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Bao H, Huang Y, Sun Y, Chen Y, Luo Y, Yan L, Man S, Yu C, Lv J, Ge M, Wang L, Li L, Wang B, Liu H, Liu X. Prevalence of anemia of varying severity, geographic variations, and association with metabolic factors among women of reproductive age in China: a nationwide, population-based study. Front Med 2024:10.1007/s11684-024-1070-x. [PMID: 39060865 DOI: 10.1007/s11684-024-1070-x] [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: 10/07/2023] [Accepted: 02/08/2024] [Indexed: 07/28/2024]
Abstract
To investigate the epidemiological characteristics of anemia of varying severity among women of reproductive age, we conducted a nationwide, cross-sectional study between January 1, 2019 and December 31, 2019, including 4 184 547 nonpregnant women aged 18-49 years from all 31 provinces in the mainland of China. Anemia was defined as having hemoglobin concentration < 120.0 g/L and categorized as mild, moderate, and severe. Multivariate logistic models with cluster effect were used to explore the association of anemia and metabolic risk factors. The standardized prevalence of anemia and moderate and worse anemia among women of reproductive age in China was 15.8% (95% CI 15.1%-16.6%) and 6.6% (6.3%-7.0%), respectively. The prevalence of anemia and the proportion of moderate and worse anemia significantly increased with age. We also observed great geographic variations in the prevalence of anemia, with a high likelihood in south, central, and northwest China. Moderate and/or severe anemia was positively associated with overweight and obesity, diabetes, and impaired kidney function. In conclusion, anemia remains a significant challenge for women of reproductive age in China. Geographic variations and metabolic risk factors should be considered in the comprehensive and targeting strategy for anemia reduction.
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Affiliation(s)
- Heling Bao
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Yuanyuan Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Yi Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Yunli Chen
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Yan Luo
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Liping Yan
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China
| | - Sailimai Man
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
- Meinian Institute of Health, Beijing, 100044, China
- Peking University Health Science Center Meinian Public Health Institute, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
- Peking University Health Science Center Meinian Public Health Institute, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
- Peking University Health Science Center Meinian Public Health Institute, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Meili Ge
- Anaemia Diagnosis and Treatment Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300052, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
- Peking University Health Science Center Meinian Public Health Institute, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China.
| | - Bo Wang
- Meinian Institute of Health, Beijing, 100044, China.
- Peking University Health Science Center Meinian Public Health Institute, Beijing, 100191, China.
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China.
| | - Hui Liu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China.
| | - Xiaoxi Liu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China.
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Zhou Y, Lyu Y, Ye W, Shi H, Peng Y, Wen Z, Narayan A, Huang X, Chang S, Yang Y, Xu Y. The Prevalence of Anemia among Pregnant Women in China: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1854. [PMID: 38931209 PMCID: PMC11206842 DOI: 10.3390/nu16121854] [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: 05/22/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
The systematic review and meta-analysis were conducted to ascertain the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among Chinese pregnant women. A total of 722 articles on maternal anemia during pregnancy published between January 2010 and December 2020 were compiled, and a systematic review and meta-analysis were conducted on 57 eligible studies including 1,376,204 pregnant women to ascertain the prevalence of anemia and the prevalence in different subgroups. The results showed that the prevalence of anemia, ID, and IDA among pregnant women in China were 30.7% (95% CI: 26.6%, 34.7%), 45.6% (95% CI: 37.0%, 54.2%), and 17.3% (95% CI: 13.9%, 20.7%), respectively. All prevalence increased with the progression of the pregnancy. There were sizable regional variations in the prevalence of anemia, ID, and IDA. Generally, lower prevalence was observed in the economically more advanced eastern region of the country, while the prevalence of ID was higher in the eastern region than that in the western region. The prevalence of anemia and IDA in rural areas was higher than that in urban areas, but ID prevalence was higher in urban areas. In conclusion, the regional differences and urban-rural disparities in the prevalence of anemia indicate the need for more context-specific interventions to prevent and treat anemia. It was found that dietary factors were one of the major causes of anemia, and iron-containing supplements and nutrition counseling could be effective interventions to reduce the prevalence of anemia, ID, and IDA among Chinese pregnant women.
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Affiliation(s)
- Yalin Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Ying Lyu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Wanyun Ye
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Hanxu Shi
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Yile Peng
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Zhang Wen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
| | - Anuradha Narayan
- Nutrition and Child Development Section, UNICEF Headquarters, 3 United Nations Plz, New York, NY 10017, USA;
| | - Xiaona Huang
- Child Health and Development Section, UNICEF Office for China, NO.12 Sanlitun Road, Chaoyang District, Beijing 100600, China; (X.H.); (S.C.); (Y.Y.)
| | - Suying Chang
- Child Health and Development Section, UNICEF Office for China, NO.12 Sanlitun Road, Chaoyang District, Beijing 100600, China; (X.H.); (S.C.); (Y.Y.)
| | - Yuning Yang
- Child Health and Development Section, UNICEF Office for China, NO.12 Sanlitun Road, Chaoyang District, Beijing 100600, China; (X.H.); (S.C.); (Y.Y.)
| | - Yajun Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China; (Y.Z.); (Y.L.); (W.Y.); (H.S.); (Y.P.); (Z.W.)
- PKUHSC-China Feihe Joint Research Institute of Nutrition and Healthy Lifespan Development, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, NO.38 Xueyuan Road, Haidian District, Beijing 100083, China
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Mankelkl G, Kinfe B. Factors associated with anemia among reproductive age women in Nigeria; evidenced by the Nigeria malaria indicators survey: spatial and multilevel model analysis. Contracept Reprod Med 2024; 9:12. [PMID: 38566232 PMCID: PMC10988975 DOI: 10.1186/s40834-024-00275-x] [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: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Anemia is a global public health problem among women of reproductive age group, especially in developing countries, which affect health, social and economic development that result in low physical activity, increased maternal morbidity and mortality and adverse neonatal outcome especially those with severe anemia. However, there is limited reliable and updated data on the spatial variations of anemia and its associated factors among reproductive-age women in Nigeria. METHODS Secondary data analysis was conducted using data from the recent Nigeria malaria indicators survey datasets. The study comprised a total of 14,476 reproductive-age women. Spatial and multilevel mixed effect analysis on determinants factors of anemia among reproductive age women in Nigeria evidenced by the recent Nigerian malaria indicators survey. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported. RESULT This study includes a total weighted sample of 14,476 reproductive-age women from the Nigeria malaria indicators survey. The prevalence of anemia was 24.6% in Ethiopia. Being between the age range of 30-34 years [AOR: 0.217, 95% CI (0.171, 0.274)], Attending higher education [AOR: 0.848, 95%CI (0.740, 0.972)] and being male headed household [AOR: 0.540, 95% CI (0.471, 0.620)] were protective for anemia. On the other hand being poorest [AOR: 1.542 95%CI (1.299, 1.830)] and being listening radio less than once a week [AOR: 1.013, 95% CI (0.908, 1.131)] were risk for anemia. CONCLUSION In this study Individual level factors were associated with anemia and also there were spatial variations in anemia across the region among reproductive-age women. Empowering women to have better educational status, improving the wealth index, and promoting education about prevention and control strategies of anemia through media especially in developing regions were the key factors to reduce anemia among reproductive age women in Nigeria.
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Affiliation(s)
- Gosa Mankelkl
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Beletu Kinfe
- Department of occupational Health and safety, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Liu X, Wang B, Man S, Bao H, Huang Y, Yu C, Lyu J, Wang L, Li L, Liu H. Variations in the Prevalence of Anemia of Varying Severity Among Urban Non-Pregnant Women - China, 2021. China CDC Wkly 2024; 6:175-180. [PMID: 38523814 PMCID: PMC10960514 DOI: 10.46234/ccdcw2024.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
What is already known about this topic? Anemia is a significant public health issue affecting women globally. Prior studies in China predominantly concentrated on anemia in pregnant or reproductive-age women, leaving a gap in available data concerning anemia in non-pregnant women of all age groups in China. What is added by this report? In 2021, the prevalence of anemia and moderate to severe anemia among women aged 18 years and older in urban China was 14.8% and 5.7%, respectively. Anemia prevalence exhibited significant variations based on factors such as age, body mass index (BMI), geographic location, and socioeconomic status. What are the implications for public health practice? The strategy for addressing anemia should account for non-pregnant women aged 30-49 years and those aged 70 years and older, taking into consideration differences related to socioeconomic development and geography.
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Affiliation(s)
- Xiaoxi Liu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Wang
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
- Meinian Institute of Health, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Sailimai Man
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
- Meinian Institute of Health, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Heling Bao
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanyuan Huang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Canqing Yu
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jun Lyu
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liming Li
- Peking University Health Science Center Meinian Public Health Institute, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Hui Liu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Lai S, Yu W, Liu Y, Yang Y, Zhang X. Current research and evidence gaps on placental development in iron deficiency anemia. Open Life Sci 2024; 19:20220827. [PMID: 38465334 PMCID: PMC10921475 DOI: 10.1515/biol-2022-0827] [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: 10/10/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 03/12/2024] Open
Abstract
Studying the effects of maternal iron deficiency anemia (IDA) is complex owing to its diverse causes, each independently impacting the placenta and fetus. Simple treatment with iron supplements does not always resolve the anemia. Therefore, delving into how IDA alters placental development at a molecular level is crucial to further optimize treatment. This review addresses the effects of IDA on placental structures and functions, including changes in oxygen levels, blood vessels, and the immune system. Profound understanding of physiological characteristics and regulatory mechanisms of placental development is key to explain the mechanisms of abnormal placental development in pregnancy-associated disorders. In turn, future strategies for the prevention and treatment of pregnancy complications involving the placenta can be devised. These studies are significant for improving human reproductive health, enhancing sociodemographic qualities, and even lifelong wellbeing, a focal point in future placental research.
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Affiliation(s)
- Shaoyang Lai
- Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University, Xiamen, China
| | - Weiwei Yu
- Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University, Xiamen, China
| | - Ying Liu
- Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University, Xiamen, China
| | - Yuxin Yang
- Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University, Xiamen, China
| | - Xueqin Zhang
- Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University, Xiamen, China
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Tirore LL, Areba AS, Habte A, Desalegn M, Kebede AS. Prevalence and associated factors of severity levels of anemia among women of reproductive age in sub-Saharan Africa: a multilevel ordinal logistic regression analysis. Front Public Health 2024; 11:1349174. [PMID: 38328546 PMCID: PMC10847295 DOI: 10.3389/fpubh.2023.1349174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Background Sub-Saharan Africa is the most anemia-prone region, with several of the sub-region's countries having a substantial prevalence of the anemia among women of reproductive age. Nonetheless, no adequate study has been conducted to illustrate severity levels and associated factors of anemia among women of reproductive age. Therefore, this study presents the most recent estimates on the prevalence and severity levels of anemia and its associated factors among women of reproductive age in 21 Sub-Saharan Africa countries. Methods This study used the most recent Demographic Health Survey (DHS) datasets, which were collected in 21 sub-Saharan African countries between 2015 and 2022. A total of 171,348 women of reproductive age were included in the analysis. Multilevel (three-level) ordinal logistic regression was done to identify factors associated with severity levels of anemia. Results The pooled prevalence of anemia was 41.74%. The pooled prevalence of mild, moderate and severe anemia was 23.45, 17.05 and 1.24, respectively. Women who were living at distance to a health facility (AOR = 1.07), women living in the poorest households (AOR = 1.49), women living in the households with unimproved toilet (AOR = 1.12) and in households that were using solid cooking fuel (AOR = 1.10), pregnant women (AOR = 1.72) and those who have given birth to more than one children within 3 years (AOR = 1.43) had greater odds of higher levels of anemia as compared to their counterparts. Women who were in the age groups of 20-24 (AOR = 0.81), 25-29 (AOR = 0.78), 30-34 (AOR = 0.79), 35-39 (AOR = 0.88), and 45-49 (AOR = 0.89), women who have attended primary school (AOR = 0.50), secondary (AOR = 0.57) and higher education (AOR = 0.76) and who were living in rural area (AOR = 1.07) had lower odds of higher levels of anemia as compared to their counterparts. Conclusion Considering individual, household and community contexts is necessary while formulating and implementing anemia prevention and control policies. Adolescent women, and women who did not attend education and at a distance to a health facility should get especial attention while implementing anemia prevention and control programs.
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Affiliation(s)
- Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abriham Shiferaw Areba
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Aklilu Habte
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Mitiku Desalegn
- Department of Anesthesia, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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Chen Y, Zhong T, Song X, Zhang S, Sun M, Liu X, Wei J, Shu J, Liu Y, Qin J. Maternal anaemia during early pregnancy and the risk of neonatal outcomes: a prospective cohort study in Central China. BMJ Paediatr Open 2024; 8:e001931. [PMID: 38233082 PMCID: PMC10806529 DOI: 10.1136/bmjpo-2023-001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the association between anaemia during early pregnancy and the risk of neonatal outcomes. METHODS We collected clinical data from pregnant women (≥18 years) who received their first antenatal care between 8 and 14 weeks of gestation in Hunan Provincial Maternal and Child Health Care Hospital. Multiple logistic regression models and restricted cubic spline regression models were used to analyse the association between anaemia during early pregnancy and the risk of neonatal outcomes. In addition, sensitivity analysis was further performed to assess the robustness of the results. RESULTS The prospective cohort study ultimately included 34 087 singleton pregnancies. In this study, the rate of anaemia during early pregnancy was 16.3%. Our data showed that there was a positive relationship between the rate of preterm birth, low birth weight as well as small for gestational age (SGA) and the severity of maternal anaemia (Ptrend<0.05). After adjustment, the association of early pregnancy anaemia and haemoglobin (Hb) levels with the risk of preterm birth (mild anaemia adjusted OR (aOR) 1.37 (95% CI 1.25 to 1.52), moderate anaemia aOR 1.54 (95% CI 1.35 to 1.76) and severe anaemia aOR 4.03 (95% CI 2.67 to 6.08), respectively), low birth weight (mild anaemia aOR 1.61 (95% CI 1.44 to 1.79), moderate anaemia aOR 2.01 (95% CI 1.75 to 2.30) and severe anaemia aOR 6.11 (95% CI 3.99 to 9.36), respectively) and SGA (mild anaemia aOR 1.37 (95% CI 1.25 to 1.52), moderate anaemia aOR 1.54 (95% CI 1.35 to 1.76) and severe anaemia aOR 2.61 (95% CI 1.74 to 4.50), respectively; Pnon-linear<0.05) was observed. However, no association was found between early pregnancy anaemia or Hb levels and the risk of congenital malformations. Sensitivity analysis verified the stability of the results. CONCLUSIONS Maternal anaemia during early pregnancy was associated with an increased risk of preterm birth, low birth weight and SGA and their rates may increase with the severity of maternal anaemia. TRIAL REGISTRATION NUMBER ChiCTR1800016635.
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Affiliation(s)
- Yige Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Department of Science and Education, Xiangya Changde Hospital, Changde, China
| | - Taowei Zhong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xinli Song
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiaoying Liu
- Public Health Institute, Changsha Medical University, Changsha, Hunan, China
- The Hospital of Trade-Business in Hunan Province, Changsha, Hunan, China
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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GARANET FRANCK, SAMPABE GERARD, TINTA AALMAME. Persistence of a high prevalence of anemia in rural areas among pregnant women in Burkina Faso. A cross-sectional study. J Public Health Afr 2023; 14:2734. [PMID: 38259427 PMCID: PMC10801396 DOI: 10.4081/jphia.2024.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Despite WHO recommendations to reduce the global prevalence of anemia among women of reproductive age by 2025, anemia remains a truly global public health problem, especially among pregnant women. The objective of our study was to examine the relationship between anemia and the place of residence in pregnant women. This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. Anemia was diagnosed using HemoCue HB 301 and a hemoglobin concentration <11 g/dl was classified as anemic. Adjusted logistic regression analysis was performed to examine relation between anemia and the place of residence in pregnant women. A total of 1027 pregnant women were included in the study. The average age of females was 25.79±6.02 years. The prevalence of anemia was 57.2% (585/1023). In logistic regression analysis adjusted for age, wealth, education and parity, women living in rural areas were more likely to be anemic compared to women living in urban areas (ORa=1.33; 95% CI [1.01-1,74]. Rural women are more likely to be anemic. Strategies to prevent anemia among pregnant women need to be strengthened in rural areas.
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Affiliation(s)
- FRANCK GARANET
- Institute of Health Sciences Research, Unit of Kaya, Kaya, Burkina Faso
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Um S, Sopheab H, Yom A, Muir JA. Anemia among pregnant women in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in pregnant women. PLoS One 2023; 18:e0274925. [PMID: 38060474 PMCID: PMC10703242 DOI: 10.1371/journal.pone.0274925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Anemia is a major public health problem for thirty-two million pregnant women worldwide. Anemia during pregnancy is a leading cause of child low birth weight, preterm birth, and perinatal/neonatal mortality. Pregnant women are at higher risk of anemia due to micronutrient deficiencies, hemoglobinopathies, infections, socio-demographic and behavioral factors. This study aimed to: 1) assess temporal and geospatial trends of anemia in Cambodia and 2) identify factors associated with anemia among pregnant women aged 15-49 years old in Cambodia. We analyzed data from the Cambodia Demographic and Health Survey (CDHS) for 2005, 2010, and 2014. Data were pooled across the three survey years for all pregnant women aged 15-49 years. Survey weights were applied to account for the complex survey design of the CDHS. Descriptive statistics were estimated for key sociodemographic characteristics of the study population. We used logistic regressions to assess factors associated with anemia among pregnant women aged 15-49 years old. Anemia in pregnant women aged 15-49 in Cambodia decreased from 56% in 2005 to 53% in 2014. With the highest in Preah Vihear and Stung Treng provinces (74.3%), in Kratie province (73%), and in Prey Veng (65.4%) in 2005, 2010, and 2014 respectively. Compared to pregnant women from the wealthiest households, women from poorest households were more likely to have anemia (AOR = 2.8; 95% CI: 1.6-4.9). Pregnant women from coastal regions were almost twice as likely of having anemia (AOR = 1.9; 95% CI: 1.2-3.0). Pregnant women were more likely anemic if they were in their 2nd trimester (AOR = 2.6; 95% CI: 1.9-3.6) or 3rd trimester (AOR = 1.6 95% CI: 1.1-2.3). Anemia remains highly prevalent among pregnant women in Cambodia. Public health interventions and policies to alleviate anemia should be prioritized and shaped to address these factors.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Heng Sopheab
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - An Yom
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Alem AZ, Efendi F, McKenna L, Felipe-Dimog EB, Chilot D, Tonapa SI, Susanti IA, Zainuri A. Prevalence and factors associated with anemia in women of reproductive age across low- and middle-income countries based on national data. Sci Rep 2023; 13:20335. [PMID: 37990069 PMCID: PMC10663544 DOI: 10.1038/s41598-023-46739-z] [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: 11/15/2022] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low- and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low- and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Jl. Mulyorejo Kampus C Unair, Surabaya, 60115, Indonesia.
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Eva Belingon Felipe-Dimog
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Nursing Department, Mountain Province State Polytechnic College, Bontoc, Mountain Province, Philippines
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Agus Zainuri
- Faculty of Public Health, Universitas Cenderawasih, Jayapura, Indonesia
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Cai Z, Li L, Feng J, Raat H, Wu Y, Zhou H, Rozelle S. Dietary Diversity and Its Contribution to the Magnitude of Anaemia among Pregnant Women: Evidence from Rural Areas of Western China. Nutrients 2023; 15:3714. [PMID: 37686751 PMCID: PMC10490469 DOI: 10.3390/nu15173714] [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: 07/28/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prenatal anaemia causes serious consequences for both mother and foetus, and dietary factors are suggested to be associated with anaemia. However, research in pregnant women living in rural areas is limited. We aim to assess the contribution of dietary diversity to the magnitude of prenatal anaemia in rural China and identify the interactions between dietary diversity and several sociodemographic and maternal characteristics in relation to anaemia. METHODS A multi-stage random cluster sampling method was used to select pregnant women in rural western China. The Woman's Dietary Diversity Score was created to measure dietary diversity, which was recoded into terciles. Multinomial logistic regression models were used to assess the associations between dietary diversity score terciles and the magnitude of prenatal anaemia. Multiplicative interactions were tested by adding the product term of dietary diversity and several sociodemographic and maternal characteristics into the regression models. RESULTS Out of 969 participants, 54.3% were measured as anaemic, with 28.6% mildly anaemic and 25.7% moderately to severely anaemic. There was an absence of agreement between self-reported and measured anaemia status (κ = 0.28, 95% CI [0.22-0.34]). Participants in the highest dietary diversity score tercile had lower odds of being moderately to severely anaemic after adjusting for potential confounders (RRR = 0.65, 95% CI [0.44, 0.98]). In participants with moderate to severe anaemia, significant interactions were found between dietary diversity score terciles, age, and parity (p for interaction < 0.05). CONCLUSIONS The prevalence of prenatal anaemia in rural China remains high, and pregnant women living in these areas are insufficiently aware of their anaemia status. Improving dietary diversity is needed to manage prenatal anaemia in rural areas.
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Affiliation(s)
- Zhengjie Cai
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Linhua Li
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Jieyuan Feng
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
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Lema EJ, Seif SA. Prevalence of anemia and its associated factors among pregnant women in Ilala Municipality - Tanzania: Analytical cross-sectional study. Medicine (Baltimore) 2023; 102:e33944. [PMID: 37335672 DOI: 10.1097/md.0000000000033944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Anaemia during pregnancy is still 1 of the leading causes of maternal and neonatal mortality in low and middle-income countries. Initiatives to address this need evidence on trends and their relevant factors, as they vary from 1 area to another. This study determined the prevalence of anemia and its associated factors among pregnant women in Ilala, Tanzania. This community-based, analytical cross-sectional study was conducted in April 2022 involving 367 randomly selected pregnant women. An interviewer-administered questionnaire and a HemoCue analyzer were used for data collection The data was described using descriptive statistics (frequency distributions, percentages, etc) and inferential statistics (Chi-square tests and logistic regression) were used to explore the associations between the study's outcome and its explanatory variables, with a significance level of P < .05. The mean age of participants was 26.2 (standard deviation = 5.2) years, 58.0% had a secondary education level, and 45.2 were prime-para. About half (57.2%) of all participants had low hemoglobin level, among which, 36.2% had moderate anemia. Having a primary education level (adjusted odds ratio [AOR] = 2.3, confidence interval [CI] = 1.1-4.7), having an inter-pregnancy interval of <18 months (AOR = 2.6, CI = 1.2-5.5), being in the third trimester (AOR = 2.4, CI = 1.2-4.7), not taking Intermittent Prophylaxis Treatment (AOR = 3.7, CI = 1.3-10), not taking iron supplement and folic acid (AOR = 3.7, CI = 1.3-10), and having a moderate appetite(AOR = 1.6, CI = 1.0-2.6) were predictors of anemia. Nutritionally related factors were not consuming on a daily basis dairy food (AOR = 3.7, CI = 1.4-9.3), meat/fish (AOR = 6.6, CI = 3-14), dark green and other vegetables (AOR = 6.6, CI = 3.1-14), fruits (AOR = 4.2, CI = 1.4-12) and having a lower dietary diversity score (AOR = 84, CI = 37-188). Approximately half of pregnant women in Ilala municipality were anemic with 1 third of them having moderate anemia. The associated factors varied from nutritional, obstetric, and socio-demographic factors. The targeted interventions should focus on health promotion campaign to sensitize the population on the dangers of anemia in pregnancy and preventive measures that must be adhered to.
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Affiliation(s)
- Eunice Justin Lema
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Saada Ali Seif
- Department of Nursing Management and Education, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
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Araujo Costa E, de Paula Ayres-Silva J. Global profile of anemia during pregnancy versus country income overview: 19 years estimative (2000-2019). Ann Hematol 2023:10.1007/s00277-023-05279-2. [PMID: 37233775 DOI: 10.1007/s00277-023-05279-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Anemia is a worldwide public health problem that is worst in low- and middle-income countries (LMICs), reaching 60% of prevalence. The etiology of anemia is diverse and multifactorial, with iron deficiency being the most prevalent, and often found in pregnant women. Iron is indispensable for the production of red blood cells and approximately 80% of the available heme iron is used for hemoglobin synthesis in mature erythroblasts. Iron deficiency affects oxygen transport, compromising energy and muscle metabolism and can occur with depletion of iron storage, defective erythropoiesis, and low hemoglobin levels. We analyzed anemia prevalence in pregnant women from 2000 to 2019 worldwide correlating them with current (2022) country income, with especial attention to LMICs using WHO dataset. Our analysis indicates that pregnant women from LMICs had a higher probability (40%) of anemia during pregnancy especially those from Africa and South Asia. Africa and the Americas showed a higher decrease in the prevalence of anemia from 2000 to 2019. The Americas and Europe have a lower prevalence, concentrated in 57% of most upper-middle- and high-income countries. Black women are also more prone to develop anemia during pregnancy, especially if they are from LMICs. However, the prevalence of anemia appears to decrease with an increase in educational level. In conclusion, anemia prevalence fluctuated from 5.2 to 65.7% worldwide in 2019, validating it as a public health problem.
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Affiliation(s)
- Evelyn Araujo Costa
- Distance Education Center of Rio de Janeiro State (CEDERJ), Rio de Janeiro, Brazil
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Kareem YO, Ameyaw EK, Bello OO, Abdus-Salam RA, Lawal OO, Obajimi G, Alade YK, Morhason-Bello IO. Ecological analysis of demographic-, nutritional- and housing-related factors associated with anaemia among women of reproductive age group in Nigeria. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:56. [PMID: 36494691 PMCID: PMC9733233 DOI: 10.1186/s41043-022-00334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/04/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Anaemia remains a major public health concern, particularly, in sub-Saharan Africa (SSA), where it is one of the causes of maternal death. The most common cause of maternal anaemia is iron deficiency or malnutrition. This study examined the prevalence of and risk factors for anaemia among women that participated in the Nigerian Demographic Health Survey. METHOD We used data of 14,454 women that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). We extracted information such as demographic, social and housing, dietary characteristics and haemoglobin concentration. The descriptive statistic results, prevalence and 95% confidence interval (CIs) of anaemia with the selected respondents background characteristics were presented. The Poisson regression model with robust variance was used to assess the risk of anaemia among women of reproductive age. All analyses were weighted and adjusted for the complex survey design. Statistical significance was interpreted at p value < 0.05. RESULTS Maternal status, body mass index, education, residence, religion, ethnicity, region and type of cooking fuel were all important determinants of anaemia. The prevalence of anaemia was high among pregnant women (61.8%; 95% CI: 58.5-65.0), adolescents (60.4%; 95% CI: 58.1-62.6), underweight women (62.6%; 95% CI: 59.5-65.5), women who had no formal education (64.1%; 95% CI: 62.2-66.0) and those who belonged to the poorest wealth quintile (65.8%; 95% CI: 63.1-68.4). Similarly, anaemia was high among women residing in rural areas (61.5%; 95% CI: 60.0-63.0), Muslims (59.9%; 95% CI: 58.1-61.6) and women with six or more children (62.1%; 95% CI: 60.0-64.1). The risk of anaemia were 2% less likely among women who took minimum adequate diet compared to those who do not. CONCLUSION To date, this is the largest data on maternal anaemia in Nigeria. The study highlighted the high burden of maternal anaemia in the country and different risk factors (medical and social) that are associated with this medical condition among women of reproductive age. We recommend future longitudinal studies to test hypothesis in order to assess whether there is any causal relationship between identified risk factors and anaemia in this group of women.
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Affiliation(s)
| | - Edward K. Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, New Territories Hong Kong
| | - Oluwasomidoyin O. Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rukiyat A. Abdus-Salam
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olatunji O. Lawal
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gbolahan Obajimi
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Imran O. Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Xu J, Li X, Zhou Q. Nationwide-free preconception care strategy: Experience from China. Front Public Health 2022; 10:934983. [PMID: 36339191 PMCID: PMC9626826 DOI: 10.3389/fpubh.2022.934983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023] Open
Abstract
Preconception care has emerged as a developing field in maternal and child healthcare worldwide. This care type provides couples of reproductive age with the opportunity for early detection and management of biomedical, behavioral, and social health problems. In 2010, the Chinese government launched a nationwide preconception care program as a welfare project. During the past decade, this project has received international attention, and experiences from the project have been published in the literature. In this review, we summarize the history, implementation, and evaluation of preconception care services in China, and its related maternal and children's health service initiatives, to thereby provide knowledge for policymakers and clinicians in other countries.
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Affiliation(s)
- Jinghui Xu
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
- Institutes of Biochemical Sciences, Fudan University, Shanghai, China
| | - Qiongjie Zhou
- Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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16
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Tao Y, Kang J, Liu J, Duan J, Wang F, Shi Y, Li Y, Wang C, Xu D, Qu X, Guo J, Ma J, Zhang Y. Association of low birthweight and small for gestational age with maternal ferritin levels: A retrospective cohort study in China. Front Nutr 2022; 9:1002702. [PMID: 36299991 PMCID: PMC9589249 DOI: 10.3389/fnut.2022.1002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Birthweight have profound impacts on health status throughout lifetime, however, the relationship between maternal ferritin level in pregnancy and birthweight of the newborn remains controversial. Objective This retrospective cohort research was to analyze the association between maternal ferritin levels during pregnancy with birthweight outcomes, primarily for low birthweight (LBW) and small for gestational age (SGA). Methods Newborns weighing lower than 2,500 grams were defined as LBW. SGA is defined as birthweight lower than the 10th percentile of the distribution of newborns' birthweight of the same gestational age. Multivariable logistic regressions have been used to explore the association of maternal ferritin levels and birthweight related outcomes, in which the ferritin concentration was logarithm transformed in the model. We further used restricted cubic spline models to explore linear/non-linear dose–response manners of ferritin level and birthweight outcomes. Results A total of 3,566 pregnant women were included in the study. In the results of the present study, we observed that maternal ferritin levels were linearly associated with the risk of LBW (p-trend = 0.005) and SGA (p-trend = 0.04), with the adjusted odds ratios (ORs) of 1.78 (95% CI 1.37–2.32) for LBW and 1.87 (95% CI 1.38–2.54) for SGA with an increase in Ln-ferritin concentrations per unit. The adjusted ORs across quartiles of ferritin levels were 2.14 (95% CI 1.03–4.47) for Quartile 2, 3.13 (95% CI 1.47–6.69) for Quartile 3, and 3.63 (95% CI 1.52–8.68) for Quartile 4 for LBW. The adjusted ORs of LBW and SGA among women using supplemental iron were 0.56 (95% CI 0.38, 0.85) and 0.65 (95% CI 0.40, 1.05) compared with non-users, respectively. Conclusions Our findings found a linear dose–response relationship between ferritin levels and an increased risk of poor birthweight outcomes, suggesting that maternal ferritin level during pregnancy may provide an additional predictor for differentiating poor birthweight related outcomes. Further exploration should be conducted to ensure maternal ferritin thresholds and iron supplement doses.
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Affiliation(s)
- Yun Tao
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Jiawei Kang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Juan Liu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Jie Duan
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Fang Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Yue Shi
- Information Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yujuan Li
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Cheng Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China
| | - Dan Xu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinlan Qu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianhong Ma
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China,Jianhong Ma
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China,Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, China,*Correspondence: Yuanzhen Zhang
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Sari P, Herawati DMD, Dhamayanti M, Hilmanto D. Anemia among Adolescent Girls in West Java, Indonesia: Related Factors and Consequences on the Quality of Life. Nutrients 2022; 14:3777. [PMID: 36145153 PMCID: PMC9503484 DOI: 10.3390/nu14183777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 12/24/2022] Open
Abstract
Anemia in adolescent girls is still a problem in Indonesia. The impact of anemia is quite significant for adolescent health. This study aims to analyze related factors of anemia among adolescent girls, and the effect of anemia on the quality of life. The study was conducted in the Soreang District, West Java, Indonesia. This cross-sectional study involved 286 female students (15−19 years). A 24-h recall questionnaire was used to collect the nutrient intake. We use the WHOQOL-BREF to analyze the quality of life. The study assessed height, weight, body mass index (BMI), mid-upper arm circumference (MUAC), and a capillary blood sample to determine hemoglobin levels. Bivariate and multiple logistic regression tests were measured to find the factors most influencing anemia. The prevalence of anemia was 14.3%. Related factors of anemia in this study were: duration of blood show per menses, iron consumption, weight, height, and MUAC. From bivariate analyses, anemia influenced the social relationships domain with p < 0.05. Multivariate logistic regression showed that the most influencing factors for anemia were MUAC and duration of blood per menses. Anemia impacted the social relationships domain. In this study, the two main factors that affected anemia were MUAC and duration of blood each menstrual cycle.
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Affiliation(s)
- Puspa Sari
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia
| | - Dewi Marhaeni Diah Herawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia
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Kwak DW, Kim S, Lee SY, Kim MH, Park HJ, Han YJ, Cha DH, Kim MY, Chung JH, Park B, Ryu HM. Maternal Anemia during the First Trimester and Its Association with Psychological Health. Nutrients 2022; 14:nu14173505. [PMID: 36079763 PMCID: PMC9460499 DOI: 10.3390/nu14173505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022] Open
Abstract
Anemia during pregnancy is known to be associated with an increased risk of antenatal and/or postnatal depression, as well as adverse pregnancy outcomes. However, there are few studies evaluating psychological health throughout the antepartum and postpartum periods in women with anemia in early pregnancy. This study analyzed data collected by the Korean Pregnancy Outcome Study, a multicenter prospective cohort study conducted in South Korea, to determine the impact of anemia during the first trimester on birth outcomes and maternal mental health during pregnancy and postpartum. Hemoglobin levels were measured during the first trimester, and psychological health was evaluated at 12, 24, and 36 gestational weeks and 4−6 weeks postpartum. Anxiety and depression were defined using the Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale, respectively. Among 4067 Korean participants, 119 (2.9%) were diagnosed with anemia during the first trimester. Incidences of anxiety and depression did not differ over the pregnancy period between those with and without anemia during the first trimester. However, postpartum anxiety and depression were significantly more common in participants with anemia than in those without (p < 0.05, both). Hence, obstetricians should pay attention to postpartum mental health in women with anemia during the first trimester.
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Affiliation(s)
- Dong-Wook Kwak
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Seokyung Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Su-Young Lee
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, Korea
| | - Min-Hyoung Kim
- Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul 07639, Korea
| | - Hee-Jin Park
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - You-Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - Dong-Hyun Cha
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - Moon-Young Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Korea
| | - Jin-Hoon Chung
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon 16499, Korea
| | - Hyun-Mee Ryu
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
- Correspondence: ; Tel.: +82-31-780-5290; Fax: +82-31-780-5069
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Si S, Peng Z, Cheng H, Zhuang Y, Chi P, Alifu X, Zhou H, Mo M, Yu Y. Association of Vitamin D in Different Trimester with Hemoglobin during Pregnancy. Nutrients 2022; 14:nu14122455. [PMID: 35745185 PMCID: PMC9230968 DOI: 10.3390/nu14122455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
The association between vitamin D and hemoglobin has been suggested. Vitamin D can affect erythropoiesis by the induction of erythroid progenitor cell proliferation and enhance iron absorption by regulating the iron-hepcidin-ferroportin axis in monocytes. However, this relationship in pregnant women is scarce. The purpose of this study was to investigate the association between plasma vitamin D levels with hemoglobin concentration in pregnant women considering each trimester and iron supplementation. The data were obtained from Zhoushan Pregnant Women Cohort, collected from 2011 to 2018. Plasma 25(OH)D was measured in each trimester using liquid chromatography−tandem mass spectrometry. Generalized estimating equations and multiple linear regressions were performed. Finally, 2962 pregnant women and 4419 observations in the first trimester were included in this study. Plasma 25(OH)D in first trimester (T1) (β = 0.06, p = 0.0177), second trimester (T2) (β = 0.15, p < 0.0001), and third trimester (T3) (β = 0.12, p = 0.0006) were positively associated with Hb. Association between plasma 25(OH)D levels in T1 and Hb concentration was positively associated with gestational age (β = 0.005, p = 0.0421). Pregnant women with VD deficiency in T1 (OR = 1.42, 95% CI: 1.07−1.88) or T2 (OR = 1.94, 95% CI: 1.30−2.89) presented an increased risk of anemia, compared with women without VD deficiency. Moreover, the significant relationship between VD and Hb was only observed among women with iron supplementation during pregnancy. Plasma 25(OH)D levels in each trimester were positively associated with Hb concentration. Iron supplementation might be an important factor affecting the relationship between VD and Hb.
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Affiliation(s)
- Shuting Si
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhicheng Peng
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haoyue Cheng
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yan Zhuang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Peihan Chi
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xialidan Alifu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haibo Zhou
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Minjia Mo
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yunxian Yu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Correspondence: ; Tel.: +86-571-8820-8191
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Xie G, Yue J, Yang W, Yang L, Xu M, Sun L, Zhang B, Guo L, Chung MC. Effects of PM 2.5 and its constituents on hemoglobin during the third trimester in pregnant women. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:35193-35203. [PMID: 35060058 PMCID: PMC9076737 DOI: 10.1007/s11356-022-18693-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Anemia has been a public health issue evoking global concern, and the low hemoglobin (Hb) concentration links to adverse pregnancy outcomes. However, the associations of PM2.5 and its constituents with Hb and anemia in pregnant women remain unclear. In this retrospective birth cohort study, 7932 pregnant women who delivered in the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018 were included. The Hb during the third trimester in pregnant women was assessed before delivery. PM2.5 and its constituents (BC, NH4+, NO3-, OM, SO42-, and Dust) during pregnancy were retrieved from the V4.CH.03 product constructed by the Atmospheric Composition Analysis Group. Generalized linear regression model was applied to investigate the effects of PM2.5 and its constituents on Hb and anemia during the third trimester in pregnant women. The means and standard deviations of PM2.5, BC, NH4+, NO3-, OM, SO42-, and Dust were 69.56 (15.24), 10.02 (2.72), 8.11 (1.77), 14.96 (5.42), 15.36 (4.11), 10.08 (1.20), and 10.98 (1.85) μg/m3, respectively. Per IQR increase (μg/m3) of PM2.5, BC, NO3-, and OM linked to - 0.75 (- 1.50, - 0.01), - 0.85 (- 1.65, - 0.04), - 0.79 (- 1.56, - 0.03), and - 0.73 (- 1.44, - 0.03) g/L decrease of Hb during the third trimester in multiparous pregnant women, but not for NH4+, SO42-, Dust, and primiparous pregnant women. PM2.5 and its constituents had no significant association with anemia, except for Dust (OR: 0.90, 95% CI: 0.82, 0.99, per IQR increase) in primiparous pregnant women. Besides, SO42- was of lag effects on Hb and anemia in multiparous pregnant women. Moreover, non-linear associations were found among PM2.5 and its constituents, Hb, and anemia. Therefore, exposure to PM2.5 and some constituents of PM2.5 was associated with reduced Hb level during the third trimester in multiparous pregnant women. Related departments and pregnant women should take targeted actions to eliminate the detrimental effects of PM2.5 and its constituents on pregnancy outcomes.
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Affiliation(s)
- Guilan Xie
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, People's Republic of China
| | - Jie Yue
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China
| | - Wenfang Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China.
| | - Liren Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, People's Republic of China
| | - Mengmeng Xu
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
| | - Landi Sun
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, People's Republic of China
| | - Boxing Zhang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, People's Republic of China
| | - Leqian Guo
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Shaanxi Province, 710061, Xi'an, People's Republic of China
| | - Mei Chun Chung
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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21
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Nainggolan O, Hapsari D, Titaley CR, Indrawati L, Dharmayanti I, Kristanto AY. The relationship of body mass index and mid-upper arm circumference with anemia in non-pregnant women aged 19-49 years in Indonesia: Analysis of 2018 Basic Health Research data. PLoS One 2022; 17:e0264685. [PMID: 35239719 PMCID: PMC8893704 DOI: 10.1371/journal.pone.0264685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Anemia remains a major public health problem worldwide. This study examined the relationship between anemia and the nutritional status of non-pregnant women aged 19–49 years in Indonesia. Methods and study design The data were derived from the 2018 Basic Health Research Data of Indonesia. We used information from 11,471 non-pregnant women aged 19–49 years. The dependent variable was anemia (hemoglobin level <12 g/dL). The independent variable was women’s nutritional status, a combined indicator of body mass index (BMI) and mid-upper arm circumference (MUAC). Our analysis controlled for women’s age, education, physical activity, fruit and vegetable consumption, and the presence of communicable or non-communicable diseases. We performed logistic regression analyses. Results The prevalence of anemia in non-pregnant women aged 19–49 years was 22.3% (95% confidence interval [CI]: 21.4–23.3). Women with overweight and obesity were less likely to develop anemia than those with a normal BMI, regardless of their MUAC score. The highest odds for developing anemia were observed in underweight women with low MUAC scores (adjusted odds ratio [aOR] = 2.83, 95%CI: 2.19–3.68). Higher odds ratios were also observed in women with insufficient physical activity, despite their sufficient consumption of fruits or vegetables (aOR = 1.87, 95%CI: 1.06–3.28). However, women who had been diagnosed with a non-communicable disease had a reduced likelihood of developing anemia (aOR = 0.75, 95%CI: 0.67–0.83). Conclusions Strengthening health promotion activities to improve nutritional status and healthy behaviors, particularly a healthy diet, remains important for women in Indonesia to reduce the prevalence of anemia and improve their overall health status.
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Affiliation(s)
- Olwin Nainggolan
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Dwi Hapsari
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | | | - Lely Indrawati
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Ika Dharmayanti
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Antonius Yudi Kristanto
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
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Ni W, Yuan X, Sun Y, Zhang H, Zhang Y, Xu J. Anaemia and associated factors among older adults in an urban district in China: a large-scale cross-sectional study. BMJ Open 2022; 12:e056100. [PMID: 35264361 PMCID: PMC8915324 DOI: 10.1136/bmjopen-2021-056100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Anaemia leads to poor health outcomes in older adults; however, most current research in China has focused on younger adults. This study aimed to investigate the prevalence of anaemia and its associated factors in older adults in an urban district in China. DESIGN A cross-sectional study. SETTING An urbanised region, Shenzhen, China. PARTICIPANTS A total of 121 981 participants aged ≥65 years were recruited at local community health service centres in Shenzhen from January to December 2018. PRIMARY OUTCOMES The prevalence of anaemia was analysed and potential associated factors were evaluated. RESULTS The mean haemoglobin level was 136.40±16.66 g/L and the prevalence of anaemia was 15.43%. The prevalences of mild, moderate and severe anaemia were 12.24%, 2.94% and 0.25%, respectively. Anaemia was positively associated with older age, being underweight (adjusted OR (AOR) 2.06, 95% CI 1.93 to 2.20), diabetes (AOR 1.23, 95% CI 1.19 to 1.28) and chronic kidney disease (AOR 1.41, 95% CI 1.36 to 1.46), and inversely with higher education level, current-smoker (AOR 0.84, 95% CI 0.78 to 0.89), non-habitual drinker (AOR 0.86, 95% CI 0.81 to 0.92), habitual drinker (AOR 0.81, 95% CI 0.75 to 0.87), overweight (AOR 0.67, 95% CI 0.64 to 0.70), obesity (AOR 0.57, 95% CI 0.53 to 0.61), central obesity (AOR 0.86, 95% CI 0.82 to 0.89), hypertension (AOR 0.86, 95% CI 0.83 to 0.89) and dyslipidaemia (AOR 0.81, 95% CI 0.78 to 0.84). CONCLUSION Anaemia is prevalent among people aged 65 years and older in China. Screening of high-risk populations and treatment of senile anaemia should be a top priority in Shenzhen, and should be listed as important public health intervention measures for implementation.
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Affiliation(s)
- Wenqing Ni
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xueli Yuan
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yuanying Sun
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Hongmin Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yan Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
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Lucà F, Abrignani MG, Parrini I, Di Fusco SA, Giubilato S, Rao CM, Piccioni L, Cipolletta L, Passaretti B, Giallauria F, Leone A, Francese GM, Riccio C, Gelsomino S, Colivicchi F, Gulizia MM. Update on Management of Cardiovascular Diseases in Women. J Clin Med 2022; 11:1176. [PMID: 35268267 PMCID: PMC8911459 DOI: 10.3390/jcm11051176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I Hospital, 10128 Turin, Italy;
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
| | - Simona Giubilato
- Division of Cardiology, Cannizzaro Hospital, 95121 Catania, Italy;
| | | | - Laura Piccioni
- Italy Cardiology Department, “G. Mazzini” Hospital, 64100 Teramo, Italy;
| | - Laura Cipolletta
- Division of Cardiology, Department of Cardiovascular Sciences, University of Ancona, 60126 Ancona, Italy;
| | - Bruno Passaretti
- Rehabilitation Cardiology Department, Humanitas Gavazzeni, 24125 Bergamo, Italy;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Angelo Leone
- Cardiology Division, Annunziata Hospital Cosenza, 87100 Cosenza, Italy;
| | | | - Carmine Riccio
- Division of Clinical Cardiology, ‘Sant’Anna e San Sebastiano’ Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Cardio Thoracic Department, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
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Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, Wang X, Jiang H, Wang X, Lu J, Ge L, Dong S, Zhuang Y, Zhao Y, Wei Y, Ma X, Qiao J. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Netw Open 2022; 5:e2147046. [PMID: 35113162 PMCID: PMC8814908 DOI: 10.1001/jamanetworkopen.2021.47046] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from China's Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China. EXPOSURES Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L. MAIN OUTCOMES AND MEASURES The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth). Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of these outcomes among pregnant females with varying severity of anemia. RESULTS Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption (mild: adjusted OR [aOR], 1.36 [95% CI, 1.34-1.38]; moderate: aOR, 1.98 [95% CI, 1.93-2.02]; severe: aOR, 3.35 [95% CI, 3.17-3.54]), preterm birth (mild: aOR, 1.08 [95% CI, 1.07-1.08]; moderate: aOR, 1.18 [95% CI, 1.17-1.19]; severe: aOR, 1.36 [95% CI, 1.32-1.41]), severe postpartum hemorrhage (mild: aOR, 1.45 [95% CI, 1.43-1.47]; moderate: aOR, 3.53 [95% CI, 3.47-3.60]; severe: 15.65 [95% CI, 15.10-16.22]), and fetal malformation (mild: aOR, 1.15 [95% CI, 1.14-1.17]; moderate: aOR, 1.19 [95% CI, 1.16-1.21]; severe: aOR, 1.62 [95% CI, 1.52-1.73]). Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock (moderate: aOR, 1.50 [95% CI, 1.41-1.60]; severe: aOR, 14.98 [95% CI, 13.91-16.13]), ICU admission (moderate: aOR, 1.08 [95% CI, 1.01-1.16]; severe: aOR, 2.88 [95% CI, 2.55-3.25]), maternal death (moderate: aOR, 0.45 [95% CI, 0.30-0.65]; severe: aOR, 1.56 [95% CI, 0.97-2.48], fetal growth restriction (moderate: aOR, 0.80 [95% CI, 0.78-0.82]; severe: aOR, 1.08 [95% CI, 1.00-1.17]), and stillbirth (moderate: aOR,0.79 [95% CI, 0.76-0.81]; severe: aOR, 1.86 [95% CI, 1.75-1.98]), and mild anemia was associated with decreased risks (maternal shock: aOR, 0.67 [95% CI, 0.63-0.71]; ICU admission: aOR, 0.80 [95% CI, 0.76-0.84]; maternal death: aOR, 0.37 [95% CI, 0.29-0.49]; fetal growth restriction: aOR, 0.79 [95% CI, 0.77-0.80]; stillbirth: aOR, 0.59 [95% CI, 0.58-0.61]) after adjusting for sociodemographic characteristics and other complications during pregnancy. CONCLUSIONS AND RELEVANCE The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved.
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Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Mengxing Sun
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Yijie Guo
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shang Ma
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Hai Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Xiaoxia Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jie Lu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lin Ge
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Shu Dong
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yu Zhuang
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Xudong Ma
- Department of Healthcare Quality Evaluation, Bureau of Medical Administration, National Health Commission of the People’s Republic of China, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
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25
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Hu S, Liu L, Pollock RF, Pöhlmann J, Wu D, Zhang Y. Intravenous iron for the treatment of iron deficiency anemia in China: a patient-level simulation model and cost-utility analysis comparing ferric derisomaltose with iron sucrose. J Med Econ 2022; 25:561-570. [PMID: 35403540 DOI: 10.1080/13696998.2022.2065092] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two intravenous (IV) iron formulations, ferric derisomaltose (FDI) and iron sucrose (IS), are currently available for the treatment of iron deficiency anemia (IDA) in China. Clinical studies have demonstrated that FDI has an improved efficacy and safety profile versus IS, while requiring fewer infusions to correct iron deficits. Based on these findings, the present study evaluated the costs and benefits of FDI and IS for the treatment of IDA, from a healthcare system and societal perspective in China. METHODS A patient-level model was developed to project time to hematological response and incidence of cardiovascular adverse events and hypersensitivity reactions (HSRs) associated with FDI and IS over 5 years. Costs included iron acquisition, administration, and adverse event/HSR treatment costs, based on published studies, fee schedules, and a physician survey. Health state utilities associated with adverse events, HSRs, and the number of infusions were obtained from the literature and a time trade-off survey. RESULTS From a healthcare system perspective, FDI was associated with incremental costs of RMB 1,934 (purchasing power parity USD 462) and incremental quality-adjusted life expectancy of 0.078 quality-adjusted life-years (QALYs) versus IS, yielding an incremental cost-utility ratio of RMB 24,901 (USD 5,949) in the base case scenario. From a societal perspective, FDI was associated with reduced total costs and therefore dominant versus IS. LIMITATIONS Limitations included the absence of clinical data specific to China and insufficient data to model persistence with treatment. CONCLUSIONS This was the first cost-utility analysis comparing FDI and IS for the treatment of IDA in China. Based on a patient-level model, FDI was found to improve quality of life and reduce administration and adverse events costs relative to IS. Using the 2020 Chinese gross domestic product per capita of RMB 72,447 (USD 17,307) as a cost-effectiveness threshold, FDI would be considered cost-effective in China.
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Affiliation(s)
- Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Limin Liu
- First Affiliated Hospital of Soochow University, Suzhou, China
| | | | | | - Depei Wu
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yabing Zhang
- Shanghai Institute of Technology, Shanghai, China
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Gestational Anemia and its effects on neonatal outcome, in the population of Hyderabad, Sindh, Pakistan. Saudi J Biol Sci 2022; 29:83-87. [PMID: 35002396 PMCID: PMC8716886 DOI: 10.1016/j.sjbs.2021.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Anemia in pregnancy is a globally health-related issue, that affects both mothers and their newborn. Anemia during pregnancy across the world involves approximately 38% of the world population. To evaluate the effect of gestational anemia on perinatal outcome in the population. The aim of present study is to evaluate the effect of gestational anemia on perinatal outcome in the population of Hyderabad, Sindh, Pakistan. Methods A cross-sectional comparative analysis was conducted among pregnant mothers who were listed to give birth at Liaquat University of medical and health sciences Jamshoro/Hyderabad during the period of September 2018 to September 2019. The study population 400 were selected by convenient random sampling, and grouped into 2 on the basis of their Hb levels, with Hb < 11 gm% they were classified as anemic mothers, Hb ≥ 11 gm% were termed as non-anemic mothers, data was collected on the preformed questionnaire, and was analyzed on SPSS 21. Results The prevalence of anemia was 51.5% in in total population out of which, the incidence of normocytic normochromic anemia was highest 52.4 %microcytic hypochromic anemia was found in 19.4%, Overall, extremely low Apgar was found in 53 anemics, and 8 non. anemic mother’s infants, LBW incidence was 47.5 %; in anemic mothers, and 15.4 % in non-anemic group, the term, small for gestational age infants were 14.5% in anemic mothers, and 3.6% in non-anemic mothers, there were 36 preterm births to anemic mothers and 10 in non-anemic mothers. The incidence of caesarian section is 53.3% in anemic mothers compared to 30.9% in non-anemic mothers. Conclusions Anemia in pregnancy significantly increases risks of low Apgar, LBW, term SGA, preterm birth, and an increase incidence of caesarian section.
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Abdu S, Ali T, Debella A, Assefa N, Teji Roba K. Magnitude and factors associated with anemia among pregnant women admitted to labor ward of Hiwot Fana Specialized University Hospital, Eastern Ethiopia. SAGE Open Med 2021; 9:20503121211047389. [PMID: 34594562 PMCID: PMC8477710 DOI: 10.1177/20503121211047389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Anemia is a common medical problem among pregnant women that will influence pregnancy and birth outcomes. In Ethiopia, there is a paucity of evidences regarding the problem among pregnant women admitted to labor ward. Therefore, the objective of this study was to assess the magnitude and factors associated with anemia among pregnant women admitted to labor ward for deliveries at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Methods A cross-sectional study was conducted among 314 pregnant women admitted to labor ward at Hiwot Fana Specialized University Hospital in June 2020. Data were collected using an interviewer administered questionnaire and were entered into EpiData and analyzed using SPSS. Descriptive statistics and multiple logistic regression analysis were done to identify predictors of anemia. Results In this study, the magnitude of anemia was 37.9% (95% confidence interval: 32.4, 43.0). Short birth interval (adjusted odds ratio = 2.5; 95% confidence interval: 1.02, 6.13), history of blood loss during pregnancy (adjusted odds ratio = 4.3; 95% confidence interval: 1.86, 9.9), less consumption of citrus fruit within a week (adjusted odds ratio = 2.9; 95% confidence interval: 1.2, 6.9), and meal frequency less than three times per day during pregnancy (adjusted odds ratio = 2.2; 95% confidence interval: 1.0, 4.6) were significantly associated with anemia, respectively. Conclusion This study pointed out that more than one-third of pregnant women affected by anemia. Thus, interventions that could reduce anemia, such as counseling about increasing of meal frequency during pregnancy, foods rich in iron, and prevention and management of blood loss are recommended.
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Affiliation(s)
- Serkalem Abdu
- Hiwot Fana Specialized University Hospital, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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