Effect Of Maternal Anemia Research Articles

The effect of maternal anemia on maternal and neonatal outcomes in twin pregnancies

Objective: The objective of this study is to investigate the effect of second trimester anemia on maternal and perinatal outcomes in twin pregnancies. Methods: A retrospective population-based study was conducted, comparing maternal and neonatal outcomes in women carrying twins, with second trimester anemia (defined as hemoglobin < 10 g/dl) to those without anemia (defined as hemoglobin > or equal to 10 g/dl). Deliveries occurred in a tertiary medical center in 2013. Results: During the study period, there were 307 twin deliveries. Hemoglobin levels were available for 247 (80.4%) twins; 66 (26.7%) of these had anemia (<10 g/dl) during the second trimester. Women with second trimester anemia had a higher parity (p= 0.03), and needed more blood transfusions than those with hemoglobin level > or equal to 10 g/dl (OR = 1.6; 95% CI 1.11–2.43, p < 0.001). No significant differences were noted between the groups regarding other obstetrical outcomes or regarding perinatal outcomes. Conclusion: Second trimester anemia in women carrying twins is associated with a high parity and increases the risk for blood transfusions. However, in our population, maternal anemia in twin gestations does not increase the risk for adverse perinatal outcome.

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Timing of umbilical cord-clamping and infant anaemia: the role of maternal anaemia

Background: Evidence from randomized controlled trials has shown that delayed cord-clamping is beneficial to infant iron status. The role of maternal anaemia in this relationship, however, has not been established.Objective: To determine the effect of maternal anaemia at delivery on the association between timing of umbilical cord-clamping and infant anaemia at 4 and 8 months of age.Methods: A cohort of pregnant women admitted to the labour room of Hospital Iquitos (Iquitos, Peru) and their newborns were recruited into the study during two time periods (18 May to 3 June and 6–20 July 2009). Between the two recruitment periods, the hospital’s policy changed from early to delayed umbilical cord-clamping. Maternal haemoglobin levels were measured before delivery, and the time between delivery and cord-clamping was recorded at delivery for the entire cohort. Mother–infant pairs were followed-up at 4 (n = 207) and 8 months (n = 184) post partum. Infant haemoglobin levels were measured at follow-up visits. Data were analysed using logistic regression models.Results: The prevalence of maternal anaemia (Hb <11·0 g/dl) at delivery was 22%. Infant haemoglobin levels at 4 and 8 months of age were 10·4 g/dl and 10·3 g/dl, respectively. Infant haemoglobin levels did not differ significantly between infants born to anaemic mothers and those born to non-anaemic mothers at either 4 or 8 months of age. However, the association between the timing of cord-clamping and infant anaemia was modified by the mother’s anaemia status. Significant benefits of delayed cord-clamping in preventing anaemia were found in infants born to anaemic mothers at both 4 months (aOR = 0·59, 95% CI 0·36–0·99) and 8 months (aOR = 0·38, 95% CI 0·19–0·76) of age.Conclusion: The study contributes additional evidence in support of delayed cord-clamping. This intervention is likely to have most public health impact in areas with a high prevalence of anaemia during pregnancy.

Anemia in pregnancy and its association with pregnancy outcomes in the Arctic Russian town of Monchegorsk, 1973–2002

Objectives. The purpose of this study was to determine the prevalence of anemia in pregnancy in Monchegorsk, north-west Russia, and to analyse its association with birth weight and the risk of stillbirth and preterm birth.Study design. A registry study based on the Kola Birth Registry. Methods. A total of 24,525 women who gave birth in Monchegorsk between 1973 and 2002 and who had data on anemia in pregnancy in the Kola Birth Registry (KBR) were included in the study. For these women, data on maternal anemia, age, occupation, marital status, parity, smoking, alcohol, gestational age, birth weight, stillbirth and year of delivery were obtained from the KBR. Linear regression was used to study the effect of maternal anemia on birth weight. Logistic regression was used to estimate the effect of anemia on the risks of stillbirth and preterm birth, with adjustment for the above-mentioned characteristics. Crude and adjusted odds ratios (OR) were calculated.Results. The prevalence of anemia increased from 43.7% in the 1970s to 89.8% in the beginning of the 2000s. Infants born to women with anemia were 48 grams (95% CI 36, 59) heavier than infants of non-anemic women. Women with anemia in pregnancy were less likely to have stillbirths (OR=0.68; 95% CI 0.52, 0.89) and preterm births (OR=0.66; 95% CI 0.58, 0.75) after adjustment for potential confounders.Conclusion. The prevalence of anemia in pregnant women as defined by the KBR more than doubled during the 30-year period. Positive associations with birth weight and negative associations with the risk of stillbirth and live preterm birth were observed.

EFFECT OF MATERNAL ANEMIA AT HIGH ALTITUDE ON INFANT HEMATOCRIT AND OXYGENATION

Hematocrit levels were determined in 36 mothers living at high altitudes (3,750 meters) and their infant cord bloods to determine the effect of maternal anemia on the infant. The arterial oxygen saturation (SaO(2)) and respiratory rate of the infants were also followed during the first four months of life. There was a negative correlation between maternal hematocrit and infant hematocrit (r(s) = - 0.57). Nineteen babies born to anemic women (hematocrit < 41%) had a significantly higher mean hematocrit (59.9%) than those born to non-anemic mothers (55.8%; P = 0.003). The SaO(2) levels and respiratory rates of infants were not different between infants born to non-anemic and anemic mothers. At high altitudes, infants from mothers with anemia have higher hematocrits than those born to non-anemic mothers.

The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin, hemoglobin and ferritin levels in mothers and newborns

Objective: Maternal and fetal serum erythropoietin levels were correlated with hemoglobin, mean corpuscular volume and serum ferritin in a group of anemic pregnant women to evaluate the effect ofmaternal anemia on fetal erythropoiesis.Methods: Serum erythropoietin, ferritin, hemoglobin and mean corpuscular volume were investigated in 33 pregnant women with anemia, 11 women with normalhematological parameters and in their newborns.Results: Maternal serum erythropoietin concentration (mean ± SEM) was significantly higher in the anemic group (145.2 ± 42.9 mU/ml)as compared to the control group (37.3 ± 7.6 mU/ml) (p < 0.05). In newborns, all parameters were comparable in both groups except cord serum erythropoietin concentration (mean ±SEM) which was significantly higher in newborns born to anemic women (43.9 ± 5.3 mU/ml) than controls (29.4 ± 3.7 mU/ml) (p < 0.05). In the anemic group, maternal serum erythropoietinwas inversely correlated to maternal hemoglobin (r = -0.375, p = 0.03), maternal hemoglobin was inversely correlated to cord serum erythropoietin (r = -0.552, p = 0.001) and maternalferritin was correlated to fetal ferritin (r = 0.521, p = 0.002).Conclusion: Although cord hemoglobin and mean corpuscular volume were not affected by maternal anemia, increasedcord serum erythropoietin levels related to low maternal hemoglobin levels suggest an induced fetal erythropoiesis in maternal anemia.

The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight

To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure. Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women. John Radcliffe Hospital, Oxford. 8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts. Placental weight and the ratio of placental weight to birthweight. Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight. Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.

Effect of maternal anaemia and iron depletion on foetal iron stores, birthweight and gestation.

Effect of maternal anaemia and iron depletion on foetal iron stores, birthweight and gestation.

Effects of Maternal Anemia on Uteroplacental and Fetal Oxidative Metabolism in Sheep

We studied the effects of acute isovolemic maternal anemia on several variables of uterine and fetal oxygenation to answer these two questions: (1) Does maternal anemia cause reductions in oxygen delivery to the uterus, placenta, and fetus? (2) If so, what is the impact of such reductions on fetal oxidative metabolism? In 15 chronically catheterized pregnant sheep and fetal lambs, we measured uterine and umbilical blood flows and uterine and fetal oxygen deliveries, oxygen extractions, and oxygen consumptions at various, randomly selected maternal hematocrits ranging from 30% to 8%. We altered maternal hematocrit by performing isovolemic exchange transfusions with plasma or packed red blood cells. Uterine and umbilical blood flows were measured with the radionuclide-labeled microsphere technique, and the variables of oxygenation were calculated with modifications of the Fick principle. Decreases in maternal hematocrit led to linear reductions in oxygen delivery to the uterus, placenta, and fetus. Despite reductions in oxygen delivery of up to 50%, fetal oxygen consumption was maintained, because of compensatory increases in oxygen extraction. When hematocrit (and thus fetal oxygen delivery) was reduced by more than 50%, fetal oxygen consumption and the arterial blood base excess both decreased, indicating that, at these hematocrit levels, the supply of oxygen to fetal tissues was inadequate for the demands for oxygen by these tissues.

Effects of maternal anemia on cardiac output, systemic oxygen consumption, and regional blood flow in pregnant sheep

We measured regional blood flows and cardiac output and calculated regional oxygen deliveries (blood flow × arterial blood oxygen concentration) and systemic oxygen delivery, oxygen extraction, and oxygen consumption as maternal hematocrit was varied randomly between 31% and 8% by exchange transfusion with plasma or packed sheep red blood cells. We observed three patterns of response: (1) In the heart, brain, and adrenal glands, oxygen delivery was constant or nearly constant over the range of hematocrits studied; (2) in the kidneys, splanchnic organs, and uteroplacental tissues, oxygen delivery was a linear function of hematocrit; (3) in the carcass tissues, oxygen delivery decreased slowly as hematocrits were reduced from 31% to 15% and dropped rapidly at hematocrits ≤15%. Systemic oxygen consumption was maintained at normal levels, despite reductions in hematocrit to about 15%, because oxygen extraction increased as compensation. At lower hematocrits, systemic oxygen consumption fell in association with a metabolic acidemia, suggesting that, with this severity of acute anemia, oxygen supply to some tissues in the pregnant sheep was inadequate for tissue metabolic demands.

Effects of maternal anemia on uteroplacental and fetal oxidative metabolism in sheep

We studied the effects of acute isovolemic maternal anemia on several variables of uterine and fetal oxygenation to answer these two questions: (1) Does maternal anemia cause reductions in oxygen delivery to the uterus, placenta, and fetus? (2) If so, what is the impact of such reductions on fetal oxidative metabolism? In 15 chronically catheterized pregnant sheep and fetal lambs, we measured uterine and umbilical blood flows and uterine and fetal oxygen deliveries, oxygen extractions, and oxygen consumptions at various, randomly selected maternal hematocrits ranging from 30% to 8%. We altered maternal hematocrit by performing isovolemic exchange transfusions with plasma or packed red blood cells. Uterine and umbilical blood flows were measured with the radionuclide-labeled microsphere technique, and the variables of oxygenation were calculated with modifications of the Fick principle. Decreases in maternal hematocrit led to linear reductions in oxygen delivery to the uterus, placenta, and fetus. Despite reductions in oxygen delivery of up to 50%, fetal oxygen consumption was maintained, because of compensatory increases in oxygen extraction. When hematocrit (and thus fetal oxygen delivery) was reduced by more than 50%, fetal oxygen consumption and the arterial blood base excess both decreased, indicating that, at these hematocrit levels, the supply of oxygen to fetal tissues was inadequate for the demands for oxygen by these tissues.

Severe anaemia in pregnancy (as seen in Kuala Lumpur, Malaysia).

Nutritional anemia is common and is found particularly among pregnant women in Malaysia as in other developing countries. Over the 1953-1962 period 73048 women were treated in the Maternity Hospital at Kuala Lumpur Malaysia; 2250 or 3.1% of this group had severe anemia. One half 1066 were investigated fully. In the remainder an accurate diagnosis was not made before treatment was instituted and the type of anemia was classified as unknown. Of those investigated fully normoblastic iron deficiency anemia was found in 676 (64%) and megaloblastic anemia was found in 373 (35%). The megaloblastic anemia was invariably associated with an iron deficiency anemia and the more severe the anemia the higher was the proportion with a megaloblastic crythropoiesis. The mortality of anemic mothers was significantly higher (15.5/1000) than those with no anemia (3.5/1000). The effects of maternal anemia on the fetus were considerable and include the following: the prematurity rate among infants of anemic mothers was 18.1% 3 times that of infants born to nonanemic mothers; the perinatal loss in the anemic mother was 13.1% twice that of the nonanemic mother (6.8%); and the stillbirth rate among infants born to anemic mothers was 91.0/1000 compared with a rate of 15.7/1000 among infants born to nonanemic mothers. The findings indicate the seriousness of severe anemia in pregnancy. Etiological factors are considered since this will be the basis of rational therapy. Iron deficiency anemia may develop for several reasons. There is usually a dietary deficiency of iron and there may also be a lowered absorption from the gut. Also there may be excessive blood loss due to hookworm and menorrhagia and there are the demands of repeated childbearing. Apart from hookworm infestation insufficient dietary intake of iron was the principal cause of anemia among the women in the study with iron deficiency anemia. Among the women with megatoblastic anemia folic acid was the prime deficiency leading to this type of anemia. The anemia was aggravated by increasing malnutrition as demonstrated by diminished serum albumin and globulin concentration. The diagnosis of severe iron deficiency anemia was made by estimation of the hemoglobin concentration supplemented in some cases by serum iron studies. Megaloblastic anemia in pregnancy can only be diagnosed with accuracy by a bone marrow smear. Consideration of the etiology of anemia in Malaysia led to a standard treatment among the pregnant women studies. The treatment approach is reviewed in detail.