trimester and living in poorest households had greater odds of being at higher levels of anemia. Conclusion In Sub-Saharan Africa, anemia is a severe public health concern for pregnant mothers. When developing and implementing strategies for the prevention and control of anemia, it is imperative to take into account the individual and community circumstances. Programs for the prevention and control of anemia should incorporate the economic and educational empowerment of women.
Collapse
Affiliation(s)
| | | | - Habtamu Tamrat
- Department of Orthopedic Surgery, Wachemo University, Hossana, Ethiopia
| | - Aklilu Habte
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Li M, Wright A, Rahim AM, Tan KH, Tagore S. Retrospective Study Comparing Treatment Outcomes in Obstetric Patients With Iron Deficiency Anemia Treated With and Without Intravenous Ferric Carboxymaltose. Cureus 2024; 16:e55713. [PMID: 38586790 PMCID: PMC10998652 DOI: 10.7759/cureus.55713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Iron deficiency anemia is associated with an increased risk of adverse maternal and perinatal outcomes. Intravenous iron preparation containing ferric carboxymaltose has been shown to be a safe and effective way of increasing hemoglobin (Hb) and mean corpuscular volume (MCV) levels and reducing the need for blood transfusion. In our center, it used to be given as an inpatient procedure because of the risks of potential drug reactions. In 2021, we initiated the administration of intravenous ferric carboxymaltose as an outpatient procedure. We compared the outcomes of patients between 2021 and 2023 after the initiation of outpatient administration of intravenous ferric carboxymaltose in 127 obstetric patients with iron deficiency anemia in the second and third trimesters. Methods In this study conducted in a large maternity unit in Singapore between 2021 to 2023, we compared the changes in maternal hematological parameters among obstetric patients with iron deficiency anemia presenting to the day care unit in the second or third trimester with a Hb level of <8 g/dl treated with a single dose of ferric carboxymaltose injection (Ferinject) against a control group who were referred for treatment but defaulted on and declined treatment. Results Ferric carboxymaltose significantly increased the Hb and MCV levels at delivery in obstetric patients with iron deficiency. The mean Hb at delivery was 10.8 g/dL in the case group compared to 8.8 g/dL in the control group. The percentage of patients with Hb ≥10.0 g/dL was 73.4% in the case group compared to 27.8% in the control group. The incidence of adverse side effects was low and mild (2/127; 1.6%). None of the patients received were hospitalized because of ferric carboxymaltose. Conclusion A single injection dose of ferric carboxymaltose as an outpatient antenatal procedure was easily administered and well tolerated. Obstetric patients with iron deficiency anemia who received intravenous ferric carboxymaltose had a significantly higher level of Hb than those who did not.
Collapse
Affiliation(s)
- Mingyue Li
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Ann Wright
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
| | - Asmira M Rahim
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Kok Hian Tan
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shephali Tagore
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
| |
Collapse
|
10
|
Taieb A, Majdoub M, Souissi N, Chelly S, Ben Abdelkrim A. Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes. Cureus 2024; 16:e56218. [PMID: 38618305 PMCID: PMC11016321 DOI: 10.7759/cureus.56218] [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: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) has been steadily increasing over the past years. It is a major risk factor for glucose intolerance and type 2 DM (T2DM). The American Diabetes Association recommends that women whose pregnancy was complicated by GDM be screened for persistent glucose abnormalities at six to 12 weeks postpartum with either a fasting plasma glucose test alone or with a fasting 75-g, two-hour oral glucose tolerance test. This study aimed to identify the main predictive factors of glucose tolerance disorders in early postpartum women with a recent history of GDM. In this retrospective descriptive study, we identified 400 women who met the eligibility criteria for the study. The mean age was 34.54 ± 5.51 years. A total of 70% had a family history of DM, 16% had a personal history of GDM, and 23% had fetal macrosomia in previous pregnancies. The overall incidence of postpartum carbohydrate tolerance disorders was 36.4%, including 12% prediabetes and 24.4% DM. The prevalence of prediabetes and T2DM after delivery was higher with older maternal age, multigravidity, a higher BMI, a history of GDM, and fetal macrosomia in previous pregnancies. Furthermore, the persistence of this impaired glucose tolerance in postpartum was associated with a higher term of diagnosis, a higher glycated hemoglobin (HbA1c) percentage (the discriminant cutoff value with the best sensitivity/specificity ratio was 5.25%), the use of insulin therapy, cesarean section delivery, and fetal macrosomia. After adjusting for confounders, only prior GDM, a higher HbA1c level, macrosomia, and gestational term were found to significantly affect postpartum glucose tolerance. Although postpartum screening for T2DM is recommended for all women with GDM, a significant number of patients fail it. A better knowledge of predictive factors for this outcome is therefore needed for a more effective and targeted medical intervention.
Collapse
Affiliation(s)
- Ach Taieb
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Marwa Majdoub
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Nesrine Souissi
- Nutrition, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Souhir Chelly
- Infectious Control and Prevention, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Asma Ben Abdelkrim
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| |
Collapse
|
11
|
Kloka JA, Friedrichson B, Jasny T, Blum LV, Choorapoikayil S, Old O, Zacharowski K, Neef V. Anaemia and red blood cell transfusion in women with placenta accreta spectrum: an analysis of 38,060 cases. Sci Rep 2024; 14:4999. [PMID: 38424178 PMCID: PMC10904858 DOI: 10.1038/s41598-024-55531-6] [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: 11/19/2023] [Accepted: 02/24/2024] [Indexed: 03/02/2024] Open
Abstract
Placenta accreta spectrum (PAS) has become a significant life-threatening issue due to its increased incidence and associated morbidity and mortality. Pregnancy is often associated with states of anaemia, and severe maternal haemorrhage represents a major risk factor for red blood cell (RBC) transfusion. The present study retrospectively analyzed the prevalence of anaemia, transfusion requirements and outcome in women with PAS. Using data from the German Statistical Office pregnant patients with deliveries hospitalized between January 2012 and December 2021 were included. Primary outcome was the prevalence of anemia and administration of RBCs. Secondary outcome were complications in women with PAS who received RBC transfusion. In total 6,493,606 pregnant women were analyzed, of which 38,060 (0.59%) were diagnosed with PAS. The rate of anaemia during pregnancy (60.36 vs. 23.25%; p < 0.0001), postpartum haemorrhage (47.08 vs. 4.41%; p < 0.0001) and RBC transfusion rate (14.68% vs. 0.72%; p < 0.0001) were higher in women with PAS compared to women without PAS. Women with PAS who had bleeding and transfusion experienced significantly more peripartum complications than those who did not. A multiple logistic regression revealed that the probability for RBC transfusion in all pregnant women was positively associated with anaemia (OR 21.96 (95% CI 21.36-22.58)). In women with PAS, RBC transfusion was positively associated with the presence of renal failure (OR 11.27 (95% CI 9.35-13.57)) and congestive heart failure (OR 6.02 (95% CI (5.2-7.07)). Early anaemia management prior to delivery as well as blood conservation strategies are crucial in women diagnosed with PAS.
Collapse
Affiliation(s)
- Jan Andreas Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Benjamin Friedrichson
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Thomas Jasny
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Lea Valeska Blum
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Oliver Old
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany.
| |
Collapse
|
12
|
Habe S, Haruna M, Yonezawa K, Usui Y, Sasaki S, Nagamatsu T, Fujita M, Suetsugu Y, Ohori R, Tanaka M, Aoyama S. Factors Associated with Anemia and Iron Deficiency during Pregnancy: A Prospective Observational Study in Japan. Nutrients 2024; 16:418. [PMID: 38337702 PMCID: PMC10857081 DOI: 10.3390/nu16030418] [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: 12/30/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Gestational anemia (GA) is a global health concern with a remarkably high prevalence in Japan, which is associated with various maternal and neonatal outcomes. This study aimed to explore whether GA and non-anemic iron deficiency (NAID) during the third trimester is associated with maternal characteristics, nutrient intake, low birth weight (LBW), and preterm birth. Participants were categorized into GA, NAID, and normal groups, based on serum ferritin and hemoglobin levels. Nutrient intake was assessed using the Brief Diet History Questionnaire. Data from 317 pregnant women were analyzed, including 110 (34.7%), 151 (47.6%), and 56 (17.6%) women in the GA, NAID, and normal groups, respectively. Factors associated with GA included being multipara (p < 0.001) and not taking any type of iron supplements in the third trimester (p = 0.043). The normal group had a significantly higher proportion of preterm birth and LBW than the GA and NAID groups. The GA group had a significantly higher energy intake than the normal group (p = 0.044). Overall, energy and micronutrient intake were significantly below the estimated average requirement in the dietary reference intakes for Japanese. Health care professionals need to consider nutritional advice that can prevent GA by focusing on overall micronutrients, not just energy intake.
Collapse
Affiliation(s)
- Sarasa Habe
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
| | - Megumi Haruna
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Yuriko Usui
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Health and Welfare, Chiba 286-8520, Japan;
| | - Megumi Fujita
- Department of Clinical Nursing, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan;
| | - Yoshiko Suetsugu
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Riko Ohori
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Moeko Tanaka
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
| | - Satoko Aoyama
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (S.H.); (K.Y.); (Y.U.); (R.O.); (M.T.); (S.A.)
| |
Collapse
|
13
|
Lucas S, Garg M. Intravenous iron: an update. Intern Med J 2024; 54:26-34. [PMID: 37490496 DOI: 10.1111/imj.16184] [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: 04/23/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Iron deficiency is the most common nutritional deficiency worldwide, with significant adverse health consequences in the presence or absence of anaemia. Total dose intravenous iron replacement is recommended for replacement of iron in patients with severe iron deficiency, especially in the presence of anaemia, intolerance or inefficacy following oral iron, or states of inflammation where upregulation of hepcidin may impair gastrointestinal absorption of iron. Currently, available intravenous iron formulations have been demonstrated to have an excellent overall safety profile, but potential adverse effects, including skin staining, infusion-related reactions and hypophosphataemia, have been described. Knowledge of differences in administration and safety profiles of currently available iron formulations will allow appropriate prescription, counselling, as well as recognition and management of adverse events in patients requiring intravenous iron.
Collapse
Affiliation(s)
- Sarah Lucas
- Northern Health, Melbourne, Victoria, Australia
| | - Mayur Garg
- Northern Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Kloka JA, Friedrichson B, Jasny T, Old O, Piekarski F, Zacharowski K, Neef V. Anemia, red blood cell transfusion and administration of blood products in obstetrics: a nationwide analysis of more than 6 million cases from 2011-2020. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:37-45. [PMID: 37847205 PMCID: PMC10812898 DOI: 10.2450/bloodtransfus.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/06/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The prevalence of anemia is high, especially in obstetrics. There is large evidence, that anemia during pregnancy is associated with increased maternal morbidity and mortality. Anemia and peripartum hemorrhage remain the main causes for transfusion of red blood cells (RBC). Patient Blood Management (PBM) reduces the need for RBC transfusion significantly. The present study retrospectively analyzed the impact and prevalence of anemia and RBC transfusion on pregnant women. MATERIALS AND METHODS Data were retrieved from the German Statistical Office on pregnant women who delivered in hospital between January 1st 2011 and December 31st 2020. The prevalence of anemia, peripartum hemorrhage, comorbidities, administration of blood products and complications were analyzed. RESULTS A total of 6,356,046 pregnant women were analyzed of whom 78,257 (1.23%) received RBC transfusion (RBC transfusion group) and 6,277,789 (98.77%) did not receive RBC transfusion (non-RBC transfusion group). In all women analyzed anemia rate was 23.74%. The rates of anemia during pregnancy (70.39 vs 23.15%; p<0.0001), postpartum hemorrhage (41.42 vs 4.35%; p<0.0001), hospital length of stay (127.5 vs 87.08 hours; p<0.0001) and single complications were higher in women with RBC transfusion compared to women without RBC transfusion. DISCUSSION The prevalence of anemia and the increased risk for RBC transfusion show that there is great potential for effective implementation of PBM in obstetrics. The treatment of anemia during pregnancy and reduction of RBC transfusions will decrease maternal morbidity and mortality.
Collapse
Affiliation(s)
- Jan A Kloka
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Benjamin Friedrichson
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Thomas Jasny
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Oliver Old
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Florian Piekarski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| |
Collapse
|
15
|
Mislu E, Assalfew B, Arage MW, Chane F, Hailu T, Tenaw LA, Kidie AA, Kumsa H. Prevalence and factors associated with restless legs syndrome among pregnant women in middle-income countries: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1326337. [PMID: 38188334 PMCID: PMC10771314 DOI: 10.3389/fmed.2023.1326337] [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] [Received: 10/23/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Restless legs syndrome (RLS) is a debilitating condition characterized by uncomfortable sensations in the legs, typically occurring during periods of rest or sleep. It is more prevalent during pregnancy and is linked to sleep disturbances, diminished quality of life, and pregnancy complications. However, previous studies yielded inconsistent findings among pregnant women in middle-income countries. Consequently, this systematic review and meta-analysis sought to determine the pooled prevalence of restless legs syndrome and its associated factors in these populations. Method A systematic review and meta-analysis was conducted on published studies from middle-income countries until May 2023. The review strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant search terms were used to search for studies in PubMed, MEDLINE, EMBASE, and Google Scholar. Data extraction was performed using the Joanna Briggs Institute tool for prevalence studies. The meta-analysis was conducted using STATA 17 software, and heterogeneity was assessed using the I2 test, while publication bias was evaluated using Egger's test. Forest plots were also used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) using the random-effects model. Result This review included 22 studies from nine countries with a total of 17, 580 study participants. The overall pooled prevalence of RLS among pregnant women in middle-income countries was 13.82% (95% CI: 13.31, 14.32), and having low hemoglobin level (AOR: 1.68, 95% CI: 1.29, 2.18), history of RLS (AOR: 7.54, 95% CI: 3.02, 18.79), muscle cramps (AOR: 3.58, 95% CI: 1.21, 10.61), excessive day time sleepiness (AOR: 4.02, 95% CI: 1.34, 12.04), preeclampsia (AOR: 2.06, 95% CI: 1.28, 3.30), and taking prophylactic iron supplementation (AOR: 0.59, 95% CI: 0.50, 0.69) were the identified factors associated with it. Conclusion Generally, nearly one in every eight pregnant women in middle-income countries develop restless legs syndrome during pregnancy. Having low hemoglobin level, a history of RLS, muscle cramps, excessive daytime sleepiness, preeclampsia, and taking prophylactic iron supplementation were the identified factors associated with it. These findings underscore the importance of addressing the identified factors associated with RLS in order to effectively mitigate its occurrence among pregnant women.
Collapse
Affiliation(s)
- Esuyawkal Mislu
- School of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Betel Assalfew
- School of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
| | | | - Fiker Chane
- School of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tilahun Hailu
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Lebeza Alemu Tenaw
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Atitegeb Abera Kidie
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Henok Kumsa
- School of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
| |
Collapse
|
16
|
Jelloul E, Sitoris G, Veltri F, Kleynen P, Rozenberg S, Poppe KG. Gestation-suppressed serum TSH levels during early pregnancy are not associated with altered maternal and neonatal outcomes. Eur Thyroid J 2023; 12:e230112. [PMID: 37855409 PMCID: PMC10620451 DOI: 10.1530/etj-23-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/02/2023] [Indexed: 10/04/2023] Open
Abstract
Objective The aim of the study was to investigate the impact of suppressed serum TSH levels (sTSH) during early pregnancy on maternal and neonatal outcomes. Methods In this single-centre, retrospective cohort study 1081 women were screened at 11.8 ± 2.4 weeks of pregnancy for TSH, free T4 (FT4) and TPOAb. Exclusion criteria were twin- and assisted- reproduction pregnancies, women with TSH levels >3.74 mIU/L, severe hyperthyroidism, treated for thyroid dysfunction before or after screening and gestational blood sampling <6 or >16 weeks of pregnancy. The prevalence of adverse pregnancy outcomes was compared between the study group sTSH (TSH: < 0.06 mIU/L; n = 36) and euthyroid controls (TSH: 0.06-3.74 mIU/L; n = 1045), and the impact of sTSH on pregnancy outcomes verified in logistic regression analyses. Results Median (IQR) serum TSH level in women with sTSH was 0.03 (0.03-0.03) vs 1.25 (0.81-1.82) mIU/L in controls and FT4 levels 18.0 (14.4-20.3) vs 14.2 (12.9-15.4) pmol/L; both P < 0.001. None of the women with sTSH had thyrotropin receptor antibodies. Compared with controls, the prevalence of TPOAb positivity (TAI) was comparable between groups (5.6% vs 6.6%; P = 0.803). The prevalence of maternal and neonatal pregnancy outcomes was comparable between the study and control group. The logistic regression analyses with corrections for TAI, FT4 and demographic parameters confirmed the absence of an association between sTSH, and the following outcomes: iron deficient anaemia (aORs (95% CI)): 1.41 (0.64-2.99); P = 0.385, gestational diabetes: 1.19 (0.44-2.88); P = 0.713, preterm birth: 1.57 (0.23-6.22);P = 0.574 and low Apgar-1' score: 0.71 (0.11-2.67); P = 0.657. Conclusions Suppressed serum TSH levels during the first to early second trimester of pregnancy were not associated with altered maternal or neonatal outcomes.
Collapse
Affiliation(s)
- Emna Jelloul
- Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| | - Georgiana Sitoris
- Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| | - Flora Veltri
- Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| | - Pierre Kleynen
- Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| | - Serge Rozenberg
- Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| | - Kris G Poppe
- Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium
| |
Collapse
|
17
|
Lee RWK, Chng ALB, Tan KH. Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study. Heliyon 2023; 9:e21186. [PMID: 38034721 PMCID: PMC10684368 DOI: 10.1016/j.heliyon.2023.e21186] [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: 02/23/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Background Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals. Methods We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries. Results Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy. Conclusion While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.
Collapse
Affiliation(s)
| | | | - Kok Hian Tan
- Corresponding author. Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
| |
Collapse
|
18
|
Neef V, Wenk M, Kranke P. [Obstetric Anesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:570-582. [PMID: 37832560 DOI: 10.1055/a-2043-4329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Patient safety and reduction of possible complications are the top priorities for anesthesiologists in everyday clinical practice. Thus, interdisciplinary early assessment and optimization of patient specific medical conditions and risk factors are crucial. In obstetrics, regional anesthesia and general anesthesia are routinely being performed. To ensure maternal and fetal safety, knowledge regarding physiological changes during pregnancy is highly important. Regional anesthesia, particularly epidural analgesia, has its main field of application in the context of natural birth in the delivery room. Spinal anesthesia, as well as epidural and combined spinal-epidural anesthesia (CSE) are widely used for caesarean section. In this context, special attention should be paid to possible bleeding disorders. The combination of risk stratification and strategies to improve the patient's preoperative medical status is capable to reduce maternal and fetal complications.
Collapse
|
19
|
O'Brien K, Wang Y. The Placenta: A Maternofetal Interface. Annu Rev Nutr 2023; 43:301-325. [PMID: 37603428 DOI: 10.1146/annurev-nutr-061121-085246] [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: 08/23/2023]
Abstract
The placenta is the gatekeeper between the mother and the fetus. Over the first trimester of pregnancy, the fetus is nourished by uterine gland secretions in a process known as histiotrophic nutrition. During the second trimester of pregnancy, placentation has evolved to the point at which nutrients are delivered to the placenta via maternal blood (hemotrophic nutrition). Over gestation, the placenta must adapt to these variable nutrient supplies, to alterations in maternal physiology and blood flow, and to dynamic changes in fetal growth rates. Numerous questions remain about the mechanisms used to transport nutrients to the fetus and the maternal and fetal determinants of this process. Growing data highlight the ability of the placenta to regulate this process. As new technologies and omics approaches are utilized to study this maternofetal interface, greater insight into this unique organ and its impact on fetal development and long-term health has been obtained.
Collapse
Affiliation(s)
- Kimberly O'Brien
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA; ,
| | - Yiqin Wang
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA; ,
| |
Collapse
|
20
|
Sangkhae V, Fisher AL, Ganz T, Nemeth E. Iron Homeostasis During Pregnancy: Maternal, Placental, and Fetal Regulatory Mechanisms. Annu Rev Nutr 2023; 43:279-300. [PMID: 37253681 PMCID: PMC10723031 DOI: 10.1146/annurev-nutr-061021-030404] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pregnancy entails a large negative balance of iron, an essential micronutrient. During pregnancy, iron requirements increase substantially to support both maternal red blood cell expansion and the development of the placenta and fetus. As insufficient iron has long been linked to adverse pregnancy outcomes, universal iron supplementation is common practice before and during pregnancy. However, in high-resource countries with iron fortification of staple foods and increased red meat consumption, the effects of too much iron supplementation during pregnancy have become a concern because iron excess has also been linked to adverse pregnancy outcomes. In this review, we address physiologic iron homeostasis of the mother, placenta, and fetus and discuss perturbations in iron homeostasis that result in pathological pregnancy. As many mechanistic regulatory systems have been deduced from animal models, we also discuss the principles learned from these models and how these may apply to human pregnancy.
Collapse
Affiliation(s)
- Veena Sangkhae
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
| | - Allison L Fisher
- Endocrine Unit and Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas Ganz
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
| | - Elizabeta Nemeth
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;
| |
Collapse
|
21
|
Wiesenack C, Meybohm P, Neef V, Kranke P. Current concepts in preoperative anemia management in obstetrics. Curr Opin Anaesthesiol 2023; 36:255-262. [PMID: 36794901 PMCID: PMC10155694 DOI: 10.1097/aco.0000000000001252] [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: 02/17/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an overview of currently recommended treatment approaches for anemia during pregnancy, with a special focus on iron deficiency and iron deficiency anemia (IDA). RECENT FINDINGS As consistent patient blood management (PBM) guidelines in obstetrics are still lacking, recommendations regarding the timing of anemia screening and the treatment recommendations for iron deficiency and IDA during pregnancy are still controversial. Based on increasing evidence, early screening for anemia and iron deficiency should be recommended at the beginning of each pregnancy. To reduce maternal and fetal burden, any iron deficiency, even without anemia, should be treated as early as possible during pregnancy. While oral iron supplements administered every other day are the standard treatment in the first trimester, the use of intravenous iron supplements is increasingly suggested from the second trimester onwards. SUMMARY The treatment of anemia, and more specifically iron deficiency anemia during pregnancy, holds many possibilities for improvement. The fact that the period of risk is known well in advance and thus there is a long optimization phase is per se an ideal prerequisite for the best possible therapy of treatable causes of anemia. Standardization of recommendations and guidelines for screening and treatment of IDA in obstetrics is required for the future. In any case, a multidisciplinary consent is the precondition for a successfully implementation of anemia management in obstetrics to establish an approved algorithm easily enabling detection and treatment of IDA during pregnancy.
Collapse
Affiliation(s)
- Christoph Wiesenack
- Department of Anaesthesiology, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg
| |
Collapse
|
22
|
Shand AW, Kidson-Gerber GL. Anaemia in pregnancy: a major global health problem. Lancet 2023; 401:1550-1551. [PMID: 37088094 DOI: 10.1016/s0140-6736(23)00396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Antonia W Shand
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney 2045, NSW, Australia.
| | | |
Collapse
|
23
|
Peterson DF, McKibben NS, Hutchison CE, Lancaster K, Yang CJ, Dekeyser GJ, Friess DM, Schreiber MA, Willett NJ, Shatzel JJ, Aslan JE, Working ZM. Role of single-dose intravenous iron therapy for the treatment of anaemia after orthopaedic trauma: protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e069070. [PMID: 36944463 PMCID: PMC10032390 DOI: 10.1136/bmjopen-2022-069070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Orthopaedic trauma and fracture care commonly cause perioperative anaemia and associated functional iron deficiency due to a systemic inflammatory state. Modern, strict transfusion thresholds leave many patients anaemic; managing this perioperative anaemia is an opportunity to impact outcomes in orthopaedic trauma surgery. The primary outcome of this pilot study is feasibility for a large randomised controlled trial (RCT) to evaluate intravenous iron therapy (IVIT) to improve patient well-being following orthopaedic injury. Measurements will include rate of participant enrolment, screening failure, follow-up, missing data, adverse events and protocol deviation. METHODS AND ANALYSIS This single-centre, pilot, double-blind RCT investigates the use of IVIT for acute blood loss anaemia in traumatically injured orthopaedic patients. Patients are randomised to receive either a single dose infusion of low-molecular weight iron dextran (1000 mg) or placebo (normal saline) postoperatively during their hospital stay for trauma management. Eligible subjects include adult patients admitted for lower extremity or pelvis operative fracture care with a haemoglobin of 7-11 g/dL within 7 days postoperatively during inpatient care. Exclusion criteria include history of intolerance to intravenous iron supplementation, active haemorrhage requiring ongoing blood product resuscitation, multiple planned procedures, pre-existing haematologic disorders or chronic inflammatory states, iron overload on screening or vulnerable populations. We follow patients for 3 months to measure the effect of iron supplementation on clinical outcomes (resolution of anaemia and functional iron deficiency), patient-reported outcomes (fatigue, physical function, depression and quality of life) and translational measures of immune cell function. ETHICS AND DISSEMINATION This study has ethics approval (Oregon Health & Science University Institutional Review Board, STUDY00022441). We will disseminate the findings through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05292001; ClinicalTrials.gov.
Collapse
Affiliation(s)
- Danielle F Peterson
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Natasha S McKibben
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Catherine E Hutchison
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Karalynn Lancaster
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Chih Jen Yang
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Graham J Dekeyser
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Darin M Friess
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Martin A Schreiber
- Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nick J Willett
- Bioengineering, University of Oregon, Eugene, Oregon, USA
| | - Joseph J Shatzel
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph E Aslan
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary M Working
- Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
24
|
Lagadinou M, Markantes G, Amerali M, Mulita F, Marangos M, Michalaki M. A Retrospective Study of Various Iron Preparations Oral Administration in Pregnant Women with Iron Deficiency Anemia. Mater Sociomed 2023; 35:157-164. [PMID: 37701349 PMCID: PMC10495134 DOI: 10.5455/msm.2023.35.157-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 09/14/2023] Open
Abstract
During pregnancy anemia is a common medical condition, with iron deficiency and megaloblastic anemia being the most common. The symptoms range from very mild to severe and if left without proper medical treatment, there can be serious consequences for both mother and fetus. The most frequent pregnancy problem is anemia. The term "Iron Deficiency Anemia" refers to erythropoiesis under conditions of absolute iron deficiency. This presupposes the depletion of iron stores in the body. Iron deficiency anemia or Sideropenic anemia is the most common form of anemia worldwide. Special attention must be given to nutrition during pregnancy. In the current retrospective study, it was evaluated the contribution of various iron preparations substitution during the pregnancy and puerperium.
Collapse
Affiliation(s)
- Maria Lagadinou
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Georgios Markantes
- Division of Endocrinology, University Hospital of Patras,
Patras, Greece
| | - Marina Amerali
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Francesk Mulita
- Department of General Surgery, University Hospital of
Patras, Patras, Greece
| | - Markos Marangos
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Marina Michalaki
- Division of Endocrinology, University Hospital of Patras,
Patras, Greece
| |
Collapse
|