Cause Of Anaemia In Pregnancy Research Articles

Pengetahuan Dan Sikap Ibu Hamil Dalam Mengkonsumsi Tablet Zat Besi Di Praktik Mandiri Bidan ‘I’ Kabupaten Bandung Tahun 2019

Angka anemia kehamilan di Indonesia menunjukkan nilai yang cukup tinggi. Angka anemia kehamilan trimester I (3,8%), trimester II (13,6%) dan trimester III (24,8%). Anemia defisiensi zat besi adalah anemia yang terjadi akibat kekurangan zat besi dalam darah. Salah satu penyebab anemia pada kehamilan adalah kurangnya pengetahuan dan sikap negatif dalam mengkonsumsi tablet zat besi (Fe). Tujuan penelitian untuk mengetahui pengetahuan dengan sikap ibu hamil dalam mengkonsumsi Fe di Praktik Mandiri Bidan ‘I’ Kabupaten Bandung Tahun 2019. Penelitian menggunakan prosedur penelitian deskriptif, dilaksanakan bulan Agustus sampai September 2019 . Populasi penelitian adalah seluruh ibu hamil yang melakukan pemeriksaan pada bulan Agustus sampai September 2019 dibidan I. Jumlah sampel 30 orang, diambil menggunakan teknik total sampling. Hasil penelitian, ibu hamil memiliki pengetahuan cukup (60%), ibu hasil dengan pengetahuan baik (37%), ibu hamil dengan pengetahuan kurang (3%), ibu hamil dengan sikap positif dalam mengkonsumsi Fe (100%). Kesimpulan penelitian adalah sebagian besar ibu hamil memiliki pengetahuan cukup dan semua ibu hamil memiliki sikap positif dalam mengkonsumsi Fe. Untuk meningkatkan pengetahuan dan sikap ibu hamil dalam mengkonsumsi Fe perlu dilakukan penyuluhan secara rutin dan peningkatan distribusi Fe oleh bidan dengan kerjasama dengan kader dan puskesmas.

The overbearing physiological changes marring iron indices interpretation in response to iron therapy during pregnancy

Background: Iron deficiency anemia (IDA) is most common cause of anemia in pregnancy. In order to prevent this iron supplementation is routinely practiced as a prophylactic measure in pregnant women all over. The biochemical parameters assessed in IDA comprise an iron profile evaluation which consists of estimation of serum ferritin, serum iron, total iron binding capacity(TIBC), serum transferrin levels and calculation of transferrin saturation. These biochemical parameters are subjected to variations due to maternal adaption phenomenon. Aim: In the current study we have chosen three iron indices, serum iron, serum TIBC and transferrin saturation percent to note their performance in diagnosing and monitoring the response to iron therapy in pregnant women. Methodology: The study population are thirty- six pregnant women in their early second trimester, who are diagnosed with mild iron deficiency anemia (Hemoglobin between 9 and 11 g %). Iron parameters, serum iron, serum TIBC and transferrin saturation levels were analyzed in these women. They are then given oral iron preparation in the form of Ferrous sulphate for a period of twelve weeks. After this the Hemoglobin level, serum iron, TIBC and transferrin saturation levels are re-analyzed in these women. Results: The hemoglobin levels increased (p= 0.002). as expected after oral iron intake. Serum iron levels improved from 58.19±39.07 to 64.78±34.96 μg/dl. Serum TIBC value before supplementation 234.22±134.49 increased to 437.33±94.95 after, which contradicts the expected pattern seen in response to therapy in general population. Similarly absurdity prevails in transferrin saturation index levels which dropped from 36.8 ± 31.8 to 16.3 ± 10.6. Conclusion: The iron status during pregnancy is highly influenced by the maternal changes. And a blind interpretation of the report can lead to erroneous diagnosis. The interpretation of values should be based on the trimester specific reference ranges during pregnancy.

A cross-sectional study in non-anaemic pregnant women in Turkey to assess necessity of iron supplementation.

Iron deficiency is the most common cause of anaemia in pregnancy. Guidelines recommend different threshold values for iron supplementation. To determine trimester-specific reference ranges for haematological values (haemoglobin, hematocrit and ferritin) in healthy pregnant women who have not used any iron supplementation during pregnancy to guide future iron treatment. A prospective cross-sectional study was carried out on 168 pregnant women aged 18-45 years, with singleton pregnancies in the first trimester, Hb ≥ 11 g/dL and ferritin ≥ 12 μg/L, and not using iron supplementation. Multiple pregnancies, pregnancies with obstetric complications and smokers were excluded from the study. Mean haemoglobin (Hb) and ferritin values, trimester-specific reference ranges and percentile values of Hb and ferritin were determined for each trimester. The normality of the variables was tested using the Kolmogorov-Smirnov test. Mean Hb decreased significantly between trimesters from 12.6 to 11.9 and then 11.5 g/dL. In addition, Hb, hematocrit and ferritin decreased significantly from the first to the second trimester (P < 0.001 for all) but stayed comparable between the second and third trimesters (P = 0.246, P = 0.575, P = 0.408, respectively). The lower reference value for Hb was calculated as 10.67, 10.08 and 9.18 g/dL for 10-14, 20-24 and 30-34 gestational weeks respectively. This pioneer study allows us to understand that iron supplementation may not be needed as any decrease is due to physiological haemodilution. These results may prevent unnecessary iron prescription during pregnancy.

Association of maternal hemoglobin and iron stores with neonatal hemoglobin and iron stores

BackgroundOne of the commonest causes of anemia in pregnancy is iron deficiency. This study aims at understanding and exploring the association between fetal and maternal iron status. Predelivery maternal hemoglobin (Hb) and iron stores, serum iron, ferritin, and soluble transferrin receptor (sTfR), were assessed and compared to the cord blood Hb and iron stores with an attempt to identify the level of maternal Hb and ferritin at which the fetal iron stores reduce, helping to identify the neonates who will require earlier iron supplementation. MethodFour hundred eight participants were enrolled, and maternal and cord blood was collected at the time of delivery and tested for Hb and iron parameters. The results were statistically analyzed. ResultsOf all mothers, 27.2% mothers were anemic (Hb less than 11 g/dl). Of all newborns, 15.4% newborns had Hb less than 14 g/dl. There was a significant association between the maternal and cord blood iron, ferritin, sTfR and sTfR/log ferritin index. Eighty-five percent of the babies with cord blood Hb <14 g/dl had maternal serum ferritin (SF) <50 μg/L. Maternal SF <10 μg/l was associated with a significant number of babies with cord blood SF <75 μg/l (77.7%). One hundred sixty six neonates had sTfR 2 μg/ml or more. Of these, 80.7% had maternal SF <50 μg/l. Of the 115 newborns with a high sTfR/log ferritin index (>1.5), 56.5% had raised maternal sTfR (>2μg/ml). ConclusionIn view of a significant association between maternal and neonatal Hb and iron stores, newborns of mothers with iron deficiency anemia (IDA) during pregnancy should be monitored and followed up after birth for development of IDA and early iron supplementation.

Effects of malaria parasitaemia on some haemostatic parameters among pregnant women of African descent in Specialist Hospital Sokoto, Nigeria.

Malaria in pregnancy is a major contributor to adverse maternal and prenatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia in pregnancy and is aggravated by poor socioeconomic circumstance. This study evaluated the prothrombin time and activated partial thromboplastin time of malaria parasitized pregnant women. A total of 90 pregnant women participated in the study, 60 of which were malaria positive and 30 of which were malaria negative. Participants were recruited from the antenatal Clinic of Specialist Hospital Sokoto, Nigeria. A structured interviewer-administered questionnaire was used to obtain some socio-demographic characteristics of subjects. Blood samples were collected in ethylene diamine tetra acetic acid and examined for malaria parasite and platelet count while citrated samples were used for the determination of some haemostatic parameters (prothrombin time and activated partial thromboplastin time). Data generated was analyzed using SPSS 25.0 statistical package. A p-value ⩽ 0.05 was considered significant in all statistical comparisons. There was a statistically significant decrease (p= 0.000) in the platelet counts of the parasitized subjects compared to the non-parasitized controls. We observed a significant prolongation on both the prothrombin time and activated partial thromboplastin time among the parasitized subjects compared to the non-parasitized controls (p= 0.000). This study has shown that malaria in pregnancy causes a significant decrease in the platelet count and prolongation in the prothrombin (PT) and the activated partial thromboplastin time (APTT). There is need for the malaria and haemostatic parameters to be assayed routinely on pregnant women particularly those presenting to antenatal clinic with febrile illness.

Multidisciplinary Implementation of an Iron Deficiency Anemia in Pregnancy Treatment Protocol

Background: Anemia in pregnancy increases the need for blood transfusion during and after delivery and is associated with an increased risk of maternal and fetal mortality, therefore preventing maternal anemia may improve outcomes. Iron deficiency is the most common pathologic cause of anemia in pregnancy and is estimated to affect about 30% of pregnant women in the third trimester in the US. The baseline peripartum blood transfusion rate at our institution is 3.2%. Historically, patients who may have benefited from intravenous (IV) iron were continued on oral iron and subsequently delivered with persistent iron deficiency anemia. If identified to need IV iron, these patients were usually referred to a hematologist. However, in the absence of a structured protocol, referral was provider-dependent. Objective: We formed a multidisciplinary work group consisting of members from the departments of Hematology, Obstetrics, Pharmacy, Nursing, and Blood Bank to reduce peripartum blood transfusions by developing a process to manage pregnant patients with iron deficiency anemia. The treatment algorithm utilized at our institution was adapted from "How I treat anemia in pregnancy: iron, cobalamin, and folate" (Achebe &amp; Gafter-Gvili, 2017), which recommends IV iron for hemoglobin less than 11 g/dL and ferritin less than 30 µg/dL in the third trimester and for hemoglobin less than 10.5 g/dL and ferritin less than 30 µg/dL in the second trimester along with recommendations for iron repletion in the first trimester. The primary endpoint was the utilization of blood transfusion. Secondary endpoints included an increase in maternal hemoglobin after treatment and evaluating the safety of IV ferric carboxymaltose as measured by side effects and frequency of hypophosphatemia. Five months after initiation of the IV iron recommendations, we performed an audit to assess its use. Methods: A retrospective IRB-approved chart review of anemic, iron-deficient pregnant women who received IV ferric carboxymaltose from 1/30/19 - 6/30/19 was performed. Thirty-six patients were identified and their charts were reviewed to determine the hemoglobin and ferritin levels prior to IV iron, the number of IV iron infusions received with any side effects, phosphorus levels on days of IV iron, hemoglobin level after IV iron, and need for peripartum blood transfusion. Results: Of the 36 patients who received IV iron for anemia in pregnancy, post-IV iron hemoglobin and blood transfusion information was only available for 26 patients. The remaining 10 patients had not delivered as yet or had delivered at another institution so data were not available. Of these 26 patients, the median age was 26.0 years and all received IV iron during their third trimester. No patients required a blood transfusion peripartum. The average hemoglobin prior to IV iron was 9.3 g/dL and the average hemoglobin after 1-2 IV iron infusions was 11.3 g/dL, an increase of 2.0 g/dL across the total group (Figure 1) (p&lt;0.0001). Of these 26 patients, 7 patients received 1 dose of IV iron and 2 patients experienced heartburn or nausea during or soon after the IV iron infusion. Phosphorus levels were checked in 24 patients and 6 experienced hypophosphatemia with no attributable side effects. No patient experienced a serious adverse effect or reaction requiring discontinuation of IV iron therapy. Conclusion: Results from the first 5 months of this project suggest using a standardized iron deficiency anemia treatment protocol including IV iron to reduce the need for peripartum blood transfusion and increase hemoglobin levels. Additionally, our data suggest IV ferric carboxymaltose is well-tolerated in these patients. These results also support using multi-professional teams to improve the quality of healthcare delivery to pregnant patients with iron deficiency anemia. We have created an IRB-approved database to study more patient-centered postpartum outcomes such as quality of life among IV iron recipients as well as lactation rates and fetal outcomes. We plan to expand this strategy to other patients who have a predictable and likely preventable need for intermittent blood transfusion, such as patients with chronic gynecologic blood loss. Reference: Achebe, M. M., &amp; Gafter-Gvili, A. (2017). How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood, 129(8), 940-949. https://doi.org/10.1182/blood-2016-08-672246. Disclosures Davidson: ABIM: Other: American Board of Internal Medicine.

El tratamiento de la anemia por deficiencia de hierro durante el embarazo y el puerperio

La anemia, la anormalidad hematológica más común en el mundo, es una reducción en la concentración de eritrocitos o hemoglobina en la sangre. La principal causa de anemia en el embarazo es la deficiencia de hierro de causa nutricional (ADHN), mientras que en el puerperio es la pérdida aguda de sangre (PAS). Los requerimientos de hierro aumentan durante el embarazo, y el hecho de no mantener niveles suficientes de hierro puede tener consecuencias adversas y graves tanto para la madre como para el feto en desarrollo y el recién nacido. Desde una perspectiva mundial, la anemia durante el embarazo es más frecuente y severa en países con pobre desarrollo social y económico. Las recomendaciones de consenso definen la anemia como un nivel de hemoglobina (Hb) &lt;10,5 g / dL durante el embarazo y &lt;10 g / dL durante el período posparto como líneas de corte para iniciar la terapia con hierro oral, hierro intravenoso o transfusión de glóbulos rojos. En el presente artículo se intenta recopilar las recomendaciones para un tratamiento seguro y efectivo, de manera de reducir la morbilidad y mortalidad asociadas con la ADHN en la gestación y/o la PAS en el posparto.

Iron stores in pregnant women with sickle cell disease: a protocol for a systematic review and meta-analysis

IntroductionSickle cell disease (SCD) is the most common inherited disease worldwide. The greatest disease burden is seen in sub-Saharan Africa. Early diagnosis and improved care of people living with SCD...

Time to start and adherence to iron-folate supplement for pregnant women in antenatal care follow up; Northern Ethiopia.

BackgroundIron folate supplementation is a cost-effective way of reducing iron deficiency anemia, low birth weight, and neural tube defects in resource-limited countries like Ethiopia. Late to start and poor adherence to iron-folate supplement has restricted its effectiveness. The aim of this study was to determine the time to start and adherence level of iron-folate supplementation to pregnant women attending at the Ayder Comprehensive Specialized Hospital.MethodsTwo hundred pregnant women were recruited in cross-sectional study design between February and April 2018.ResultsFrom the total participant pregnant women the urban dweller constituted the major proportion of 182 (91%). Seventy-eight (39%) of the participants had two antenatal care visits, whereas only, 21 (10.5%) of them had an antenatal care visit three and above. One hundred fifty-five (77.5%) participants women had knowledge about the cause of anemia in pregnancy. In this study, 143 (71.5%) of the pregnant women started their iron folate supplement in the second and third trimester. The adherence of iron folate intake was 10.5%. Healthcare education and counseling about iron-folate supplementation (AOR =4.55, 95% CI =[1.534, 13.512]), number of pregnancies (AOR =6.941, 95% CI =[1.511, 31.09]), and number of antenatal visit (AOR =0.242, 95% CI =[0.069, 0.852]) were significantly associated with adherence to iron-folate supplementation.ConclusionTime to start iron folate supplement in the first trimester was low and the adherence level was also very poor, which can be attributed by the number of antenatal care visits, frequency of pregnancy and healthcare education and counseling about iron folate supplement.

Knowledge, attitude and practice on prevention of iron deficiency anemia among pregnant women attending ante–natal care unit at public hospitals of Harar Town, Eastern Ethiopia: institutional based cross-sectional study

Introduction: - Globally, the most common cause of anemia is iron deficiency, which is responsible for about half of anemia cases in pregnancy, and it is estimated that in developed countries 38% of pregnant women have iron depletion. In developing countries, the major causes of anemia in pregnancy are nutritional deficiencies, parasitic infestations, HIV infection, hemorrhage and some chronic medical disorders like renal and hepatic diseases. Recent statistics indicate that anemia affects 57% of pregnant women globally with the highest prevalence in sub-Saharan Africa. Anemia is an indicator of nutritional deficiencies that significantly contribute to birth defects, preterm labour and low birth weight, hence it causes global public health problem. Despite interventions of treating and preventing maternal anemia, still many pregnant women are affected by anemia related health problems and the contributing factors. Objectives: - To assess knowledge, attitude and practice on prevention of Iron deficiency anemia among pregnant women attending ante-natal care unit at public Hospitals of Harar town, eastern Ethiopia from March, 12 - April 06, 2018. Method & Materials :- The study was done in Harar town on the public hospitals from March 12-April 12, 2018. The study design was institutional based cross sectional study. By using a single population formula & by making a correction formula our sample size was 128, which the pregnant women was select by simple random sampling from each Hospitals after proportional allocated based on the total sample size. The data was collected using close ended semi-structured questioners by trained 4 diploma nurses with 1 supervisor. For processing & analyzing SPSS version 20 was used & the data were presented by table, graph & chart using frequency & percentage of the results. Result : according to our study form total N=158 most 68% had no(Iron deficiency anemia) IDA, but 32% had IDA, most of them heard about anemia, most define anemia, knew cause & prevention method 75(58.6%), most had positive perception on consumption of folic acid, family planning, feed regular meal, also related to practice most take 76(59.4%) folic acid on current pregnancy, 72(56.3%) feed fiber rich food. Discussion : In our study the prevalence anemia shows 32% which indicate less than study done in Azerbaijan, Kazakhstan, Uzbekistan, Kyrgyz, Egypt, Jordan, higher than Armenia & Moldova this may due to sample size & study area difference. Similar study in Sierra Leone among the 185 subjects, majority (89.2%) had heard about anemia. Which is comparable to our study, 68.1% recognized lack of iron in food as the cause for anemia, which is low in our study. About 69.7% pointed that consuming iron rich foods could prevent anemia, in our study it is less. Conclusion and Recommendation : according to our study the prevalence of IDA were low, this may related to most had knew, had positive attitude and practice method use to prevent iron deficiency anemia. But there were 32% with IDA so to prevent this strengthens health education, involve private health institution & husbands of the pregnant mothers, health facilities & stakeholders should to work on increasing the awareness, positive perception & skill on prevention of IDA. Keywords : Knowledge , Attitude , Practice , Anemia DOI : 10.7176/JMPB/53-02 Publication date :March 31 st 2019

Knowledge, Attitude and Practice on Prevention of Iron Deficiency Anemia Among Pregnant Women Attending Ante-Natal Care Unit at Public Hospitals of Harar Town, Eastern Ethiopia: Institutional Based Cross-Sectional Study

Introduction: - Globally, the most common cause of anemia is iron deficiency, which is responsible for about half of anemia cases in pregnancy, and it is estimated that in developed countries 38% of pregnant women have iron depletion. In developing countries, the major causes of anemia in pregnancy are nutritional deficiencies, parasitic infestations, HIV infection, hemorrhage and some chronic medical disorders like renal and hepatic diseases. Recent statistics indicate that anemia affects 57% of pregnant women globally with the highest prevalence in sub-Saharan Africa. Anemia is an indicator of nutritional deficiencies that significantly contribute to birth defects, preterm labour and low birth weight, hence it causes global public health problem. Despite interventions of treating and preventing maternal anemia, still many pregnant women are affected by anemia related health problems and the contributing factors. Objectives: - To assess knowledge, attitude and practice on prevention of Iron deficiency anemia among pregnant women attending ante-natal care unit at public Hospitals of Harar town, eastern Ethiopia from March, 12 - April 06, 2018. Method & Materials :- The study was done in Harar town on the public hospitals from March 12-April 12, 2018. The study design was institutional based cross sectional study. By using a single population formula & by making a correction formula our sample size was 128, which the pregnant women was select by simple random sampling from each Hospitals after proportional allocated based on the total sample size. The data was collected using close ended semi-structured questioners by trained 4 diploma nurses with 1 supervisor. For processing & analyzing SPSS version 20 was used & the data were presented by table, graph & chart using frequency & percentage of the results. Result : according to our study form total N=158 most 68% had no(Iron deficiency anemia) IDA, but 32% had IDA, most of them heard about anemia, most define anemia, knew cause & prevention method 75(58.6%), most had positive perception on consumption of folic acid, family planning, feed regular meal, also related to practice most take 76(59.4%) folic acid on current pregnancy, 72(56.3%) feed fiber rich food. Discussion : In our study the prevalence anemia shows 32% which indicate less than study done in Azerbaijan, Kazakhstan, Uzbekistan, Kyrgyz, Egypt, Jordan, higher than Armenia & Moldova this may due to sample size & study area difference. Similar study in Sierra Leone among the 185 subjects, majority (89.2%) had heard about anemia. Which is comparable to our study, 68.1% recognized lack of iron in food as the cause for anemia, which is low in our study. About 69.7% pointed that consuming iron rich foods could prevent anemia, in our study it is less. Conclusion and Recommendation : according to our study the prevalence of IDA were low, this may related to most had knew, had positive attitude and practice method use to prevent iron deficiency anemia. But there were 32% with IDA so to prevent this strengthens health education, involve private health institution & husbands of the pregnant mothers, health facilities & stakeholders should to work on increasing the awareness, positive perception & skill on prevention of IDA. Keywords : Knowledge , Attitude , Practice , Anemia DOI : 10.7176/JMPB/53-02 Publication date :March 31 st 2019

Knowledge, Attitude and Practiceon Prevention of Iron Deficiency Anemia Among Pregnant Women Attending Ante Natal Care Unitat Public Hospitals of Harar Town, Eastern Ethiopia

Background: Globally, the most common cause of anemia is iron deficiency, which is responsible for about half of anemia cases in pregnancy, and it is estimated that in developed countries 38% of pregnant women have iron depletion. In developing countries, the major causes of anemia in pregnancy are nutritional deficiencies, parasitic infestations, HIV infection, hemorrhage and some chronic medical disorders like renal and hepatic diseases. Recent statistics indicate that anemia affects 57% of pregnant women globally with the highest prevalence in sub-Saharan Africa. Anemia is an indicator of nutritional deficiencies that significantly contribute to birth defects, preterm labour and low birth weight, hence it causes global public health problem. Objectives:- To assess knowledge, attitude and practice on prevention of Iron deficiency anemia among pregnant women attending ante-natal care unit at public Hospitals of Harar town, eastern Ethiopia from March, 12 - April 06, 2018. Method:- The study was done in Harar town on the public hospitals from March 12-April 12, 2018. The study design was institutional based cross sectional study. By using a single population formula & by making a correction formula our sample size was 128, which the pregnant women was select by simple random sampling from each Hospitals after proportional allocated based on the total sample size. The data was collected using close ended semi-structured questioners by trained 4 diploma nurses with 1 supervisor. For processing & analyzing SPSS version 20 was used & the data were presented by table, graph & chart using frequency & percentage of the results. Discussion: In our study the prevalence anemia shows 32% which indicate less than study done in Azerbaijan, Kazakhstan, Uzbekistan, Kyrgyz, Egypt, Jordan, higher than Armenia & Moldova this may due to sample size & study area difference. Similar study in Sierra Leone among the 185 subjects, majority (89.2%) had heard about anemia. Which is comparable to our study, 68.1% recognized lack of iron in food as the cause for anemia, which is low in our study. About 69.7% pointed that consuming iron rich foods could prevent anemia, in our study it is less. Conclusion: according to our study the prevalence of IDA were low, this may related to most had knew, had positive attitude and practice method use to prevent iron deficiency anemia.

Comparative Efficacy between Intravenous Iron and Oral Iron on Enhancing Hemoglobin Level among Pregnant Women with Iron Deficiency Anemia in Low and Middle Income Countries: A Meta-Analysis

Background: Iron deficiency was a major cause of anemia in pregnancy. The incidence of large de­ficiency anemia was mostly experienced in pregnancy which can result in general hematological disorders with considerable complications both for the mother and the fetus. This study aimed to com­pare the efficacy of intravenous iron administration and oral iron for the treatment of iron de­fi­ci­ency anemia in pregnancy. Subjects and Method: This was a meta-analysis conducted using PRISMA systematic guide­li­nes. The process of searching articles was carried out between 2000 and 2018 using a database se­arch engine consisting of; PubMed, Science Direct, Springer Link, and Google Scholar. Based on da­tabase searches, nine articles that met the Randomized Control Trial (RCT) criteria and study we­re conducted in lower middle income countries. This study involved 967 samples divided into two groups of 484 intravenous iron and 483 oral iron. The analysis was carried out with Review Ma­nager (RevMan) software 5.3. The results were assessed for Mean Difference (MD) and the analysis was carried out for heterogeneity. Results: There was a high heterogeneity between experiments (I 2 = 91%; p <0.001) so that Ran­dom Effects Model (REM) was used. Intravenous iron administration can increase hemoglobin levels 0.70 g / dL higher than oral iron administration, and it was statistically significant (MD 0.70; 95 % CI: 0.37 to 1.02; p<0.001). Conclusion: Intravenous iron administration was more effective than oral iron for the treatment of iron deficiency anemia in pregnancy. Pregnant women given intravenous iron more quickly reach the desired hemoglobin level target than oral iron. Keywords : anemia, iron deficiency, intravenous iron, oral iron, meta-analysis Correspondence : Fiki Cahya Ningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ningrum.fiki@gmail.com. Mobile: 081­216494956. Indonesian Journal of Medicine (2019), 4(2): 135-144 https://doi.org/10.26911/theijmed.2019.04.02.07

Might high body mass index contribute to anemia in pregnancy in malaria-endemic areas?

Background: Anemia in pregnancy has remained a public health challenge in the developing countries. The emerging epidemiological and nutritional transitions as well as the decrease in malaria burden make investigating other causes of anemia imperative. We hypothesized that high body mass index (BMI) might contribute to anemia in pregnancy in malaria-endemic regions. Materials and Methods: Using a two-stage sampling technique, we interviewed 338 pregnant women and antenatal care attendees at primary health-care centers in Ibadan, Oyo State. Blood and stool samples were collected from all the study participants. Thick and thin blood films were prepared for the identification of malaria parasite while Kato–Katz technique was used for quantification soil-transmitted helminthes in the stool samples. Multivariate logistic regression analysis was performed to assess the association between malaria and high BMI with anemia while controlling for the established causes of anemia in pregnancy. Results: The prevalence of anemia was 47.9%. About half, 50.8% of the study population had normal weight while 43.8% were overweight/obese. Malaria (AOR 2.54 and 95% CI: 1.40 - 4.61), gestational age (AOR: 1.96 and 95% CI: 1.18–3.25), and being overweight/obese (AOR: 1.96 and 95% CI: 1.18–3.25) were associated with anemia in pregnancy. Conclusion: Malaria remains a significant cause of anemia in pregnancy, but the association between BMI and anemia will require further investigation among the Nigerian pregnant population.

Effect of treatment with single total-dose intravenous iron versus daily oral iron(III)-hydroxide polymaltose on moderate puerperal iron-deficiency anemia.

BackgroundIron-deficiency anemia is the most common nutritional cause of anemia in pregnancy and is often responsible for puerperal anemia. Puerperal anemia can impair postpartum maternal and neonatal well-being.ObjectiveTo determine the effect of treatment of moderate puerperal iron-deficiency anemia using a single intravenous total-dose iron dextran versus daily single dose oral iron(III)-hydroxide polymaltose.MethodologyA randomized controlled study in which postpartum women with moderate iron-deficiency anemia were randomized into treatment with either a single total-dose intravenous iron dextran or with daily single doses of oral iron(III)-hydroxide polymaltose tablets for 6 weeks. Effects on hemoglobin concentration using either method were compared at 6 weeks postpartum. Analysis was per protocol using SPSS version 17 for windows. P-values ≤0.05 were considered significant.ResultsTwo hundred eighty-four women were recruited for the study: 142 women received single total dose intravenous infusion of iron dextran while 142 received daily oral iron(III)-hydroxide polymaltose tablets. Approximately 84.0% (237/282) completed the study and were analyzed including 81% (115/142) of those randomized to injectable iron therapy compared to 85.9% (122/142) of those randomized to oral treatment. The proportions of women who had attained hemoglobin concentration of at least 10 g/dL by the 6 weeks postpartum visit did not differ significantly between cases and controls (95.7% vs 94.3%; P=0.73). Similarly, the mean increases in hemoglobin following either therapeutic route were comparable (1.03±0.56 g/dL for intravenous iron and 0.97±0.46 g/dL for the oral group; P=0.42).ConclusionSingle total-dose intravenous iron for treatment of puerperal iron-deficiency anemia was as effective as daily single doses of ferric iron tablets. For puerperal patients with iron-deficiency anemia in whom compliance with and tolerability of oral iron are not certain, a single total-dose intravenous iron can be safely offered.

Hematologic features among anemic Cameroonian pregnant women: a cross sectional study.

IntroductionIron deficiency anemia is the leading cause of anemia worldwide. It may also be the leading cause of anemia in pregnancy, although this has not yet been demonstrated in our country. The aim of the study was to describe hematologic features of Cameroonian anemic pregnant women.MethodsThis cross sectional analytical study was carried out in the maternity of the Yaoundé University Teaching Hospital, Cameroon, from March 1st, 2011 to February 28th, 2013. Two hundred women with singleton pregnancies and Hb concentration at booking <10 g/dl were recruited. Main variables recorded were maternal age, parity, marital status, gestational age, Hb concentration, blood group, Hb electrophoresis, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), pack cell volume (PCV). Data were analyzed using SPSS 18.0. P<0.05 was considered statistically significant.ResultsFigures for 110 women (55%) showed microcytosis, hypochromia was observed in 122 (61%) women and megaloblastic anemia in eight women (4%). Thrombopenia was observed in 16 women (8%) and thrombocytosis in six women (3%). Anemia was microcytic hypochromic in 110 women (55%), megaloblastic in eight women (4%), normocytic hypochromic in 12 women (6%), and normocytic normochromic in 70 women (35%).ConclusionHematologic features of Cameroonian anemic pregnant women showed that although iron deficiency anemia is the leading cause of anemia, megaloblastic anemia is also present in our environment. A normal hematologic feature in more than the third of women shows that the cause of anemia is not always nutritional.

Anemia in Pregnancy

Anemia is the commonest hematological disorder that occurs in pregnancy. According to the recent standard laid down by ‘WHO’, anemia is present when the Hemoglobin (Hb) concentration in the peripheral blood is 11 gm/dl or less. The most common cause of anemia in pregnancy is lack of iron. Less often, it is caused by folic acid deficiency. In some populations, 80% of pregnant women are anemic. Those most at risk are women from low socio-economic groups and teenagers. Anemia is diagnosed by estimating the hemoglobin concentration and examining a peripheral blood smear for the characteristic red blood cell changes. Iron and folate supplementation is indicated during pregnancy to prevent the complications. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21314 Medicine Today 2014 Vol.26(1): 49-52

Anemia during the Pregnancy: The Management and Outcomes Depending on the Etiology

Background: Anemia is the most common hematological abnormality in pregnant women. The main cause of anemia in pregnancy and puerperium is the deficiency of iron. Iron requirements increase during pregnancy, and a failure to maintain sufficient levels of iron may result in adverse maternal-fetal consequences. Antenatal iron deficiency anemia (IDA) must be adequately and safely treated to avoid complications during the pregnancy. Other causes of anemia in pregnancy require early diagnosis and precise therapy.Aim. Establishment of algorithms for management of pregnancy, delivery and postpartum period in different types of anemia is crucial to pregnancy outcomes. We have been optimizing strategies for the management of pregnant patients with anemia.Results: From 2012 to 2014 we observed 1284 pregnant women aged 19-44 years. 312(24,3%) of them had decreased hemoglobin (Hb) during the pregnancy. IDA was diagnosed in 267(85,6%), myeloprolyferative neoplasms (MPN) –18(5,8%), hemoglobinopathies –7(2,2%), hematological malignancies (MHD) in remission –6(1,9%), folic acid or B12 deficiency –5(1,6%), paroxysmal nocturnal hemoglobinuria (PNH) –4(1,3%), aplastic anemia (AA) –3 (1%), myelodysplastic syndrome (MDS) –2(0,6%). Hb level was below 90 g/l in 58(18,6%) patients. The most of anemia cases were identified during the pregnancy -187(59,9%), others existed before that. For IDA diagnosis we used the serum ferritin level, ratio of serum iron and total iron-binding capacity and transferrin. 88 (33%) of IDA patients had already had IDA during their lifespan. IDA was treated with ferric carboxymaltose intravenously weekly after the first trimester of pregnancy in Hb up to 90 g/l (the course summary dose –1500-2000 mg). In other cases we administered ferric (III) hydroxide polymaltosate per os (100-200 mg daily during 1-3 months). Hb was normalized by delivery in 216 (80,9%) patients. We have analyzed the outcomes of pregnancy in IDA. The most common complaint was impaired physical performance (91%). Spontaneous miscarriages were registered in 2(0,8%) cases. We did not observe a neonatal mortality. 242 (90,6%) pregnancies ended up with a birth of full-term healthy infants without birth defects. Preterm birth occurred in 23(8,6%) cases, IDA persisted in 19 (82,6%) of them. 38(14,3%) of patients with IDA in third trimester reported maternal and fetal complications, such as chronic placental insufficiency (36,8%), fetal growth retardation syndrome and low birth weight for gestational age (57,9%), placental abruption (5,3%), postpartum hemorrhage (10,5%). IDA was diagnosed in 14(5,3%) neonates and 26(9,8%) women noted the reduced lactation. Anemia in postpartum period was registered in 43(16,2%) patients. Also we have analyzed outcomes of 44 pregnancies in women with non-IDA anemia. The majority of them were patients remained in complete or partial remission of MHD, MPN, AA, PNH, MDS, who underwent the special treatment. Some of them required special treatment during the pregnancy (interferon in MPN, eculizumab in PNH). The non-severe types of hemoglobinopathies required observation and supportive care until postpartum period. Macrocytic anemia with folic or B12 deficiency was successfully treated with folic acid or cyanocobàlamin. The level of Hb by delivery was below 110 g/l in 32(72,7%) non-IDA women (blood transfusion required 2 patients). 40(90,9%) of pregnancies ended up with a birth of full-term infants. Preterm birth occurred in 4(9,1%) cases. In our study exposure to special therapy was not associated with congenital anomalies, and no spontaneous miscarriages were registered. The fetal growth retardation syndrome and low birth weight registered in 3(6,8%) patients. No hemorrhagic complications during labor or postpartum period have been observed.Conclusion: Despite the regular antenatal observation, maternal anemia is still high. Anemia during pregnancy is a diverse group of disorders with varied pathophysiology, treatment options and overall prognosis. IDA is the most frequent anemia reason. We have concluded that the prognosis for pregnant women timely treated for IDA is similar to that of healthy women. Mothers with persistent IDA reported different pregnancy complications. The modern IDA treatment approaches allow the majority of patients to achieve the effect in shortest time. Another anemia reasons require diagnosis and special treatment of underlying disease. DisclosuresNo relevant conflicts of interest to declare.

Evaluation of Hematological Parameters of Sudanese Pregnant Women attending at Omdurman Al Saudi Maternity Hospital

Background: There are subtle and substantial changes in hematological parameters during pregnancy and the puerperium total blood volume increases by about 1.5 liter mainly to supply the needs of the new vascular bed(Taylor, 1979). Pregnant places extreme stresses on the hematological system and understanding of the physiological changes that result as obligatory in order to interpret any need for therapeutic intervention. (William and Cindy 2005). Iron deficiency is the most common cause of anemia in pregnancy (Odekule 2010). As consequences various quantitative and qualitative hematological changes occur during pregnancy including cell counts, hemoglobin levels, hematocit, leucocytes, thrombocytes, red blood cells indices, morphological changes and reticulocyte production index. (Lewis et al. 2001). Methods: This a case control study in which 100 pregnant women were enrolled as study group and 50 non pregnant healthy women as control subjects. The study was conducted at Omdurman Al Saudi Maternity Hospital in period from 5/3/ 2011 to 6/6/ 2011 to evaluate hematological parameters of Sudanese pregnant and to establish classification of anemia’s on bases of complete blood count (CBC), reticulocyte production index (RPI) and peripheral blood picture. Results: The study revealed that there were significant decreased in RBCs count, hemoglobin (Hb) and packed cell volume (PCV) of pregnant women compared to non pregnant women (P value <0.05) and significant decreased in mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) of pregnant women (P value <0.05). TWBCs count was increased significantly (P. value < 0.050) in contrast platelets count significantly lower than the normal control (P. value <0.05). On bases of blood picture we classified anemia’s of pregnancy as normocytic normochromic 37 (37%) with RPI mean value of 0.49±0.2, microcytic hypochromic 52(52%) with RPI mean value of 0.76±0.6, and dimorphic picture11 (11%) with RPI of mean value 2.1±0.8. Conclusion: We observed significant decreased in RBC count, hemoglobin, PCV, red cell indices and platelet count during pregnancy and significant increased in leukocyte count of pregnant women when compared to non pregnant women. We found the most common type of anemia among Sudanese pregnant women is microcytic hypochromic type and likely to be of iron deficiency second class is normocytic normochromic type, and less of occurrence type is dimorphic picture types with increased reticulocyte production index results from prophylaxes iron response.

PM.78 Use of Intravenous Iron Sucrose Injections in the Treatment of Iron Deficiency Anaemia in Pregnancy

Background Iron deficiency anaemia (IDA) is the commonest cause of anaemia in pregnancy affecting 19% of the Leeds pregnant population1. It is associated with maternal morbidity including fatigue and postpartum...