Iron Deficiency Anemia In Pregnant Women Research Articles

Особенности беременности и родов у женщин с железодефицитной анемией

Aim. To study the features of the course of pregnancy, childbirth and the postpartum period in patients with iron deficiency anemia (IDA) with and without the use of iron supplements. Design. Retrospective case-control study. Materials and methods. A clinical and statistical analysis of exchange charts and birth histories of women was carried out at the clinical sites of the Department of Obstetrics and Gynecology with the course of perinatology of the Medical Institute of the Patrice Lumumba People's Friendship University of Russia. Pregnant women with IDA (n = 80) were divided into two groups: the 1st (n = 30) included patients who did not take iron supplements, the 2nd (n = 50) included women who received iron supplements after the diagnosis of IDA. Anthropometric, anamnestic, clinical and laboratory data of patients, features of the course of pregnancy, childbirth and the postpartum period were studied. Results. In patients of the 2nd group at the time of detection of IDA, lower levels of hemoglobin, erythrocytes and hematocrit were detected. However, against the background of timely initiation of iron supplementation, women in this group showed statistically significantly better indicators compared to patients who refused to take anti-anemic therapy: lower levels of blood loss during childbirth (p < 0.05), lower odds of hypotonic bleeding (odds ratio (OR) = 4.246; 95% confidence interval (CI) — 1.370–13.155) and obstetric perineal trauma (OR = 4.529; 95% CI — 1.707–12.018), Conclusion. The course of pregnancy, childbirth and the postpartum period in patients with IDA depends on timely treatment. Prescribing iron supplements for IDA in pregnant women helps reduce the frequency of threatened premature births, reduce the risks of pathological blood loss, uterine hypotension during childbirth and in the early postpartum period, as well as obstetric perineal trauma. The elasticity of tissues, in particular the perineum, in women with IDA after the use of iron supplements and normalization of hemoglobin levels corresponds to normal parameters, in contrast to postpartum women who did not receive iron supplements. Key words: iron deficiency anemia, pregnancy, childbirth, complications.

Role of parenteral iron sucrose in the treatment of iron-deficiency anemia in pregnant women of gestational age 20–34 weeks

Role of parenteral iron sucrose in the treatment of iron-deficiency anemia in pregnant women of gestational age 20–34 weeks

Prevalence of iron-deficiency anemia in pregnant women with various thalassemia genotypes: Thoughts on iron supplementation in pregnant women with thalassemia genes.

There are limited studies on iron-deficiency anemia (IDA) in carriers of various thalassemia genotypes. However, for pregnant women (PW) with high iron demand, ignoring the phenomenon of carrying the thalassemia genes combined with IDA may lead to adverse pregnancy outcomes. The hematological phenotype indexes of 15,051 PW who received a prenatal diagnosis of thalassemia in our hospital were analyzed, and the plasma ferritin (PF) of 714 anemic pregnant women (APW) was determined. The results showed that 87.43% of APW without thalassemia suffered from IDA. Among APW with various thalassemia genotypes, we found that 40.00∼77.78% of subjects with α-thalassemia silent genotypes [αCS (or QS)α/αα (40.00%), -α3.7(or 4.2)/αα (57.65%), and αWSα/αα (77.78%)] and 18.18∼84.21% of subjects with α-thalassemia minor genotypes [αCS (or QS)α/-α3.7(or 4.2) (18.18%), -α3.7(or 4.2)/-α3.7(or 4.2) (40.00%), αα/-SEA (44.55%), and αWSα/-α3.7(or 4.2) (84.21%)] developed IDA, while in subjects with α-thalassemia intermedia genotypes, only αWSα/-SEA was associated with IDA, with an incidence of 16.67%. However, the incidence of IDA in APW with common β-thalassemia minor genotypes (βCD17(A>T)/β, βCD41/42 (-TTCT)/β, βCD71/72(+A)/β, βIVS-II-654(C>T)/β, and β-28(A>G)/β) was less than 10.85%. In addition, the APW with β-thalassemia minor had a higher PF level than the APW without thalassemia. Our study is the first to reveal differences in the prevalence of IDA among PW with various thalassemia genotypes, indicating that the possibility of IDA should be fully considered when managing PW with α-thalassemia silent or minor genotypes in high-risk areas, and that iron supplementation should be monitored dynamically for PW with β-thalassemia minor genotypes.

Prevalence of iron deficiency anemia in pregnancy and its therapeutic response to treatment: a retrospective audit in a tertiary hospital

Background: Iron deficiency anemia is the commonest type of nutritional anemia seen during pregnancy. Despite implementing oral iron prophylaxis in pregnancy, IDA in pregnant women constitute a major health problem. The present study aims to look at the prevalence of IDA in a pregnant population in Seremban, Malaysia and their response to treatment.Methods: This is a retrospective study looking into the prevalence of iron deficiency anaemia among pregnant women who delivered between October 2019 to March 2020 in a state hospital in Seremban, Malaysia and their response to treatment. Main outcome measures were the prevalence of iron deficiency anaemia, associated demographic and clinical factors and response to iron therapy. Results: About 920 patients’ records were included for analysis. The prevalence of anaemia in this cohort was 42.8% (N=394). The prevalence of iron deficiency anemia (IDA) was 31.5% (N=124) among the anemic patients or 13.5% of the studied population. The mean hemoglobin level for this group was 10.0±0.74 g/dl (6.8-10.9 g/dl) and majority had mild anemia (91.9%, N=114). 68.5% IDA patients were successfully treated by 36 weeks pregnancy. Of the remaining 39 patients who were still anemic, 37 (94.9%) had mild anemia with mean hemoglobin level of 10.3g/dl (SD 0.48, range 9.0-10.9 g/dl). Conclusion: Current treatment strategy is inadequate to achieve the set national target. There is a role for an early recourse to parenteral iron therapy to improve treatment outcome.

Altered fecal microbial and metabolic profile reveals potential mechanisms underlying iron deficiency anemia in pregnant women in China.

The gut microbiome and its metabolism may provide crucial insight into the cause of iron deficiency anemia (IDA) in pregnant women. This study aimed to investigate the effect of the gut microbiome and its related metabolites on pregnant women with iron deficiency (ID) and IDA. Maternal cubital venous blood and stool samples were collected from healthy control pregnant women (HC, non-anemic, n=10), pregnant women with ID non-anemia (ID, n=10), and IDA (n=10). All groups were subjected to fecal metagenomics and metabolomics. The composition and function of the gut microbiome were then compared in pregnant women with ID and IDA with HC after excluding the possibility of inflammation and insufficient iron absorption capacity. Whole-genome shotgun libraries were prepared by quantifying metagenomic DNA samples with Quant-iT PicoGreen dsDNA Assay. The levels of 41 microbial species, including 21 Streptococci and ten metabolites (catechol), which could serve as siderophores, were increased. In contrast, 3 Bacteroides and six metabolites were decreased in pregnant women with IDA (p<0.05). The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis indicated that the bio-pathways, including biosynthesis of siderophore group non-ribosomal peptides (p<0.01), ABC transporters (p<0.05) and membrane transport of the gut microbiota (p<0.01) in IDA patients were expressed differently compared with HC. Correlation analysis also indicates that these increased bacteria formed strong co-occurring relationships with metabolites in the occurrence and development of IDA in pregnant women. The current study identified that streptococci and catechol (fecal metabolite) were significantly increased in pregnant women with IDA. Therefore, adjusting the intestinal homeostasis using long-term living and eating habits on oral Streptococcus in pregnant women with IDA before iron supplementation may be more conducive to iron supplementation, thus providing novel therapies for IDA.

Effectiveness of Dietary Interventions in Prevention and Treatment of Iron-Deficiency Anemia in Pregnant Women: A Systematic Review of Randomized Controlled Trials.

Pregnant women are among the population groups most vulnerable to the development of anemia, as the overall iron requirement during pregnancy is significantly higher than in non-pregnant women. The aim of the systematic review was to assess the effectiveness of dietary interventions in the prevention and treatment of iron-deficiency anemia in pregnant women based on randomized-controlled trials. The systematic review was based on the PRISMA guidelines and is registered in the PROSPERO database (CRD42021261235). The search was conducted within PubMed and Web of Science databases for the period until June 2021. The included randomized controlled trials presented effectiveness of dietary interventions in prevention and treatment of iron-deficiency anemia in pregnant women. From the total number of 7825 screened records, the final number of seven studies were included in the systematic review. The procedure of screening, inclusion, reporting, and assessment of the risk of bias while using the revised Cochrane risk of bias tool for randomized trials was conducted by two independent researchers. The studies included in the systematic review were conducted in populations of anemic pregnant women, or mixed populations of anemic and non-anemic pregnant women. The interventions described within the studies were associated with including fortified products, regular products, or dietary counselling. They were based on providing an increased amount of iron, providing an increased amount of multiple nutrients, or general counselling only, while effectiveness was compared with effectiveness of the placebo, supplementation, or control group. The study duration was diversified from a few weeks to half a year or longer. The major biochemical measure assessed within the included studies was hemoglobin. All applied dietary interventions, based on providing increased amount of iron, providing increased amount of multiple nutrients, or general counselling only, were effective. The majority of included studies were assessed as ones of a medium risk of bias. For some studies a high risk of bias was indicated, which resulted from a risk of bias arising from the randomization process, due to deviations from the intended interventions, and in selection of the reported result. Considering this fact, more randomized controlled trials should be planned and conducted in a rigorous manner to confirm the formulated observations of effectiveness of the studied interventions based on providing an increased amount of iron, providing an increased amount of multiple nutrients, or general counselling only.

Iron deficiency anaemia in pregnancy and its prevention; paradigm changes over three decades

In Sri Lanka, the prevalence of anaemia in pregnancy was estimated to be approximately 29% in 2001 but is estimated to have significantly reduced to be &lt; 20%, at least in certain areas, during the last decade. Among its many causes, nutritional iron deficiency anaemia (IDA) is the commonest, but establishing a definitive diagnosis is difficult. Strategies adopted globally, as well as in Sri Lanka, to prevent IDA in pregnancy, have changed significantly during the last three decades. A comprehensive literature review was carried out and inter alia three relevant World Health Organization Guidelines, in which the author was a member of the guideline development group and six other publications of the author, on the topic of iron deficiency (ID) and IDA in pregnancy are included in this review. Ten studies on the detection and prevention of ID and IDA in pregnancy, carried out from 1990 to 2017 at the Academic Obstetrics and Gynaecology Unit (AOGU) of the Teaching Hospital Mahamodera, Galle (THMG) are described. The results and conclusions of these studies were: poor compliance and unsatisfactory methods of ingestion of the antenatal oral iron supplement could have contributed to the high rates of ID and IDA at term during the period 1990 to 1992; haematological indices during pregnancy need to be interpreted with caution; although the agreement between haematological indices obtained from different laboratories in Galle in 2000 was unsatisfactory, better agreement was observed in 2015; the rates of ID and IDA in pregnant women presenting for antenatal care to the AOGU of the THMG have significantly decreased from approximately 69% and 44% respectively in 1990 to approximately 37% and 17% respectively in 2015. Therefore, weekly antenatal oral iron supplements should be adequate to improve birth outcomes in the non-anaemic women attending this clinic.

Differential diagnosis of thalassemia and iron deficiency anemia in pregnant women using new formulas from multidimensional analysis of red blood cells.

BackgroundIron deficiency anemia (IDA) and thalassemia trait (TT) are the most common conditions of microcytic hypochromic anemia (MHA) in pregnant women. We used the BC-6800Plus analyzer to study the utility of erythrocyte and reticulocyte parameters for distinguishing TT from IDA in pregnant women.MethodsA total of 454 anemic pregnant women, including 340 with IDA, 66 with β-thalassemia trait (β-TT) and 48 with α-thalassemia trait (α-TT), were included. Multiple comparisons among groups were performed, and diagnostic performance of parameters was determined using receiver operating characteristic (ROC) curve analysis, with P<0.05 indicating statistical significance.ResultsReticulocyte production index (RPI) and the average volume of mature red blood cells (MCVm) in the IDA group were significantly higher than in the β-TT and α-TT groups. Red blood cell (RBC), reticulocyte percentage (Ret%), and RPI in the IDA group were significantly lower than in the α-TT and β-TT groups. We devised MHA 1=0.42× MCH −0.57× RPI −0.08× %MICROr −9.38 to distinguish IDA from α-TT. With a cut-off value of 0.61, the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.868, 90.9%, and 68.5%, respectively. We devised MHA 2=0.04× %MICROr +0.12× MCVm −13.76× Ret# −6.29 to distinguish IDA from β-TT. With a cut-off value of 0.55, the AUC, sensitivity, and specificity were 0.878, 81.3%, and 80.3%, respectively.ConclusionsErythrocyte indices and formulas can be used as initial methods for the differential diagnosis of TT and IDA. MHA 1 and MHA 2 were the most useful indices in the differential diagnosis of α-TT from IDA and β-TT from IDA in pregnant women.

Treatment of anemia using parenteral iron supplements

Background. Anemia occurs in 30 % of women of childbearing age worldwide. The main causes of iron deficiency and iron deficiency anemia (IDA) are the decrease in iron intake from food (vegetarian diet, unbalanced diet, anorexia, eating disorders), impaired iron absorption (celiac disease, malabsorption, concomitant digestive diseases, drug use), blood losses (menstrual bleeding, childbirth, surgery, gastrointestinal bleeding, blood donation), and the increased need for iron (children and adolescents, pregnancy and lactation, endurance exercise). In the 3rd trimester of pregnancy, the need for iron is almost 10 times higher than in the 1st trimester (7.5 vs. 0.8 mg per day).&#x0D; Objective. To describe the treatment of anemia with parenteral iron supplements.&#x0D; Materials and methods. Analysis of literature sources on this topic.&#x0D; Results and discussion. Hemoglobin content &lt;90 g/l increases the risk of miscarriage, low birth weight and gestational age, premature birth, preeclampsia and eclampsia. Low hematocrit (&lt;29 %) is accompanied by an increase in the probability of growth retardation and fetal death. On the part of the pregnant woman, tolerance to physical activity worsens, the probability of heart failure increases (in severe anemia), the condition of the thyroid gland and wound healing deteriorates. Among children born to mothers with IDA, the probability of IDA is higher than among children born to mothers with normal hemoglobin levels (47.2 % vs. 6.5 %; Colomer I. et al., 1990). Childbirth deepens IDA due to blood loss. During vaginal childbirth or cesarean section 300-500 ml of blood is lost, in case of profuse bleeding – 500-1000 ml, and in case of profuse bleeding, uterus atony, and in case of the disseminated intravascular coagulation – 2-3 L or even more. Iron supplements are prescribed for the treatment of IDA. They can be divided into oral (iron salts, iron complexes, elemental iron) and parenteral. Pregnant women are recommended to take 60 mg of iron per day from the beginning of gestation (as early as possible) until the end of pregnancy, as well as during the first 3 months of lactation. Oral iron preparations have a number of side effects: constipation, diarrhea, heartburn, nausea, and epigastric pain. This causes unsatisfactory adherence: one in five women stops taking iron supplements. Polymaltose iron complex is tolerated slightly better than iron sulfate. In case of intolerance to oral drugs, intravenous iron may be prescribed. Its advantages include fast action and good efficiency. Drugs for intravenous administration are divided into iron preparations and iron complexes with carbohydrates (carboxymaltose, sucrose, dextran). The sucrose complex of iron allows to reach the maximum level of hemoglobin much faster than iron sulfate (6.6 against 9.4 weeks). According to German and French guidelines for the treatment of anemia in pregnant women, if the hemoglobin is reduced to &lt;90 g/l, IDA should be treated with intravenous iron. In the recommendations of the Asia-Pacific region, the threshold value is 100 g/l.&#x0D; Conclusions. 1. Insufficient iron levels before pregnancy and the increased need in iron during pregnancy justify the proactive assessment and correction of IDA in pregnant women. 2. In case of moderate anemia and early stages of pregnancy, normal iron levels can be restored before delivery with the help of oral medications. 3. Intravenous iron supplements normalize iron levels faster than oral ones.

A few steps before ..., or how to protect a pregnant woman from iron deficiency and anemia. Literature review

The article presents modern data on the etiology, pathogenesis, diagnosis, prevention and treatment of iron deficiency anemia (IDA) and anemia of chronic disease, as well as their combination on the eve of and during pregnancy. The emphasis is made on the role of iron deficiency of any etiology in the development of obstetric and perinatal complications, especially its impact on the central nervous system formation and further psychophysical child development. Need for prevention of iron deficiency states in risk groups which includes all women of reproductive age who have menstruation is shown based on evidence-based medicine data. Effectiveness and safety of modern drugs containing iron in oral and parenteral forms has analyzed. The paper presents data on the safety and effectiveness of an innovative form of ferric iron in the form of liposomal iron, which differs in the mechanism of action, digestibility and the absence of side effects typical for this group of drugs.According to various authors the frequency of IDA in pregnant women ranges up to 80%, in puerperas up to 40%. It is unimpossible to stop IDA without iron supplementation only with an iron-rich diet. Two main groups of iron preparations are used to correct iron deficiency differing in the valence of iron atoms – bivalent iron salts and trivalent complexes. These drugs differ in the tolerability and bioavailability of atomic iron. Liposomal iron is a new drug for treatment of iron deficiency and IDA today; it has an innovative way of iron delivery to the body. Liposomal iron has advantages for the prevention of anemia in patients with anemia of chronic disease or its combination with IDA (inflammatory bowel diseases, obesity, after resection of the stomach and intestines, etc.). An innovative form of liposomal iron in Ukraine is represented by a dietary supplement Ferroview containing 30 mg of elemental iron, that is corresponds to the average prophylactic dose recommended in WHO documents

FOR A FEW STEPS TO..., OR HOW TO AVOID FOR IRON DEFICIENCY AT PREGNANCY. LITERATURE REVIEW

The article presents modern data on the etiology, pathogenesis, diagnosis, prevention and treatment of iron deficiency anemia (IDA) and anemia of chronic disease, as well as their combination on the eve of and during pregnancy. The emphasis is made on the role of iron deficiency of any etiology in the development of obstetric and perinatal complications, especially its impact on the central nervous system formation and further psychophysical child development. Need for prevention of iron deficiency states in risk groups which includes all women of reproductive age who have menstruation is shown based on evidence-based medicine data. Effectiveness and safety of modern drugs containing iron in oral and parenteral forms has analyzed. The paper presents data on the safety and effectiveness of an innovative form of ferric iron in the form of liposomal iron, which differs in the mechanism of action, digestibility and the absence of side effects typical for this group of drugs. According to various authors the frequency of IDA in pregnant women ranges up to 80%, in puerperas up to 40%. It is unimpossible to stop IDA without iron supplementation only with an iron-rich diet. Two main groups of iron preparations are used to correct iron deficiency differing in the valence of iron atoms – bivalent iron salts and trivalent complexes. These drugs differ in the tolerability and bioavailability of atomic iron. Liposomal iron is a new drug for treatment of iron deficiency and IDA today; it has an innovative way of iron delivery to the body. Liposomal iron has advantages for the prevention of anemia in patients with anemia of chronic disease or its combination with IDA (inflammatory bowel diseases, obesity, after resection of the stomach and intestines, etc.). An innovative form of liposomal iron in Ukraine is represented by a dietary supplement Ferroview containing 30 mg of elemental iron, that is corresponds to the average prophylactic dose recommended in WHO documents.

Профілактика та лікування залізодефіцитної анемії при багатоплідній вагітності

The objective: to reduce the frequency and severity of iron deficiency anemia (IDA) in multiple pregnancies by optimizing its prevention, treatment and proving the effectiveness and safety of the therapy. Materials and methods. 90 pregnant women were under observation. The control group (CG) consisted of 30 pregnant women with one fetus, group I – 30 women with multiple pregnancies who did not use the recommended therapy, group II – 30 women with multiple pregnancies, conducted according to our proposed method. The effectiveness of therapy was evaluated weekly by subjective evaluation of improvement and according to laboratory parameters of peripheral blood. General clinical methods included clinical, general blood analysis and determination of serum iron, quantitative determination of the concentration of sulfhydryl groups and lipoproteins in erythrocyte elements of peripheral blood, studied the surface architecture of erythrocyte membranes. Results. There was a significant reduction in the frequency and severity of IDA in pregnant women of group II in 1.6 times.Diagnosed with a significant increase in the number of discocytes (group I 67.340.81; group II 84.531.04; p&lt;0.05), a decrease in the number of ellipses (group I 0.990.05; group II 0.600.05; p&lt;0.05); flat disks (group I 0.870.07; group II 0.560.03; p&lt;0.05); dome-shaped (I group 2.410.14; ІІ group 1.820,11; р&lt;0.05) and spherical erythrocytes (І group 4.110.12; ІІ group 2.440, 13; p&lt;0.05). Significant decrease in the number of transitional forms (group I 3.410.31%; group II 2.530.21; p&lt;0.05); pre hemolytic (I group 2.410.14%; ІІ group 1.440.11%; р&lt;0.05) and degenerative forms (І group 1.180.14%; ІІ group 0.520.03; p&lt;0.05), as well as the ratio of the inner and outer diameters of erythrocytes (group I 66.710.91; group II 45.810.63; p&lt;0.05). There was a significant increase in the ratio of sulfhydryl groups and lipoproteins in erythrocyte membranes. Conclusions. The complex composition of the drug Fersinol and Fersinol-Z, taking into account the effective antianemic action, can be considered optimal for the prevention and treatment of iron deficiency in multiple pregnancies and recommended for use in practical health care. Keywords: multiple pregnancy, iron deficiency anemia, prevention, treatment, Fersinol ampoules, Fersinol-Z capsules.

REGAIN STUDY: Retrospective Study to Assess the Effectiveness, Tolerability, and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnant Women.

Iron deficiency anemia (IDA) during pregnancy arises because of preexisting inadequate stores or complex physiological changes and can lead to serious maternal and fetal complications. Oral iron, either as iron sulfate or fumarate, with or without folic acid, is the most commonly used treatment for IDA in pregnancy. Intravenous (IV) iron has a role in the treatment of IDA in pregnancy, particularly in women who present late, display severe anemia (Hb ≤ 9 g/dL), or risk factors, and are intolerant/noncompliant of oral iron. Previously, administration of IV iron was minimal, owing to potentially serious anaphylactic reactions. Recently, new IV iron products have been developed, offering better compliance, tolerability, efficacy, and a good safety profile. Our study aimed to assess the effectiveness, safety, and tolerability of IV ferric carboxymaltose (FCM) in the treatment of IDA in pregnant women in the UAE. Data from 1001 pregnant women who received at least one administration of FCM (500, 1000, or 1500 mg) during their second or third trimester of pregnancy (2 years backward from study initiation) were collected retrospectively from electronic medical records at Corniche Hospital, Abu Dhabi, UAE. Results showed that 41.4% of the women were able to achieve an increase of ≥2 g/dL in blood hemoglobin overall. A change of ≥2 g/dL was achieved by 27.5% of women administered a dose of 500 mg, 39.2% of women administered a dose of 1000 mg, and 63.9% of women administered a dose of 1500 mg of IV FCM. This indicates a directly proportional relationship between increasing IV FCM dose and the increase of ≥2 g/dL in blood hemoglobin. A total of 7 (0.7%) women reported mild, nonserious adverse events during the study. Within the limits of this retrospective study, IV FCM therapy was safe and effective in increasing the mean hemoglobin of pregnant women with IDA.

Analysis of the iron profile and the incidence of iron deficiency anemia in the third-trimester pregnant women in the coendemic areas of Bengkulu City, Indonesia

Pregnant women are at risk for iron deficiency anemia especially pregnant women in malaria-endemic areas. This study aimed to analyze the profile of iron in the third trimester pregnant women with iron deficiency anemia in co-endemic area of Bengkulu city. This study was cross-sectional study with a total sample of 66 pregnant women who met the inclusion criteria. Examination profile of iron in pregnant women is done by taking blood specimen through the vena cubity. Profile iron includes examination sTfR levels, hepcidin, transferrin were examined by ELISA. Determination of iron deficiency anemia is based on the results of Hb, serum iron and TIBC. The results showed 39.4% of pregnant women experience iron deficiency anemia. There is an average difference between hepcidin levels with the incidence of iron deficiency anemia (p-value 0.031). Based on binary logistic regression analysis profile iron with irondeficiency anemia in pregnant women, hepcidin levels are predictors factors on the incidence of iron deficiency anemia (p-value 0.000, 95% CI .296-.709).

Intravenous or oral iron for treating iron deficiency anaemia during pregnancy: systematic review and meta-analysis.

To compare the effects on perinatal maternal and neonatal outcomes of intravenous and oral iron therapy as first-line treatment of iron deficiency anaemia (IDA) in pregnant women. A meta-analysis, applying fixed and random effects models, of randomised controlled trials (RCTs) that compared the effects of intravenous and oral iron therapy for pregnant women with IDA. MEDLINE, EMBASE, Scopus, Cochrane Register of Controlled Trials, Web of Science; bibliographies of identified articles. Fifteen eligible studies with a total of 1938 participants were identified. Each was at high risk of bias in at least one domain; ten were undertaken in low or middle income countries. Evidence (from nine RCTs) that intravenous iron was superior to oral iron in reducing the need for blood transfusion at delivery was low quality (Peto odds ratio, 0.19 [95% CI, 0.05-0.78]; number needed to treat, 95 [95% CI, 81-348]). Evidence that intravenous iron was superior to oral iron in increasing neonatal birthweight (eight RCTs: mean difference, 58g; 95% CI, 4-112g) or reducing the rate of breastfeeding cessation within 24 months of delivery (one RCT: hazard ratio, 0.70; 95% CI, 0.50-0.99) was of low or very low quality. While intravenous iron treatment was superior to oral iron for improving maternal haematological parameters at delivery, their effects on neonatal haematological parameters were similar. There is no strong evidence that first-line therapy with intravenous iron is superior to oral administration for treating IDA in pregnant women. The few identified differences in outcomes were small in magnitude and from studies at high risk of bias. International Prospective Register of Systematic Reviews (PROSPERO), CRD42019120652.

Reticulocyte hemoglobin content (CHr) untuk skrining defisiensi besi pada ibu hamil

Reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant womenBackground: Anemia in pregnancy is a major public health problem in developing countries. In Indonesia, such anemia is generally caused by nutritional deficiencies, particularly iron deficiency. Iron deficiency screening is needed to prevent the development of iron-deficiency anemia in pregnant women that may affect the health of the mother and fetus.Objective: The study objective was to determine the diagnostic validity of reticulocyte hemoglobin content (CHr) for iron deficiency screening in pregnant women.Method: This research is analytic observational research with a cross-sectional design. The subjects were 73 pregnant women in Bantul district with various gestational ages. CHr was examined with an Advia 120 automatic hematology analyzer. Examination of ferritin as gold standard uses chemiluminescens method with Elecsys 1010 immunology analyzer. Table 2x2 is used to test several CHr values in the CHr range for women of reproductive age of 28.8 - 34.5 pg.Results: Based on ferritin &lt;15 μg / L as a gold standard, 13 pregnant women were suffered from iron deficiency while others were normal.Conclusion: CHr at 30.7 pg cut off has a sensitivity of 92.31%; negative predictive value (NPV) 96.2%; and likelihood ratio (LR) produce conclusive changes in post-test probability. In this cut-off, CHr can be used as an iron deficiency screening test in pregnant women.

Hepcidin as a diagnostic biomarker of iron deficiency anemia during pregnancy

Objectives Hepcidin hormone production is suppressed in the case of iron deficiency. The role of hepcidin as a hormone in iron metabolism along with its diagnostic cut-off values and its sensitivity and specificity among pregnant women with iron deficiency anemia (IDA) was examined in this study. Methods In this case-control study, three groups of pregnant subjects were included according to the following criteria: cases/patient group: pregnant women with IDA based on, Hb < 11.5 g/dl, S ferritin < 10 ng/ml, TS%<15%; positive control group: pregnant women with non-IDA based on, Hb < 11.5 g/dl, S ferritin > 10 ng/ml, TS%>15%; and negative control group: included non-anemic apparently healthy pregnant women based on, Hb > 11.5 g/dl, S ferritin > 10 ng/ml, TS%>15%. Results The serum hepcidin was significantly lower in pregnant women with IDA (0.34 ng/ml) compared to its level in pregnant women with non-IDA (23.48 ng/l) and apparently healthy pregnant women (13.86 ng/ml; p<.001). The study found a significant correlation between serum hepcidin and iron deficiency-related parameters with adjustment for study groups (p<.01). Moreover, the study found that serum hepcidin has good sensitivity in the range of 0.49–0.76 ng/ml (80.6–83.3%) and good specificity (76.2%) over positive IDA. Similar results were found for serum hepcidin over negative control group (0.49–0.83 ng/ml; sensitivity: 80.6–83.3%; specificity: 75.8–78.8%). Conclusions This study suggests that serum hepcidin is superior to hemoglobin, serum iron, serum ferritin, TS, and TIBC as an indicator of IDA in pregnant women. Study register 24012018-1 on 24 January 2018.

Efficacy of iron sulfate with ascorbic acid in pregnant women with iron deficiency of varying degrees of severity

Iron deficiency anemia (IDA) is one of the most common diseases in the world, characterized by hemoglobin synthesis disorder due to iron deficiency and manifested by anemia. According to WHO, the rate of IDA in pregnant women in different countries ranges from 21 to 80%, judging by the level of hemoglobin, and from 49 to 99% - by serum iron. Lack of treatment of iron-deficient pregnant women with varying degrees of iron deficiency leads to an increase in the frequency of complicated pregnancy, such as the threat of termination of pregnancy, placental insufficiency, delay in intrauterine development and hypoxia of the fetus, premature delivery, poor uterine contraction strength, pathological bleeding, infectious complications. Aim of the study: study of the efficacy of the drug containing iron sulfate (Ferrous sulfate) and ascorbic acid in pregnant women with latent and manifest forms of iron deficiency. Patients and methods: 66 pregnant women were examined. Group 1 consisted of 36 pregnant women with latent iron deficiency, Group 2–30 pregnant women with manifest iron deficiency and moderate anemia. Pregnant women in the 1st group were prescribed the drug only for 1 month due to the fact that there were no manifestations of anemia in this category of patients. Blood parameters were monitored dynamically after 1 month of treatment and after 2 months, which means after 1 month of absence of the drug intake. Patients of the 2nd group received treatment during 2 months, dynamic treatment after laboratory parameters was carried out after 1 and 2 months of treatment. Results of the study. Analyzing the data obtained, it was found that all laboratory parameters differ significantly from those before treatment. Pregnant women of the 1st group have no reliable changes between the parameters after 1 and 2 months of observations, as during this period the patients did not receive iron medication. And even a slight decrease in some indicators is noted, but when compared with laboratory data before treatment, the results differ significantly. Conclusion: Ferrous sulfate and ascorbic acid can be recommended to compensate iron deficiency in pregnant women with LID to prevent the development of anemia, in patients with MID to treat anemia and prevent the development of possible complications in pregnant women associated with this condition. Thus, earlier detection and elimination of LID leads to prevention of anemia later on.

Survey of prevalence of iron deficiency and iron deficiency anemia in pregnant women in urban areas of China

Objective: To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods: The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country.Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results: The median serum ferritin level during pregnancy was 20.60 μg/L (11.78-36.98 μg/L) , the hemoglobin level was (118±12) g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L (34.48-94.01 μg/L) , 28.60 μg/L (16.40-50.52 μg/L) , and 16.70 μg/L (10.20-27.00 μg/L) respectively (P<0.01) . The mean hemoglobin levels were (127±10) g/L, (119±11) g/L and (117±11) g/L respectively (P<0.01) . The prevalence of ID in urban pregnant women was 48.16% (5 973/12 403) , and IDA prevalence was 13.87% (1 720/12 403) . The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019) , 8.40% (293/3 487) and 17.82% (1 407/7 897) ,respectively (P<0.01) . The prevalence of standardized ID and IDA were significantly different in various regions of China (P<0.01) . The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%, the differents in various regions were significant (all P<0.01) . Conclusion: The current phenomenon of ID and IDA in pregnant women is still very common, and nutrition and health care during pregnancy should be strengthened.

Iron deficiency anaemia in pregnancy and its correction

The frequency of anaemia in pregnant women varies from 15 to 30%, iron deficiency anaemia (IDA) is the most common disorder, it accounts for about 90% of all anaemia. Iron deficiency adversely affects the course of pregnancy, childbirth, the postpartum period, the condition of the fetus and the newborn. The main complications of pregnancy in IDA are threatened miscarriage (20–42%); preeclampsia (40%); premature separation of placenta (25–35%); intrauterine growth restriction (25%); premature birth (11–42%).Daily intake of iron-containing drugs is more effective in preventing anaemia in mothers, and in reducing the risk of giving birth to children with low body weight. Daily iron supplementation in preventive programs may reduce the risk of anaemia in the mother at the time of delivery by 70%. It is preferable to take supplements that contain bivalent iron and possess a high degree of absorption, good tolerance by patients and minimal risk of side effects. Complex supplements containing vitamins and microelements are recommended for the treatment and prevention of IDA in pregnant women. Sorbifer Durules is one of such supplements. The Sorbifer Durules therapy of IDA in pregnant is highly effective treatment of therapy, which leads to normalization of hemogram parameters, improvement of the general condition of patients, reduction of obstetric and neonatal complications.