Cause Of Anaemia In Pregnancy Research Articles

Comparative study of efficacy and safety of Iron polymaltose complex with ferrous sulphate in antenatal women with moderate anemia

Iron deficiency is the most common cause of anemia in pregnancy. The conventional iron preparations with ferrous salts showed noncompliance due to various side effects when compared to iron polymaltose complex. But the efficacy of iron polymaltose complex (IPC) in the treatment of iron deficiency anaemia (IDA) during pregnancy has not been established, and the evidence is inconclusive. The aim of this study was to compare efficacy, safety, compliance and cost-effectiveness of ferrous sulphate (FS) with IPC in antenatal women. 100 antenatal women with 14 to 20 weeks of gestation were recruited in the study, one group of 50 women were given FS and the other group of 50 women were given IPC for 6 weeks. Haemoglobin concentration (Hb), Packed cell volume(PCV),Mean Corposcular Haemoglobin concentration and serum iron were estimated before and after treatment with the above iron formulations. Compliance with pill count and safety with adverse effects monitoring in followup were noted. Statistical analysis was done with student's T test and chi square test. The improvement of haematological parameters was comparable in both groups statistically but compliance and safety were better with the IPC group when compared to FS group. IPC is a better alternative to FS as it is safe and showed more compliance.

English

The most common cause of anaemia in pregnancy is Iron deficiency which can affect the newborns. This study was done to compare the serum Iron & Total Iron Binding Capacity (TIBC) levels in the 20 newborns of non-anaemic and anaemic mothers each. Results showed that Haemoglobin % was significantly lower (P≤ 0.001) in newborns of anaemic mothers. Serum Iron levels did not show any significant difference (P = 0.1) & TIBC levels were significantly higher (P≤ 0.01) in newborns of anaemic mothers as compared to newborns of

Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy

BackgroundIron deficiency anaemia (IDA) is the most common cause of anaemia in pregnancy in Indians and is associated with increased risk of low birth-weight infants. Studies from developed countries recommend iron supplementation based on serum ferritin levels. However, screening by serum ferritin is not feasible in all cases in India. This study was undertaken to document haematological profile of pregnant Indian women. MethodsWe studied the correlation between second and third trimester ferritin concentration and haemoglobin (Hb) and red cell indices in 100 consecutive ANC cases to select the best haematologic characteristic to identify women who needed iron therapy. Hb and red cell indices, RBC count, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width were analysed and PBS studied to subtype anaemia if present. ResultsProportion of iron deficiency anaemia in pregnancy was 34% and significant correlation was found between serum ferritin and RDW-CV% and TRBC. No correlation was found between ferritin levels and Hb, MCV, MCH and MCHC. Serum ferritin levels were <12 ng/mL in 30 out of 52 non-anaemic cases suggesting prevalence of sub-clinical iron deficiency in 58% cases. None of the red cell indices correlated with ferritin level in this group. Only TRBC showed some correlation with ferritin (r = −0.090, p > 0.05). ConclusionAll pregnant women in India should continue to get iron supplements unlike what is recommended in the developed countries where iron supplementation is based on serum ferritin levels.

Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: A randomized clinical trial

Iron deficiency is a leading cause of anemia in pregnancy. The present study aimed to compare the efficacy of oral and intravenous iron therapy in improving iron deficiency anemia in pregnancy and restoring iron stores, compare the obstetric outcome in the two groups and evaluate the safety of intravenous iron sucrose. This was a prospective study, where 100 anemic antenatal women with hemoglobin 7-9 g/dL, mean corpuscular volume <85 fL and serum ferritin <15 ng/mL, were randomized into two groups. In group A (n=50), the women received 200 mg tablets of ferrous sulphate, each containing 60 mg elemental iron, three times a day for 4 weeks. In group B (n=50), iron sucrose was given in divided doses of 200 mg each on alternate days by slow intravenous infusion. Primary outcome measure was treatment efficacy, assessed by measurement of hemoglobin, red blood cell indices and reticulocytes on days 7, 14, 21, and 30 and at delivery, and of ferritin on day 30 and at delivery. Any side-effects of treatment and the neonatal outcome were studied as secondary outcome measures. There was a statistically significant difference in increase of hemoglobin levels (3.1g/dL in group A vs 5.1 g/dL in group B; P=0.002) and ferritin levels between the two groups on day 30 (P=0.005). The adverse effects from iron treatment were mild but more prominent in group A. Neonatal outcome was comparable in the two groups. Intravenous administration of iron sucrose is a safe treatment for correction of anemia in pregnancy, without serious side-effects.

Haemoglobin and ferritin concentrations of pregnant women at term.

Anaemia in pregnancy is defined as haemoglobin (Hb) concentrations of less than 11 g/dL while low ferritin is defined as serum ferritin (SR) levels of less than 10 µg/L. Hb and ferritin concentrations of pregnant women at term were determined to establish their mean values and to determine the prevalence of anaemia in our locality. Haemoglobin and ferritin levels of 170 non-smoking and HIV-negative pregnant women were determined at term. The majority 143 of 170 (84.1%) of the pregnant women recruited for the study, booked at the beginning of the second trimester and received 200 mg elemental iron in three divided doses and 5 mg folic acid daily which were commenced at booking. Five millilitres of blood were collected from each patient at term into EDTA bottles for full blood count analysis and another 5 mL into plain bottles for SR assay. The mean Hb and ferritin values were 10.9 ± 1.9 and 47.84 ± 98.39 µg/L, respectively. The prevalence of anaemia at term was 46.4%. Only 11.2% (19 of 170) of pregnant women at term had low SR (iron stores). A statistically significant relationship was found between women's education and SR (P = 0.032). Booking status also correlated directly with SR and haemoglobin concentrations, while increasing age and parity did not. About half of the patients were anaemic. Iron deficiency is not the major cause of anaemia in pregnancy in this study because the majority of the pregnant women had normal iron stores. Education and booking status are possible factors that contribute to anaemia.

Deficiência de ferro na gestação, parto e puerpério

A anemia por deficiência de ferro representa desordem nutricional de maior prevalência em todo o mundo. As duas causas mais comuns de anemia na gestação e pós-parto são a deficiência de ferro e as perdas sanguíneas agudas. Na gestação, as mudanças fisiológicas podem dificultar o diagnóstico das doenças hematológicas. O propósito deste estudo é revisar a deficiência de ferro na gestação, as consequências adversas materno-fetais, o diagnóstico e manejo da anemia na gestação.

Biochemical and haematological changes in pregnant malaria patients and pregnant non-malaria women

Malaria has been known to alter hematological and biochemical parameters during pregnancy and is one of the causes of anemia in pregnancy. In a cross sectional study, changes in hematological and selected biochemical parameters were investigated in pregnant malarial patients (17) compared with 20 healthy pregnant non-malarial women (controls). Assay for transferrin (TF), total iron binding capacity (TIBC), serum iron, protein, cholesterol and triglyceride were evaluated on sera while hemoglobin concentration, total white blood cell count were carried out on whole blood using standard laboratory methods and enzyme colorimetric kits. The mean values of serum transferrin (4.31 ± 0.54 g/l), TIBC 112.45 ± 14.22 µmol/L serum iron 29.64 ± 2.78 µmol/L in pregnant malaria parasitaemic group were significantly (p < 0.01) higher than the respective values of 3.13 ± 0.45 g/l, 81.70 ± 11.70 µmol/L and 21.36 ± 2.41 µmol/L in the control. Total serum cholesterol (4.28 ± 1.1 mmol/L) and triglycerides (1.56 ± 0.14 mmol/L) were significantly (p < 0.01) elevated in the pregnant malarial parasitaemic group compared with the control values of 2.9 5 ± 0.71 and 1.17 ± 0.28 mmol/L, respectively. The white blood cell (WBC) count did not show any significant change and there were no changes in hemoglobin, transferrin saturation as well as serum protein in pregnant-malaria group compared with the control. The results suggest that malaria may aggravate the hypertransferinaemia and hyperlipidemia syndrome of human pregnancy. Key words: Pregnancy, malaria, hematological indices, transferrin, cholesterol.

Malaria parasitaemia among pregnant women in a rural community of eastern Nigeria; need for combined measures

Malaria in pregnancy is a major contributor to adverse maternal and perinatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia in pregnancy in both immune and non-immune individuals and is aggravated by poor socioeconomic circumstances. The aim of this study is to assess the prevalence of asymptomatic malaria parasitaemia among pregnant women in a rural setting. 272 pregnant women, aged between 18 and 40 years in some remote rural areas of Ebonyi State, Nigeria were recruited between January 2007 and March 2008.Their blood samples were collected and examined for malaria parasite, haemoglobin and packed cell volume using standard methods. Our results showed 59.9% prevalence of parasitaemia with the highest prevalence occurring in the first trimester [84.1%]. Among the positive cases, mild parasitaemia was recorded in 47.2% moderate parasitaemia in 37.4% while severe parasitaemia was recorded in 15.3% of cases. These differences were statistically significant [P<0.016]. Furthermore the distribution of malaria densities in different gravidity groups showed an inverse relationship, 45.4% in primigravidae, [31.9%] in secundigravidae and [10.4%] among people with more than five pregnancies. These findings were statistically significant [P<0.0001]. The prevalence of anaemia in pregnancy in this study was 62.4%. Apart from the use of nets, drugs and vector control, the prevention of malaria in pregnancy in very poor socioeconomic settings should make provision for nutritional support.

Vitamin B6 deficiency and anemia in pregnancy

Iron deficiency is the most common cause of anemia in pregnancy. Pregnant women with anemia are, in general, exclusively treated with iron supplementation. We observed that several pregnant women with anemia who were nonresponsive to iron supplementation also had vitamin B6 deficiency, and that anemia in these cases improved with the administration of vitamin B6. Our prospective study in healthy pregnant women showed that blood levels of iron, ferritin and vitamin B6, in particular, fell to the lower limit of the nonpregnant reference range by the third trimester. We conclude that it is important to take into account the deficiency of vitamin B6 besides iron in the evaluation of anemia during pregnancy.

ACOG Practice Bulletin No. 95: Anemia in Pregnancy

Anemia, the most common hematologic abnormality, is a reduction in the concentration of erythrocytes or hemoglobin in blood. The two most common causes of anemia in pregnancy and the puerperium are iron deficiency and acute blood loss. Iron requirements increase during pregnancy, and a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences. The purpose of this document is to provide a brief overview of the causes of anemia in pregnancy, review iron requirements, and provide recommendations for screening and clinical management of anemia during pregnancy.

Anaemia in pregnancy: Plasmodium falciparum infection is an important cause in primigravidae in Hoima district, western Uganda.

Infection with Plasmodium falciparum is a major cause of anaemia in pregnancy, especially in primigravidae. Of 853 primigravidae visiting an antenatal clinic in Hoima district, western Uganda, for the first time, 530 (62.1%) were found to have P. falciparum parasitaemias and 305 (57.5%) of these had at least 1000 parasites/microliter blood. Plasmodium falciparum parasitaemia was significantly associated with anaemia (relative risk = 0.84, with 95% confidence limits = 0.74-0.96; P = 0.01). Malarial parasites were detected in > 80% of the women who had severe anaemia (P = 0.0008) and haemoglobin concentrations decreased with increasing intensity of infection (P = 0.03). Malarial hyper-reactive splenomegaly was associated with high parasite density (P = 0.01) and low haemoglobin level (P < 0.0001). Effective measures aimed at prevention of malaria and anaemia in pregnancy, especially in primigravidae, would significantly reduce anaemia and its deleterious effects on both the mother and the baby.

The Complexity of Pregnancy Anemia in Dar-es-Salaam

Objectives: To investigate the main causes of anemia in pregnancy in Dar-es-Salaam and identify appropriate investigations at all levels of care. Materials: All pregnant women booking for antenatal care at 2 clinics (n = 2,235) were screened for anemia. Investigations for etiology of anemia were done in all anemic women (Hb <10.5 g/dl) (n = 361). Methods: Blood cell counts, microscopy of blood films, S-ferritin, C-reactive protein, HIV, stool parasite and bone marrow analysis were performed. Results: Iron deficiency dominated in 86% and malaria in 1/3 of anemia cases. Since 42% had indication of ongoing inflammation, S-ferritin was less useful as indicator of iron deficiency but blood film microscopy identified most cases.

Anaemia in pregnancy--a cross-sectional study in Singapore.

To determine the prevalence and predictors of anaemia in pregnancy in Singapore. Hospital based case controlled study. National University Hospital, between January-December 1993. All women delivered at the National University Hospital, Singapore in 1993 had their haemoglobin estimated. If it was less than 11 gm/dl, blood was taken to establish the cause of anaemia. Data was also collected with regard to their antenatal progress, and factors predisposing to anaemia in pregnancy. Logistic regression, Chi-square test, Fischer's exact test, Mantel-Haenszel test were used to assess the relationships between categorical variables. The prevalence of anaemia at delivery was 15.3%. The most common cause of anaemia in pregnancy was due to iron deficiency (81.3%). The occurrence of anaemia in pregnancy is related to the socio-economic status of the women. Multiparous women of the lower socio-economic class who tend to book late in pregnancy were found to have the highest risk of anaemia. Multivariate logistic regression analysis revealed iron prophylaxis, haemoglobin level at booking, race and previous history of anaemia in earlier pregnancy as important predictors of anaemia at delivery. The odds of anaemia for a woman not on therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76-14.13). A 55% reduction in odds of anaemia was estimated per 1 gm% increase in haemoglobin level at booking. As compared to Chinese, Malays and Indians who experienced significant increase in odds of anaemia of 95% and 58% respectively. Further, a pregnant woman with a previous history of anaemia is 2.6 times as likely to be anaemic, as compared with one without history of anaemia. Except for a higher incidence of preterm delivery, there was no other statistically increased risk of complications in the antepartum, intrapartum or postpartum periods. There was no difference in the incidence of antepartum haemorrhage/operative deliveries, postpartum haemorrhage, low birthweight, intrauterine growth retardation and neonatal outcome. The study confirms that iron deficiency anaemia is the most common cause of anaemia in pregnancy and is a major health problem in developing and developed countries.

Seasonality, malaria, and impact of prophylaxis in a West African village I. Effect of anemia in pregnancy.

The importance of malaria as a cause of anemia in pregnancy in endemic areas remains controversial. The prevalence of anemia in pregnant women following the dry (May) and the rainy (November) seasons was compared in two successive years in Bougoula village (region of Sikasso, Mali). Phase I (1992) was observational and included 172 pregnant women and 208 controls. In Phase II (1993, 174 pregnant women and 206 controls), malaria prophylaxis with proguanil (200 mg/day) and chloroquine (300 mg/week) was offered to pregnant women. A strong seasonal variation in the prevalence of moderate to severe anemia in pregnant women (hematocrit < 30%) occurred in Phase I (dry season = 8.7%, rainy season = 41.2%). This variation was present only in women of parity lower than five, and paralleled variation in parasitemia. In Phase II, the seasonal variation of anemia was suppressed in women under malaria prophylaxis (presence of antimalarial metabolites in urine), and the overall prevalence of moderate to severe anemia in pregnancy decreased by 55.5% (22.8-74.3%). We conclude that malaria is the major cause of anemia in pregnancy in this region. A high priority should be given to prevention of malaria in pregnancy.

Neutrophil hypersegmentation and defective folate metabolism in pregnancy.

SummaryAn increase in the proportion of hypersegmented neutrophils (the neutrophil lobe index) in the peripheral blood, shows a close correlation with the finding of megaloblastic erythropoiesis in bone marrow.In pregnant patients these changes are most likely to be due to folate depletion but altered folate metabolism, as judged by biochemical evidence, does not always result in morphological changes. Neither low vitamin B12 levels nor iron deficiency have a significant influence on neutrophil morphology during pregnancy.Assessment of the neutrophil lobe index is a simple procedure and is applicable when more comprehensive laboratory facilities are not available. The investigation is of value in elucidating the cause of anaemia in pregnancy but cannot be regarded as a satisfactory screening test to detect patients with early or minor degrees of folate deficiency.