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Ebrahim M, Vadive PD, Dutton T, Anyasodor AE, Osuagwu UL, Bailey J. Retrospective audit compares screening and treatment of pregnancy-related anaemia in regional New South Wales with Australian guidelines. BMC Pregnancy Childbirth 2024; 24:457. [PMID: 38961376 PMCID: PMC11223411 DOI: 10.1186/s12884-024-06634-5] [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: 08/18/2023] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. METHODS This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. RESULTS Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. CONCLUSIONS This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap.
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Affiliation(s)
- Mariam Ebrahim
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | - Priya Dharshini Vadive
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | - Tegan Dutton
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | | | - Uchechukwu Levi Osuagwu
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia.
| | - Jannine Bailey
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
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Locks LM, Bhaise S, Dhurde V, Gugel A, Lauer J, Shah M, Goghari A, Hibberd PL, Patel A. The prevalence of anemia during pregnancy and its correlates vary by trimester and hemoglobin assessment method in Eastern Maharashtra, India. MATERNAL & CHILD NUTRITION 2024:e13684. [PMID: 38943254 DOI: 10.1111/mcn.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/29/2024] [Indexed: 07/01/2024]
Abstract
Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low-resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger-prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation-adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron-folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation-adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community-based strategies targeting iron deficiency, as well as other causes of anemia.
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Affiliation(s)
- Lindsey M Locks
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | | | | | - Abigail Gugel
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Jacqueline Lauer
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Miloni Shah
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Aboli Goghari
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Patricia L Hibberd
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Higher Education and Research, Wardha, India
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Xiao H, Li Y, Liu X, Wen Q, Yao C, Zhang Y, Xie W, Wu W, Wu L, Ma X, Li Y, Ji A, Cai T. High ambient temperature may increase the risk of anemia in pregnancy: Identifying susceptible exposure windows. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:172059. [PMID: 38556012 DOI: 10.1016/j.scitotenv.2024.172059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Anemia in pregnancy (AIP) is associated with multiple severe maternal and perinatal adverse outcomes. However, there is a lack of evidence on the association between environmental factors and AIP. Aim to explore the association between ambient temperature and the risk of AIP, and identify susceptible exposure windows, we conducted a matched case-control study from 2013 to 2016 in Xi'an, China, which included 710 women with AIP and 1420 women without AIP. The conditional logistic regression model was used to evaluate the association between ambient temperature and AIP at different gestational weeks and gestational months. The association between extreme temperature and AIP was evaluated using the distributed lag nonlinear model (DLNM). We conducted stratified analyses of age, parity, and season of conception, and estimated the interaction between ambient temperature and air pollutants on AIP. Ambient temperature was significantly positively associated with the risk of AIP, and the susceptible exposure windows were 2-25 gestational weeks and 1-6 gestational months, respectively. The strongest effect was observed in the week 8 and month 2, for each 1 °C increase in weekly and monthly mean temperature, the odds ratio (OR) for AIP was 1.038 (95 % confidence interval (CI): 1.022, 1.055) and 1.040 (95 % CI: 1.020, 1.060), respectively. Extreme heat may increase the risk of AIP. Stratified analyses showed that there was no significant difference among different age, parity, and season of conception groups. No significant interaction effect of ambient temperature with air pollution on AIP was found. In summary, high ambient temperature may increase the risk of AIP, and the first and second trimesters may be susceptible exposure windows. Understanding the effect of temperature on pregnant women will be beneficial to reduce the occurrence of AIP.
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Affiliation(s)
- Hua Xiao
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yunlong Li
- Department of Hematology, Chongqing Hospital of Jiangsu Province Hospital (Qijiang People Hospital), Chongqing 401420, China
| | - Xiaoling Liu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qin Wen
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), 400037, China
| | - Chunyan Yao
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yao Zhang
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Weijia Xie
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Wenhui Wu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Long Wu
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ailing Ji
- Department of Digital Health, Chongqing College of Architecture and Technology, Chongqing 401331, China.
| | - Tongjian Cai
- Department of Epidemiology, College of Preventive Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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Thakur GK, Shankar H, Arora TK, Kulkarni B. Role of mineral nutrients other than iron in pregnancy: under recognized opportunities to improve maternal/fetal outcomes: a literature review. Arch Gynecol Obstet 2024; 309:895-905. [PMID: 37698602 DOI: 10.1007/s00404-023-07183-6] [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: 03/30/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Anemia during pregnancy is an important global health concern, affecting 40% of women worldwide, and iron deficiency shares a significant proportion of the burden. From conception to birth, pregnancy is a period when women undergo metabolic and physiological changes. The nutritional needs are higher during pregnancy; thus, adequate nutrition is essential to maintain fetal growth and development. However, adverse effects due to deficiency in nutrition during pregnancy can result in maternal, fetal and neonatal complications. Despite the multifactorial etiology of anemia, iron deficiency is assumed as the primary cause of anemia during pregnancy and hence, mitigation strategy pivots around it for anemia management. Therefore, excluding other contributors, a single-micronutrient approach with iron supplements remains a myopic approach and this can exacerbate iron deficiency anemia. Micronutrient deficiencies are of particular concern as they may pose a silent threat to the survival and well-being of reproductive-age women and their infants. AIM Micronutrients, especially trace minerals, play a myriad of roles in pregnancy, and the lack of each one causes adverse complications to both the mother and the fetus. In this review paper, we attempt to piece together available information regarding the adverse effects of abnormal trace mineral levels along with iron deficiency on the mother and the fetus. METHOD A non-systematic literature search in PubMed, Google Scholar, and the Cochrane databases, for publications on minerals and vitamins during pregnancy and the possible influence of supplements on pregnancy outcomes. CONCLUSION Micronutrient deficiency exacerbates the pregnancy-induced anemia and other adverse birth outcomes. Micronutrient supplementation during pregnancy can combat anemia as well as reduce a number of adverse pregnancy outcomes in a comprehensive manner.
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Affiliation(s)
- Gaurav Kr Thakur
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Hari Shankar
- Central Procurement Cell, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Taruna K Arora
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Bharati Kulkarni
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
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Totade M, Gaidhane A, Sahu P. Interventions in Maternal Anaemia to Reduce Maternal Mortality Rate Across India. Cureus 2023; 15:e46617. [PMID: 37937034 PMCID: PMC10626415 DOI: 10.7759/cureus.46617] [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: 09/15/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Anaemia is one of the most prevalent issues encountered throughout pregnancy, with Iron deficiency anaemia and megaloblastic anaemia being the most common causes in India. It is critical to address anaemia in pregnancy since it has been linked to adverse pregnancy outcomes like preterm delivery, low-birth-weight newborns, fetal mortality, and, in certain circumstances, maternal death. The maternal mortality rate (MMR) is one of the significant health challenges, particularly in developing countries. It has substantially impacted the population's social situation and requires quick management. In this review article, we discuss recent developments and advancements in treating maternal anaemia with the aid of some government health programs, which can help with lowering the risk of maternal mortality. The primary goal of this manuscript is to raise awareness about anaemia in pregnancy. We examined the literature on anaemia during pregnancy, with a view to offering current and unambiguous guidance for preventing and managing this illness, which, if not appropriately managed, can result in severe maternal and neonatal problems.
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Affiliation(s)
- Manisha Totade
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Abhay Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Palash Sahu
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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6
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Raut AK, Hiwale KM. Iron Deficiency Anemia in Pregnancy. Cureus 2022; 14:e28918. [PMID: 36225459 PMCID: PMC9541841 DOI: 10.7759/cureus.28918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Through its functions in oxygen delivery, electron transport, and enzymatic activity, iron is crucial for the operation of all cells. High metabolic rate cells need more iron and are more likely to malfunction when there is an iron deficit. Since the mother's blood volume expands during pregnancy, and the fetus grows and develops, there is a sharp increase in the need for iron. Negative pregnancy outcomes, such as increased maternal sickness, low birthweight, preterm, and intrauterine growth restriction, are linked to iron deficiency. IDA, or nutritional iron deficiency anemia, affects more than two billion people worldwide and is the most prevalent disease. Based on the regression-based analysis, the prevalence of anemia in the World Health Organization's global database was calculated to be 14%. According to recent data, there are 17.4% more IDA cases among pregnant women in industrialized countries than in poor ones (up to 56% more cases). Despite the fact that oral iron supplementation is frequently used to treat IDA, not all patients benefit from oral iron therapy. This is caused by a number of things, which include the adverse effects of oral iron, resulting in low compliance and ineffectiveness. In a sizable group of patients taking oral iron preparations, the adverse effects primarily include GI symptoms. Intravenous iron was previously underutilized since it was linked to unfavorable and occasionally dangerous side effects. New type II and III iron complexes have been created recently, though, and they offer superior compliance and toleration in addition to strong efficacy and a good safety profile.
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Liu ZZ, Sun JH, Wang WJ. Gut microbiota in gastrointestinal diseases during pregnancy. World J Clin Cases 2022; 10:2976-2989. [PMID: 35647135 PMCID: PMC9082698 DOI: 10.12998/wjcc.v10.i10.2976] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/18/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
Gut microbiota (GM) is a micro-ecosystem composed of all microorganisms in the human intestine. The interaction between GM and the host plays an important role in maintaining normal physiological functions in the host. Dysbiosis of the GM may cause various diseases. GM has been demonstrated to be associated with human health and disease, and changes during individual development and disease. Pregnancy is a complicated physiological process. Hormones, the immune system, metabolism, and GM undergo drastic changes during pregnancy. Gastrointestinal diseases during pregnancy, such as hepatitis, intrahepatic cholestasis of pregnancy, and pre-eclampsia, can affect both maternal and fetal health. The dysregulation of GM during pregnancy may lead to a variety of diseases, including gastrointestinal diseases. Herein, we review recent research articles on GM in pregnancy-related gastrointestinal diseases, discuss the interaction of the GM with the host under normal physiological conditions, gastrointestinal diseases, and pregnancy-specific disorders. As more attention is paid to reproductive health, the pathogenic mechanism of GM in gastrointestinal diseases during pregnancy will be further studied to provide a theoretical basis for the use of probiotics to treat these diseases.
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Affiliation(s)
- Zhong-Zhen Liu
- BGI-Shenzhen, Shenzhen 518083, Guangdong Province, China
| | - Jing-Hua Sun
- BGI-Shenzhen, Shenzhen 518083, Guangdong Province, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wen-Jing Wang
- BGI-Shenzhen, Shenzhen 518083, Guangdong Province, China
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8
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Helmer P, Schlesinger T, Hottenrott S, Papsdorf M, Wöckel A, Diessner J, Stumpner J, Sitter M, Skazel T, Wurmb T, Härtel C, Hofer S, Alkatout I, Girard T, Meybohm P, Kranke P. [Patient blood management in the preparation for birth, obstetrics and postpartum period]. Anaesthesist 2022; 71:171-180. [PMID: 35234987 DOI: 10.1007/s00101-022-01109-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/17/2023]
Abstract
The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. As the information regarding anesthesiological procedures for pregnant women and the peripartum period including an informed consent process should be carried out long before childbirth, this provides a good possibility in this connection to incorporate PBM. An anesthesiological risk estimation as well as the diagnostic workup and treatment of potential anemia should be carried out during the pregnancy. Furthermore, loss of blood in anticipation of bleeding complications should be reduced by interdisciplinary preventive measures and an individually coordinated postpartum care should be organized. This results in an early diagnosis of anemia or iron deficiency with subsequent treatment also postpartum, analogous to the prepartum period.
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Affiliation(s)
- Philipp Helmer
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Sebastian Hottenrott
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Michael Papsdorf
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Achim Wöckel
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Joachim Diessner
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jan Stumpner
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Skazel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Christoph Härtel
- Kinderklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Stefan Hofer
- Klinik für Anästhesie, Intensiv‑, Notfallmedizin und Schmerztherapie, Westpfalz-Klinikum, Kaiserslautern, Deutschland
| | - Ibrahim Alkatout
- Klinik für Gynäkologie und Geburtshilfe (Frauenheilkunde), Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Thierry Girard
- Anästhesiologie, Universitätsspital Basel, Basel, Schweiz
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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9
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Maternal first trimester iron status and its association with obstetric and perinatal outcomes. Arch Gynecol Obstet 2022; 306:1359-1371. [PMID: 35088196 DOI: 10.1007/s00404-022-06401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess the following in singleton pregnant women: (1) associations between first trimester iron deficiency and obstetric and perinatal outcomes, (2) overall first trimester iron status and (3) post-treatment iron status after intensified iron supplementation. METHODS A prospective cohort study was conducted with linkage of first trimester hemoglobin and plasma ferritin with obstetric and perinatal data from a hospital database. Blood sample data were obtained from a Danish University Hospital. The cohort was divided into groups according to ferritin and hemoglobin: (1) iron-deficient anemic (ferritin < 30 ng/mL and Hb < 110 g/L), (2) iron-deficient non-anemic (ferritin < 30 ng/mL and Hb ≥ 110 g/L), and (3) iron-replete non-anemic (ferritin 30-200 ng/mL and Hb ≥ 110 g/L). Obstetric and perinatal outcomes in each iron-deficient group were compared to the iron-replete non-anemic group using multivariable logistic regression. The effect of 4 weeks intensified iron supplementation on hemoglobin and ferritin was assessed by groupwise comparisons. RESULTS The cohort comprised 5763 singleton pregnant women, of which 14.2% had non-anemic iron deficiency, and 1.2% had iron-deficiency anemia. Compared to iron-replete non-anemic women, iron-deficient anemic women had a higher risk of gestational diabetes (aOR 3.8, 95% CI 1.4-9.0), and iron-deficient non-anemic women had a higher risk of stillbirth (aOR 4.0, 95% CI 1.0-14.3). In group 1 and 2, 81.5% and 67.7% remained iron-deficient after intensified iron supplementation. CONCLUSION Iron-deficiency anemia was associated with gestational diabetes, and non-anemic iron deficiency with stillbirth, although risk estimates were imprecise due to few events. Iron deficiency was present in 15.4% and often persisted despite 4 weeks intensified iron supplementation.
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10
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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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Ruiz de Viñaspre-Hernández R, Gea-Caballero V, Juárez-Vela R, Iruzubieta-Barragán FJ. The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines. Birth 2021; 48:14-25. [PMID: 33274766 DOI: 10.1111/birt.12519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postpartum anemia can negatively affect maternal health and interfere with early parenting. Thus, it is important to have clear, evidence-informed recommendations on its diagnosis and treatment. OBJECTIVE To compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences. METHODS Systematic searches were conducted in the databases PubMed, CINAHL, LILACS, TRIP database, and Scopus, and in the websites of health institutions and scientific societies. Search terms were related to anemia and the postpartum period. Two hundred and eighty papers were identified; the full texts of 30 sets of guidelines were reviewed, with seven being included in the final analysis. Recommendations were extracted through an evaluation of the evidence on the definition, screening, and diagnosis of anemia. The quality of the guidelines was assessed using the AGREE II instrument. RESULTS Two sets of guidelines have been elaborated by international organizations, and the rest were produced by professional associations within high-resource countries. The discrepancies found in the guidelines are important and affect the definition of anemia, the criteria for screening asymptomatic women, or the criteria guiding treatment. The quality of the guidelines commonly scored between 4 and 6 on a scale of 0 to 7. Recommendations with poor-quality evidence predominated over recommendations with high-quality evidence. CONCLUSIONS This review highlights the need to reach a consensus on the definition of postpartum anemia, to agree on what constitutes a problem for maternal health, and to provide recommendations that reach greater consensus on its diagnosis and treatment.
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Affiliation(s)
- Regina Ruiz de Viñaspre-Hernández
- Community Midwifery, Centro de Salud "Cascajos", Servicio Riojano de Salud, Logroño, Spain.,Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | - Vicente Gea-Caballero
- School of Nursing La Fe, Adscript Center University of Valencia, Valencia, Spain.,Research Group GREIACC, Health Research Institute La Fe, University of Valencia, Valencia, Spain
| | - Raúl Juárez-Vela
- Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain.,School of Nursing, Universidad of La Rioja, Logroño, Spain
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12
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[Treatment of iron deficiency anemia during pregnancy with oral iron: State of practice among midwives]. ACTA ACUST UNITED AC 2021; 49:246-254. [PMID: 33429111 DOI: 10.1016/j.gofs.2021.01.001] [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: 11/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Iron deficiency anemia represents a public health issue which is usually managed by midwives. Because it is associated with maternal and fetal risks, a treatment is warranted. Oral iron represents the main option for treating this condition. Despite the existence of national and international guidelines no consensus about its modality of use has emerged so far. The primary objective of this study was to analyze midwives'practice with regards to iron deficiency anemia treatment using oral iron formulations. METHODS We conducted an observational and descriptive cross-sectional in a sample of midwives from the Gironde administrative region using a questionnaire. RESULTS We obtained 85 questionnaires from midwives working in private or public health facilities. Doses of iron and duration of treatment seem insufficient for a majority of responders. Folic acid and vitamin C are often associated with oral iron. Most midwives assess the efficacy of oral iron at one month with hemoglobin and ferritin levels. A significant fraction of these midwives shares similar practices which are in good accordance with the literature such as patient counselling with regards to drug intake, management of gastrointestinal side effects and inefficacity of oral iron. Noticeably, some of these midwives don't follow any guidelines. CONCLUSION The majority of participants demonstrated practices in accordance with various national guidelines although no precise therapeutic algorithm is available as reference. Larger studies on the management of iron deficiency anemia in pregnancy by health professionals and harmonization of practices are necessary.
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Abstract
PURPOSE OF REVIEW Anaemia affects up to 50% of pregnancies worldwide, and is associated with maternal and neonatal morbidity and mortality. Prevention and management of anaemia remains a priority. Despite this, there is ongoing debate on the optimal approach to identifying anaemia in pregnant women and the best strategies for prevention and management. The objective of this review is to describe the current landscape of haemoglobin testing in pregnancy in low and high-income countries. RECENT FINDINGS Current definitions of anaemia in pregnancy comprise a laboratory threshold of haemoglobin below which treatment is offered. Haemoglobin measurement is not sensitive in detecting iron deficiency - the most common cause of maternal anaemia. Furthermore, these historical thresholds were derived from heterogeneous populations comprising men and women. Women with anaemia in pregnancy are offered iron therapy, without testing for the underlying cause. This may be appropriate in high-income settings, where iron deficiency is the likely cause, but may not address the complex causes of anaemia in other geographical areas. SUMMARY Current thresholds of haemoglobin defining anaemia in pregnancy are under review. Further research and policy should focus on optimal strategies to identify women at risk of anaemia from all causes.
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14
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Günaydın B, Işık G, Bağcaz S, İnan G, Bozkurt N, Özkurt ZN, Onan MA. Retrospective Evaluation of Effects of Preoperative Anaemia Treatment in Gynaecological and Obstetric Surgical Patients. Turk J Anaesthesiol Reanim 2020; 49:25-29. [PMID: 33718902 PMCID: PMC7932708 DOI: 10.5152/tjar.2020.484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Objective In anemic patients undergoing surgery, there is an increase in the requirement of blood transfusion, longer hospital stay and higher intensive care unit adimission. In this study we aimed to evaluate the efficacy of iv iron treatment before elective obstetric or gynecological operations retrospectively. Methods After obtaining approval of ethics committee, records of 5688 patients underwent either obstetric or gynecological surgery between January 1st of 2016 to December 31st of 2018 were documented retrospectively and 241 anemic cases were identified. Eighty-one anemic patients who did not receive any iv iron treatment preoperatively were excluded and 160 cases treated with either iv iron (either sucrose or ferric carboxy maltose) were included. The laboratory results including haemoglobin (Hb), MCV,MCH and serum iron binding capacities, ferritin, iron and transferrin levels were documented before (preoperative) and after iv iron treatment (postoperative 10th day) were collected from files. Difference between preoperative and postoperative Hb, MCV, MCH, TIBC, serum ferritin, iron and transferrin levels of these cases were determined. Results In 97 obstetric cases, the differences of Hb, MCV, MCH, serum iron, ferritin, iron binding capacity values before surgery and postoperative 10th day were respectively found as 1.3 g dL-1 (p=0.000); 1.9 fL (p=0.000); 0.3 pg (p=0.01); 44.4 μg dL-1 (p=0.008); 85.9 μg L-1 (p=0.009); 211.7 μg dL-1 (p=0.001). In 63 gynecologic cases, same measurements were evaluated and similar differences in Hb, MCV, MCH, serum ferritin and transferrin saturation values were 1.25 g dL-1 (p=0.000); 2.2 fL (p=0.000); 0.8 pg (p=0.000); 215.6 μg L-1 (p=0.002); 41.5% (p=0.044). Two obstetric patients and 7 gynaecologic patients were transfused erytrocyte suspensions after surgery. Conclusion Efficacy of preoperative iv iron therapy in gynaecologic-obstetric patients with IDA has been demonstrated and its importance has been revisited once again.
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Affiliation(s)
- Berrin Günaydın
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Gizem Işık
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
| | - Selin Bağcaz
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Gözde İnan
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Nuray Bozkurt
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - M Anıl Onan
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
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15
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Iron homeostasis and perioperative management of iron deficiency. BJA Educ 2019; 19:390-397. [DOI: 10.1016/j.bjae.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
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16
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Pavord S, Daru J, Prasannan N, Robinson S, Stanworth S, Girling J. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2019; 188:819-830. [PMID: 31578718 DOI: 10.1111/bjh.16221] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Sue Pavord
- Department of Haematology Oxford University Hospitals Oxford UK
| | - Jan Daru
- Women's Health Research Unit Centre for Primary Care and Public Health WHO Collaborating Centre Blizard Institute London UK
| | - Nita Prasannan
- Department of Obstetrics and Gynaecology Guys and St Thomas' NHS Foundation Trust London UK
| | - Susan Robinson
- Haematology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Simon Stanworth
- NHSBT/Department of Haematology John Radcliffe Hospital Oxford UK
| | - Joanna Girling
- Department of Obstetrics and Gynaecology West Middlesex University Hospital and Chelsea & Westminster Hospital London UK
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17
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Yang Y, Wang R, Jiang H, Hu M, Tang A, Xiang Z. Changes of iron metabolism during pregnancy and the establishment of reference intervals for pregnant Chinese women. Ann Clin Biochem 2019; 56:556-563. [PMID: 30974959 DOI: 10.1177/0004563219835853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Abnormalities of iron metabolism in pregnancy pose risks for maternal and fetal health. Robust reference intervals for iron metabolism indices have not been established in a pregnant Chinese population. The purpose of this study was to derive reference intervals for indices of iron metabolism during pregnancy in a Chinese population. Methods A total of 360 healthy pregnant women were recruited and divided into three groups of 120 by gestational age: first trimester (1–13 weeks), second trimester (14–27 weeks) and third trimester (≥28 weeks). An additional 120 healthy non-pregnant women were recruited as the non-pregnant control group. Serum ferritin was measured by electrochemiluminescence immunoassay. Serum iron and total iron-binding capacity were measured by a direct bathophenanthroline method. Transferrin saturation value was calculated with formula TS = SI/TIBC. The reference intervals were established using a non-parametric method. Results In first and second trimesters (combined), the reference intervals for serum ferritin, serum iron, total iron-binding capacity and transferrin saturation are 14.7–184.3 mg/L, 14.50–33.45 µmol/L, 36.53–68.81 µmol/L and 19.04–64.76%, respectively. In the third trimester, the reference intervals for serum ferritin, serum iron, total iron-binding capacity and transferrin saturation are 7.2–122.2 mg/L, 5.83–21.52 µmol/L, 49.40–122.76 µmol/L and 8.22–52.75%, respectively. Conclusion The reference intervals for iron metabolism indices for healthy pregnant Chinese women were established in accordance with CLSI C28-A3 guidelines. This will be a valuable tool for clinical practice and research.
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Affiliation(s)
- Yuanqing Yang
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,2 Department of Blood Transfusion, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Rong Wang
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongmin Jiang
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Hu
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Aiguo Tang
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhongyuan Xiang
- 1 Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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18
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Estcourt LJ, Roberts DJ. Patient blood management - a renaissance of transfusion medicine. Transfus Med 2018; 28:85-88. [PMID: 29744975 DOI: 10.1111/tme.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- L J Estcourt
- National Health Service Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - D J Roberts
- National Health Service Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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