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An Z, Li Y, Li J, Jiang Z, Duan W, Guo M, Zhu Y, Zeng X, Wang L, Liu Y, Li A, Guo H, Zhang X. Associations between co-exposure to per- and polyfluoroalkyl substances and organophosphate esters and erythrogram in Chinese adults. CHEMOSPHERE 2024; 362:142750. [PMID: 38960049 DOI: 10.1016/j.chemosphere.2024.142750] [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: 03/10/2024] [Revised: 03/31/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Erythrogram, despite its prevalent use in assessing red blood cell (RBC) disorders and can be utilized to evaluate various diseases, still lacks evidence supporting the effects of per- and polyfluoroalkyl substances (PFASs) and organophosphate esters (OPEs) on it. A cross-sectional study involving 467 adults from Shijiazhuang, China was conducted to assess the associations between 12 PFASs and 11 OPEs and the erythrogram (8 indicators related to RBC). Three models, including multiple linear regression (MLR), sparse partial least squares regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate both the individual and joint effects of PFASs and OPEs on the erythrogram. Perfluorohexane sulfonic acid (PFHxS) showed the strongest association with HGB (3.68%, 95% CI: 2.29%, 5.10%) when doubling among PFASs in MLR models. BKMR indicated that PFASs were more strongly associated with the erythrogram than OPEs, as evidenced by higher group posterior inclusion probabilities (PIPs) for PFASs. Within hemoglobin and hematocrit, PFHxS emerged as the most significant component (conditional PIP = 1.0 for both). Collectively, our study emphasizes the joint effect of PFASs and OPEs on the erythrogram and identified PFASs, particularly PFHxS, as the pivotal contributors to the erythrogram. Nonetheless, further investigations are warranted to elucidate the underlying mechanisms.
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Affiliation(s)
- Ziwen An
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zexuan Jiang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Wenjing Duan
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Mingmei Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yiming Zhu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xiuli Zeng
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Huicai Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China.
| | - Xiaoguang Zhang
- Core Facilities and Centers of Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, Hebei Province, China.
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Magfirah N, Ansariadi A, Amiruddin R, Wijaya E, Maria IL, Salmah U, Ibrahim E. Inadequate food diversity and food taboo associated with maternal iron deficiency among pregnant women living in slum settlements in Makassar City, Indonesia. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:67. [PMID: 38559487 PMCID: PMC10979773 DOI: 10.4103/jehp.jehp_824_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Anemia in pregnancy is a major public health problem, especially in developing countries. The most common cause is nutritional deficiencies, especially iron deficiency. Adequate nutritional intake from food is essential during pregnancy. Therefore, this study aimed to investigate the relationship between food access and intake patterns with the incidence of iron deficiency among pregnant women living in the slum settlement in Makassar City. MATERIALS AND METHODS This research is a sub-study of the Indonesian Birth Cohort Study based in Makassar City. This sub-study used a cross-sectional design and recruited 173 pregnant women in their second and third trimesters using total sampling. All data were collected using a structured questionnaire and recorded using KoboToolbox software. Serum ferritin levels were examined for iron status using the ELISA method at the Microbiology Laboratory Unit at Hasanuddin University Teaching Hospital. The statistical data were analyzed using STATA version 14 with Chi-square analysis and logistic regression. RESULTS The prevalence of iron deficiency in pregnant women living in slum settlements in Makassar City was 78%. Logistic regression analysis showed that inadequate food diversity (AOR: 2.58; 95% CI: 1.17-5.69; P = 0.019) and food taboos (AOR: 2.81; 95% CI: 1.26-6.26; P = 0.011) were significantly associated with the incidence. CONCLUSIONS Most pregnant women living in slum settlements in Makassar City experienced iron deficiency. Pregnant women who experience iron shortages have been connected to food taboos and dietary diversity.
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Affiliation(s)
- Nurul Magfirah
- Master Program in Public Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Ansariadi Ansariadi
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ridwan Amiruddin
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Eri Wijaya
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ida L. Maria
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Ummu Salmah
- Department of Biostatistic, Faculty of Public Health, Hasanuddin University, Makassar Indonesia
| | - Erniwati Ibrahim
- Department of Environmental Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
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Hull JC, Bloch EM, Ingram C, Crookes R, Vaughan J, Courtney L, Jauregui A, Hilton JF, Murphy EL. Slower response to treatment of iron-deficiency anaemia in pregnant women infected with HIV: a prospective cohort study. BJOG 2021; 128:1674-1681. [PMID: 33587784 DOI: 10.1111/1471-0528.16671] [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: 01/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia. DESIGN Prospective cohort study. SETTING Hospital-based antenatal anaemia clinic in South Africa. SAMPLE Equal-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia. METHODS Haemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation. MAIN OUTCOME MEASURES Haemoglobin trajectories. RESULTS Of 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002). CONCLUSIONS Compared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion. TWEETABLE ABSTRACT Among pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.
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Affiliation(s)
- J C Hull
- Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - E M Bloch
- Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - C Ingram
- National Bone Marrow Registry, Cape Town, South Africa
| | - R Crookes
- Cryo-Save Inc., Johannesburg, South Africa
| | - J Vaughan
- National Health Laboratory Services, CH Baragwanath Hospital, Soweto, South Africa.,Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - A Jauregui
- Stanford University School of Medicine, Stanford, CA, USA
| | - J F Hilton
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - E L Murphy
- University of California San Francisco (UCSF), San Francisco, CA, USA.,Vitalant Research Institute (VRI), San Francisco, CA, USA
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Taubman-Ben-Ari O, Skvirsky V, Strauss T, Morag I. Pre-term delivery, optimism and initial personal growth as predictors of mothers' long-term personal growth. J Reprod Infant Psychol 2018; 37:277-289. [PMID: 30525992 DOI: 10.1080/02646838.2018.1554245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Positive outcomes in the aftermath of childbirth have increasingly been studied in the last decade. However, most of the studies concentrate on short-term outcomes. The current study examined the perceived personal growth of mothers four years after childbirth, investigating the contribution of the event characteristics (full-term/pre-term birth), internal resources (optimism, self-esteem) and personal growth as measured one year after the birth. Methods: Mothers (n=259) participated in the study by completing a set of self-report questionnaires one and four years following the birth of their child/ren. Results: Personal growth after four years was found to be higher among mothers of pre-terms than of full-terms, and higher four years after the birth than it had been three years earlier. Furthermore, regression analysis indicated the significant contributions of being a mother to pre-term baby/ies, optimism and personal growth one year after the birth to women's personal growth three years later. Discussion: The results highlight the potential long-term effects of giving birth to a pre-term baby on personal growth, as well as the contribution of optimism as an important internal resource. They also indicate the development of personal growth over time. Explanations for the findings are offered and their practical implications are discussed.
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Affiliation(s)
- Orit Taubman-Ben-Ari
- a The Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat Gan , Israel
| | - Vera Skvirsky
- a The Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat Gan , Israel
| | - Tzipora Strauss
- b Department of Neonatology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center and Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Iris Morag
- b Department of Neonatology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center and Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Bresani Salvi CC, Braga MC, Figueirôa JN, Batista Filho M. Could the erythrocyte indices or serum ferritin predict the therapeutic response to a trial with oral iron during pregnancy? Results from the Accuracy study for Maternal Anaemia diagnosis (AMA). BMC Pregnancy Childbirth 2016; 16:218. [PMID: 27516193 PMCID: PMC4982235 DOI: 10.1186/s12884-016-1005-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 08/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Treatment of maternal iron-deficiency anaemia can reduce risks of prematurity and low birth weight; hence a reliable diagnosis of maternal iron needs is critical. However, erythrocyte indices and serum ferritin have shown a weak correlation with iron status during pregnancy. This study verified the accuracy of those tests to predict the responsiveness to a therapeutic test with oral iron as reference standard for iron deficiency in pregnant women. Methods A prospective diagnostic study phase 3 was conducted in a single prenatal care center in Northeast Brazil. Between August 2011 and October 2012 a consecutive sampling included 187 women in their 2nd-3rd trimesters of low-risk pregnancy and having anaemia (haemoglobin <11.0 g/dL). Until December 2012, 139 women completed a trial with daily pills of ferrous sulfate (40 mg of iron), during 23 to 125 days. Haemoglobin (Hb), other erythrocyte indices and ferritin (index-tests) were assessed pre-treatment by automated analyzers. Hb was performed also post-treatment to assess the therapeutic response by its post-pretreatment differences. We estimated sensitivity (Se), specificity (Sp), predictive values (PV), likelihood ratios (LR), diagnostic Odds Ratio (OR), area under Receiver Operating Characteristic curve (AUC), accuracy ratio and agreement coefficient of the index-tests against an increase of at least 0.55 Hb Z-score (reference standard test). We calculated the Z-scores according to the reference population from Centers for Disease Control and Prevention. Results Hb had a mean increase of 0.24 Z-score after 30 iron pills (p 0.013). All index-tests demonstrated PV- above 70 %, PV+ around 40 %, LR around 1.0, and AUC of 0.5 to 0.6. Hb and haematocrit had Se of 50 % (95 % CI 40 to 70); and Sp of 59 % (95 % CI 43 to 74) and 47 % (95 % CI 38 to 57), respectively. Ferritin, Mean Corpuscular Volume, Mean Corpuscular Haemoglobin, Mean Corpuscular Haemoglobin Concentration and Red blood cell Distribution Width had Se below 40 % with Sp above 70 %. Conclusions Erythrocyte indices and ferritin could not predict the iron needs of anemic pregnant women. Increases of Hb Z-scores after a short treatment with oral iron may be a reliable therapeutic test. Trial registration World Health Organization International Clinical Trials Registry Platform U1111-1123-2605; Brazilian Registry of Clinical Trials RBR-237wbg, registered 28 July 2011 Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1005-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristiane Campello Bresani Salvi
- Nutrition Research Group at Instituto de Medicina Integral Prof Fernando Figueira - IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE, CEP: 50.070-550, Brazil. .,Instituto Nacional do Seguro Social/Ministério da Previdência Social - INSS/MPS, Av Jorn Mário Melo, 343, Santo Amaro, Recife, PE, CEP: 50.040-010, Brazil.
| | - Maria Cynthia Braga
- Postgraduate Program in Maternal and Child Health of IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE, CEP: 50.070-550, Brazil.,Postgraduate Program in Public Health at Centro de Pesquisas Aggeu Magalhães - Fundação Oswaldo Cruz - CPQAM/FIOCRUZ, Av. Professor Moraes Rego, s/n - Campus da UFPE - Cidade Universitária, Recife, PE, CEP: 50.670-420, Brazil
| | - José Natal Figueirôa
- Postgraduate Program in Maternal and Child Health of IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE, CEP: 50.070-550, Brazil
| | - Malaquias Batista Filho
- Nutrition Research Group at Instituto de Medicina Integral Prof Fernando Figueira - IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE, CEP: 50.070-550, Brazil.,Postgraduate Program in Maternal and Child Health of IMIP, Rua dos Coelhos, 300, Boa Vista, Recife, PE, CEP: 50.070-550, Brazil
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Rukuni R, Knight M, Murphy MF, Roberts D, Stanworth SJ. Screening for iron deficiency and iron deficiency anaemia in pregnancy: a structured review and gap analysis against UK national screening criteria. BMC Pregnancy Childbirth 2015; 15:269. [PMID: 26487281 PMCID: PMC4618150 DOI: 10.1186/s12884-015-0679-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/04/2015] [Indexed: 12/22/2022] Open
Abstract
Background Iron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The aim of this study was to appraise the evidence against the UK National Screening Committee (UKNSC) criteria as to whether a national screening programme could reduce the prevalence of iron deficiency anaemia and/or iron deficiency in pregnancy and improve maternal and fetal outcomes. Methods Search strategies were developed for the Cochrane library, Medline and Embase to identify evidence relevant to UK National Screening Committee (UKNSC) appraisal criteria which cover the natural history of iron deficiency and iron deficiency anaemia, the tests for screening, clinical management and evidence of cost effectiveness. Results Many studies evaluated haematological outcomes of anaemia, but few analysed clinical consequences. Haemoglobin and ferritin appeared the most suitable screening tests, although future options may follow recent advances in understanding iron homeostasis. The clinical consequences of iron deficiency without anaemia are unknown. Oral and intravenous iron are effective in improving haemoglobin and iron parameters. There have been no trials or economic evaluations of a national screening programme for iron deficiency anaemia in pregnancy. Conclusions Iron deficiency in pregnancy remains an important problem although effective tests and treatment exist. A national screening programme could be of value for early detection and intervention. However, high quality studies are required to confirm whether this would reduce maternal and infant morbidity and be cost effective. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0679-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruramayi Rukuni
- National Perinatal Epidemiology Unit, University of Oxford, Old Road, Campus, Oxford, OX3 7LF, UK.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Old Road, Campus, Oxford, OX3 7LF, UK.
| | - Michael F Murphy
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
| | - David Roberts
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
| | - Simon J Stanworth
- Department of Haematology, John Radcliffe Hospital, NHS Blood & Transplant/Oxford University Hospital Trust, University of Oxford, Oxford, UK.
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Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. The Relation of Maternal Blood Arsenic to Anemia During Pregnancy. Women Health 2015; 55:42-57. [DOI: 10.1080/03630242.2014.972016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alkozei A, McMahon E, Lahav A. Stress levels and depressive symptoms in NICU mothers in the early postpartum period. J Matern Fetal Neonatal Med 2014; 27:1738-43. [PMID: 25005861 DOI: 10.3109/14767058.2014.942626] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined whether particular maternal and infant factors can identify mothers at risk for increased stress upon admission to the neonatal intensive care unit (NICU). METHODS Eighty-five mothers of preterm infants (25-34 weeks gestation) were assessed using the Parental Stressor Scale (PSS:NICU) and the Edinburgh Postnatal Depression Scale (EPDS) within 3.24 ± 1.58 d postpartum. Hierarchical linear regression models were used to determine the extent to which maternal stress is influenced by individual factors. RESULTS Fifty-two percent of mothers experienced increased stress (PSS:NICU score ≥3) and 38% had significant depressive symptoms (EPDS score ≥10). Stress related to alterations in parental role was the most significant source of stress among NICU mothers. Distance from the hospital and married marital status were significant predictors for stress related to alterations in parental role (p = 0.003) and NICU sights and sounds (p = 0.01), respectively. Higher stress levels were associated with higher depressive scores (p = 0.001). Maternal mental health factors, demographic factors, pregnancy factors and infant characteristics were not associated with increased stress. CONCLUSION Elevated stress levels and depressive symptoms are already present in mothers of preterm infants upon NICU admission. Being married or living long distance from the hospital is associated with higher stress. Future work is needed to develop effective interventions for alleviating stress in NICU mothers and preventing its potential development into postnatal depression.
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Affiliation(s)
- Anna Alkozei
- Department of Pediatrics & Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston MA , USA and
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