Iron Deficiency In Pregnant Women Research Articles

A community-based cluster randomised controlled trial in rural Bangladesh to evaluate the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality: the Shonjibon trial

BackgroundIron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. However, most of the evidence is from observational epidemiological studies except for a very few randomised controlled trials. IFA supplements have also been found to reduce the preterm delivery rate and neonatal mortality attributable to prematurity and birth asphyxia. These results combined indicate that IFA supplements in populations of iron-deficient pregnant women could lead to a decrease in the number of neonatal deaths mediated by reduced rates of preterm delivery. In this paper, we describe the protocol of a community-based cluster randomised controlled trial that aims to evaluate the impact of maternal antenatal IFA supplements on perinatal outcomes.Methods/designThe effect of the early use of iron-folic acid supplements on neonatal mortality will be examined using a community based, cluster randomised controlled trial in five districts with 30,000 live births. In intervention clusters trained BRAC village volunteers will identify pregnant women & provide iron-folic acid supplements. Groundwater iron levels will be measured in all study households using a validated test kit. The analysis will follow the intention to treat principle. We will compare neonatal mortality rates & their 95% confidence intervals adjusted for clustering between treatment groups in each groundwater iron-level group. Cox proportional hazards mixed models will be used for mortality outcomes & will include groundwater iron level as an interaction term in the mortality model.DiscussionThis paper aims to describe the study protocol of a community based randomised controlled trial evaluating the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality. This study is critical because it will determine if antenatal IFA supplements commenced in the first trimester of pregnancy, rather than later, will significantly reduce neonatal deaths in the first month of life, and if this approach is cost-effective.Trial registrationThis trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 31 May 2012. The registration ID is ACTRN12612000588897.

RET-HE DALAM DIAGNOSIS SEBAGAI TOLOK UKUR DALAM MENDETEKSI KEKURANGAN ZAT BESI DI IBU HAMIL (Ret-He in Diagnostic Parameter to Detecting Iron Deficiency in Pregnant Women)

Varieties of the laboratory test can be applied in the detecting of iron status. These test are divided into conventional hematologicindex and biochemical iron serum. With the development of an hematological analyzer, new parameter has been found to monitor theiron status with reticulocytes hemoglobin analysis (Ret-He). To know the diagnostic accuracy of Ret-He and to conclude whether Ret-Hecan be used as a parameter to detect iron deficiency in pregnant women by obtaining certain information. This study used analyticalcross sectional was conducted at Haji Adam Malik Hospital Medan, in March−June 2013. The Applying samples consisted of 64 thirdtrimester pregnant women which divided into two (2) groups: the noniron deficiency group using 28 subjects and in the iron deficiency36 subjects. In this study, the researchers found AUC for Ret-He about 77.7% with the best cut off value of <31.4 pg. Using the cut offvalue the researchers obtained the sensitivity about 61.1%, specificity 75.0%, Positive Predictive Value (PPV) 75.8%, Negative PredictiveValue (NPV) 60.0%, Likehood Ratio (LR) (+) 2.44 and LR (–) 0.51%. Based on this study, can be concluded, that the diagnostic accuracyRet-He is a good parameter to detect iron deficiency in the pregnant women.

KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN (Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy)

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume andthe development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stageparameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-Heexamination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered fromPKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from thecubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while theRet-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serumof the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzerC501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two(2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency inpregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for irondeficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively.The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.

Anaemia and iron deficiency in pregnant women attending an antenatal clinic in a Teaching Hospital in Southern Sri Lanka

In Sri Lanka the current prevalence of anaemia during pregnancy is estimated to be less than 20%. To determine the rate of anaemia defined as hemoglobin concentration < 11 g/dl, and the rate of iron deficiency using the best cut off level of serum ferritin, in women presenting for antenatal care. Three hundred and fifty consecutive pregnant women with gestations between 12 to 20 weeks, presenting to the Academic Obstetric Unit at the Teaching Hospital Mahamodera, Galle, Sri Lanka from 10.11.2014 to 13.01.2015 had their heamoglobin and hematocrit measured by flowcytometry and hydro-dynamic focusing methods using a Sysmex- XS-500i System and serum ferritin measured by electro-chemiluminescence method using a Cobas-e411 Analyzer. The rate of anaemia was calculated. The best cut off level of serum ferritin for the detection of anaemia was obtained using a Receiver Operator Characteristics (ROC) curve, and using this cut off, the rate of iron deficiency was calculated. The rate of anaemia was 16.6%. The best cut off level of serum ferritin for the detection of anaemia was < 30 μg/L (the area under the ROC curve was 0.77; 95% CI -0.72 to0.81), with a sensitivity of 78.3% (95% CI 65.8 - 87.9) and a specificity of 74% (95% CI 68.6 -79.0) in detecting anaemia. Using this cut off, 36.9% of the pregnant women had iron deficiency. Rates of anaemia (16.6%) and iron deficiency (36.9%) in pregnancy are at levels of mild to moderate public health significance respectively.

Iron Supplementation in Twin Pregnancy - The Benefit of Doubling the Iron Dose in Iron Deficient Pregnant Women: A Randomized Controlled Trial.

To assess the efficacy of doubling the daily dose of iron supplement in iron-deficient women with twin pregnancies. Using a prospective randomized controlled trial, iron-deficient women with twin gestations were randomized to receive a single or a double dose of daily iron from 16 weeks of gestation until 6 weeks postpartum. The primary outcome was hemoglobin at 32 weeks. Secondary outcomes included ferritin at 32 weeks, hemoglobin during pregnancy and postpartum, birth weights, preterm birth rate, gastrointestinal side effects, intravenous iron administration, and compliance with treatment. Eighty-five and 87 women were randomized to receive one capsule (group A) or two capsules (group B) of 34 mg of ferrous sulfate, respectively. Mean hemoglobin (9.6 g/dL and 9.7 g/dL) and ferritin (8.6 ng/ml and 8.5 ng/ml) were similar in both groups A and B, respectively, at allocation. Hemoglobin in group B was significantly higher from 32 weeks onward, until 6 weeks postpartum. There were no significant differences in any of the secondary outcomes examined. In twin pregnancies complicated by iron deficiency anemia, doubling the dose of iron increases hemoglobin and ferritin without worsening gastrointestinal side effects.

Iron supplementation in singleton pregnancy: Is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? a randomized controlled trial.

To assess the efficacy of doubling the 30 mg dose of iron in women with iron deficiency anemia (IDA) in singleton pregnancies. Prospective randomized controlled trial. Iron-deficient women were randomized during the second trimester to receive one or two capsules of daily iron supplement, containing 34 mg of ferrous sulfate, from 17 weeks until 6 weeks postpartum. The primary outcome was hemoglobin (Hgb) at 35 weeks. Secondary outcomes included ferritin at 35 weeks, Hgb during pregnancy and postpartum, birth weights, preterm birth rate, gastrointestinal side effects, intravenous iron administration and compliance. In all, 160 women were randomized to receive one capsule and 164 received two capsules. Both groups had similar Hgb (10.1 g dl-1) and ferritin (9.3 and 9.4 ng l-1) at allocation. Hgb concentration in both groups was similar at 35 weeks (10.8 g dl-1). There were no significant differences in any of the secondary outcomes. In IDA pregnant women, a single dose of iron is as effective as a double dose.

Effect of intra-cellular trafficking on flow cytometric measurement of neutrophil's oxidative status in iron deficient pregnant females.

Iron deficiency and iron deficiency anemia are prevalent among pregnant women particularly in developing countries. This study aimed to evaluate the iron status among Egyptian pregnant women and its impact on their neutrophil's count and antimicrobial functions. Ninety pregnant females underwent complete blood count, iron profile, flow cytometric studies for neutrophil myeloperoxidase expression & oxidative burst using dihydrorhodamine 123 (DHR) after phorbol-12-myristate-13-acetate (PMA) stimulation as well as neutrophil phagocytic and lytic indices. According to percent saturation 54/90 women (60%) were iron deficient (<15% saturation) (cases) and 36/90 (40%) were iron sufficient (controls). A higher proportion of iron deficient pregnant women were in their third trimester compared to controls. No significant difference was found between the iron deficient & sufficient groups as regards anemia despite a positive correlation between haemoglobin level and percent saturation (P=.02). Both the phagocytic and lytic indices were significantly lower among the cases compared to controls (P=.014 & .002 respectively). Cases and controls were comparable as regards flow cytometric studies of neutrophils' myeloperoxidase and oxidative burst (P>.05). No significant correlation was found between any of the iron profile parameters and the oxidative burst by flow cytometry. Functional microphage assay (phagocytic and lytic indices) may be more relevant and cost effective than flow cytometry assays of myeloperoxidase and oxidative burst in reflecting either iron status or cellular immunity in pregnancy.

Особенности железодефицитных состояний у беременных с системной красной волчанкой

Особенности железодефицитных состояний у беременных с системной красной волчанкой

IRON-DEFICIENCY ANEMIA IN PREGNANCY: PECULIARITIES OF THERAPY

Anemia is common in women during pregnancy and in the postpartum period. This disorder is caused by the physiologically increasing needs of the fetus and often initially reduced iron stores in the mother’s body. Iron deficiency can underlie a number of complications of the gestation period for both the woman and the newborn at a later time. The fastest, most effective and safe management of iron deficiency anemia, especially in its severe forms, allows avoiding complications and improving pregnancy outcomes. Administration of iron supplements is the main method of management of iron deficiency anemia. However, oral forms do not allow achieving the effect in all cases, taking into account the peculiarities of iron absorption from the GI tract. Ferric carboxymaltose is an intravenous drug that has good tolerability and, what is most importantly, effectively and quickly replenishes iron deficiency in pregnant women starting from the second trimester and in the postpartum period.

Effect of Intravenous Iron Supplementation on Hepcidin Levels in Iron Deficient Pregnant Females in Second and Third Trimester.

Objective of the study was to assess effect of iron therapy on serum hepcidin levels in iron deficient pregnant women and its correlation with hemoglobin, serum iron profile and C-reactive protein (CRP). A total of 100 pregnant women were enrolled in the study; 25 were included in the "control group" having normal hematological and biochemical parameters while 75 iron deficient pregnant women were enrolled in the "patient group" with low hematological and biochemical parameters. CRP was done to rule out inflammation and to observe its association with hepcidin. Intravenous iron was administered to the patient group. Post treatment CBC, serum iron, serum ferritin and serum hepcidin were determined. Difference between pre and post treatment hemoglobin, serum iron, serum ferritin and serum hepcidin levels were determined and correlation among them was calculated. Post treatment serum hepcidin levels were significantly higher than pretreatment level (p=0.001). However, no correlation was seen between serum hepcidin, serum iron, serum ferritin and hemoglobin. Hepcidin levels remain low during pregnancy as there is increased demand for iron in pregnancy. Iron supplementation results in increased hepcidin levels; however no mathematical correlation was found between serum hepcidin level and serum iron profile.

RET-HE DALAM DIAGNOSIS SEBAGAI TOLOK UKUR DALAM MENDETEKSI KEKURANGAN ZAT BESI DI IBU HAMIL

Varieties of the laboratory test can be applied in the detecting of iron status. These test are divided into conventional hematologic index and biochemical iron serum. With the development of an hematological analyzer, new parameter has been found to monitor theiron status with reticulocytes hemoglobin analysis (Ret-He). To know the diagnostic accuracy of Ret-He and to conclude whether Ret-He can be used as a parameter to detect iron deficiency in pregnant women by obtaining certain information. This study used analyticalcross sectional was conducted at Haji Adam Malik Hospital Medan, in March-June 2013. The Applying samples consisted of 64 third trimester pregnant women which divided into two (2) groups: the noniron deficiency group using 28 subjects and in the iron deficiency 36 subjects. In this study, the researchers found AUC for Ret-He about 77.7% with the best cut off value of &lt;31.4 pg. Using the cut off value the researchers obtained the sensitivity about 61.1%, specificity 75.0%, Positive Predictive Value (PPV) 75.8%, Negative Predictive Value (NPV) 60.0%, Likehood Ratio (LR) (+) 2.44 and LR (–) 0.51%. Based on this study, can be concluded, that the diagnostic accuracy Ret-He is a good parameter to detect iron deficiency in the pregnant women

KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume and the development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stage parameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-He examination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered from PKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from the cubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while the Ret-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serum of the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzer C501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two (2) groups based on the Hb levels, namely: anemia (Hb&lt;11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat &lt;9%) and normal (Tsat ≥9%). From 291 subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency in pregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for iron deficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively. The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.

Overview of the Dietary Intakes of the Mexican Population: Results from the National Health and Nutrition Survey 2012

Background:Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in young children, iron deficiency in pregnant women, and widespread obesity across age groups.Objective:The aim was to summarize and discuss findings published in this supplement on dietary intakes and the eating habits of the Mexican population.Methods:A 24-h recall questionnaire that used the multiple-pass method with a repeated measure in a fraction of the sample was applied in a nationally representative sample. We estimated mean intakes and percentages of inadequacy for macronutrients and micronutrients; mean intakes and percentages of the population who adhere to dietary recommendations for food groups; sources of added sugars; intakes of discretionary foods by mealtime, place, and activity; and mean dietary intakes in children <2 y old.Results:Infant formula was consumed by almost half of infants aged <6 mo and sugar-sweetened beverages were consumed by two-thirds of children aged 12–23 mo. In the different age groups, a high proportion of the population had excessive intakes of added sugars (58–85%) and saturated fats (54–92%), whereas a high prevalence of insufficient intakes was found for fiber (65–87%), vitamin A (8–70%), folates (13–69%), calcium (26–88%), and iron (46–89%). Discretionary foods (nonbasic foods high in saturated fats and/or added sugars) contributed 26% of the population’s total energy intake, whereas only 1–23% met recommendations for legumes, seafood, fruit, vegetables, and dairy foods.Conclusions:High proportions of Mexicans consume diets that do not meet recommendations. Breastfeeding and complementary feeding diverged from recommendations, intakes of discretionary foods were high, and the prevalence of nutrient inadequacies and age groups not meeting intake recommendations of basic food groups were also high. The results are consistent with the high prevalence of the double burden of malnutrition and are useful to design food and nutrition policies.

Iron Supplementation Affects Hematologic Biomarker Concentrations and Pregnancy Outcomes among Iron-Deficient Tanzanian Women

Background: Iron deficiency is a highly prevalent micronutrient abnormality and the most common cause of anemia globally, worsening the burden of adverse pregnancy and child outcomes.Objective: We sought to evaluate the response of hematologic biomarkers to iron supplementation and to examine the predictors of the response to iron supplementation among iron-deficient pregnant women.Methods: We identified 600 iron-deficient (serum ferritin ≤12 μg/L) pregnant women, aged 18–45 y, presenting to 2 antenatal clinics in Dar es Salaam, Tanzania using rapid ferritin screening tests, and prospectively followed them through delivery and postpartum. All women received 60 mg Fe and 0.25 mg folate daily from enrollment until delivery. Proportions meeting the thresholds representing deficient hematologic status including hemoglobin <110 g/L, ferritin ≤12 μg/L, serum soluble transferrin receptor (sTfR) >4.4 mg/L, zinc protoporphyrin (ZPP) >70 mmol/L, or hepcidin ≤13.3 μg/L at baseline and delivery were assessed. The prospective change in biomarker concentration and the influence of baseline hematologic status on the change in biomarker concentrations were assessed. Regression models were estimated to assess the relation of change in biomarker concentrations and pregnancy outcomes.Results: There was significant improvement in maternal biomarker concentrations between baseline and delivery, with increases in the concentrations of hemoglobin (mean difference: 15.2 g/L; 95% CI: 13.2, 17.2 g/L), serum ferritin (51.6 μg/L; 95% CI: 49.5, 58.8 μg/L), and serum hepcidin (14.0 μg/L; 95% CI: 12.4, 15.6 μg/L) and decreases in sTfR (−1.7 mg/L; 95% CI: −2.0, −1.3 mg/L) and ZPP (−17.8 mmol/L; 95% CI: −32.1, 3.5 mmol/L). The proportions of participants with low hemoglobin, ferritin, and hepcidin were 73%, 93%, and 99%, respectively, at baseline and 34%, 12%, and 46%, respectively, at delivery. The improvements in biomarker concentrations were significantly greater among participants with poor hematologic status at baseline – up to 12.1 g/L and 14.5 μg/L for hemoglobin and ferritin concentrations, respectively. For every 10-g/L increase in hemoglobin concentration, there was a 24% reduced risk of perinatal mortality (RR = 0.76; 95% CI: 0.59, 0.99) and a 23% reduced risk of early infant mortality (RR = 0.77; 95% CI: 0.60, 0.99). The risk of anemia at delivery despite supplementation was predicted by baseline anemia (RR = 2.11; 95% CI: 1.39, 3.18) and improvements in ferritin concentration were more likely to be observed in participants who took iron supplements for up to 90 d (RR = 1.41; 95% CI: 1.13, 1.76).Conclusion: Iron supplementation decreases the risk of maternal anemia and increases the likelihood of infant survival among iron-deficient Tanzanian pregnant women. Interventions to promote increased duration and adherence to iron supplements may also provide greater health benefits.

94: Iron supplementation in twin gestations--one versus two ferrous sulfate capsules for iron deficient pregnant women

94: Iron supplementation in twin gestations--one versus two ferrous sulfate capsules for iron deficient pregnant women

Эффективность и безопасность перорал ьного железа (III) – гидроксид полимальтозного комплекса по сравнению с сульфатом железа у беременных женщин с железодефицитной анемией: многоцентровое рандо мизированное контролируемое исследование

Objective: To evaluate the efficacy and safety of iron (III) polymaltose complex (Maltofer) versus ferrous sulfate in iron-deficient pregnant women using recommended doses. Methods: An exploratory, open-label, randomized, controlled, multicenter study was undertaken in 80 pregnant women with iron-deficiency anemia (hemoglobin ≤ 10,5 g/dL, serum ferritin ≤ 15 ng/mL and mean corpuscular volume < 80 fL). Patients were randomized 1:1 to oral iron(III) polymaltose complex or ferrous sulfate (each 100 mg iron twice daily) for 90 days. Results: The primary endpoint, change in hemoglobin from baseline to days 60 and 90, did not differ significantly between treatment groups. The mean change to day 90 was 2,16 (0,67) g/dL in the iron (III) polymaltose complex group and 1,93 (0,97) g/dL in the ferrous sulfate group. Mean serum ferritin at day 90 was 179 (38) ng/mL and 157 (34) ng/mL with iron (III) polymaltose complex and ferrous sulfate, respectively (p = 0,014). Adverse events were significantly less frequent in the iron (III) polymaltose group, occurring in 12/41 (29,3%) patients, than in the ferrous sulfate group (22/39 [56,4%]) (p = 0,015). Conclusions: Oral iron (III) polymaltose complex offers at least equivalent efficacy and a superior safety profile compared to ferrous sulfate for the treatment of iron-deficiency anemia during pregnancy.

Hemoglobin A1C but not Glycated Albumin Overestimates Glycemic Control due to Iron Deficiency in Pregnant Women with Diabetes

Background: Pregnant women are frequently complicated with iron deficiency. Because Hemoglobin A1c (HbA1c) shows an apparently high value in patients with iron-deficiency, HbA1c was reported to be elevated due to iron deficiency in pregnant women with or without diabetes. In the present study, we investigated whether HbA1c or Glycated Albumin (GA) accurately reflects glycemic control state estimated from the Mean Blood Glucose (MBG) obtained by Continuous Glucose Monitoring (CGM) in pregnant women with diabetes. Methods: We studied 20 pregnant women with diabetes whose glycemic control was stable and CGM was performed to determine MBG. The estimated HbA1c and GA were calculated from the MBG, and the measured values were compared with the estimated values. Correlations between Mean Corpuscular Hemoglobin (MCH), an index of iron-deficiency, and continuous variables were examined. Results: HbA1c was not significantly correlated with GA. The measured GA was not significantly different from the estimated GA (16.0 ± 2.7% vs. 16.0 ± 1.8%, P=0.982). On the other hand, the measured HbA1c was significantly higher than the estimated HbA1c [6.4 ± 0.9% (46.3 ± 10.3 mmol/mol) vs. 5.6 ± 0.5% (38.2 ± 5.4 mmol/mol), P<0.001]. The measured HbA1c (R= –0.598, P=0.005) and the measured HbA1c/estimated HbA1c ratio (R= –0.566, P=0.009) showed significant inverse correlations with MCH. Conclusions: HbA1c overestimates glycemic control due to iron deficiency in pregnant women with diabetes, whereas GA accurately reflected their glycemic control. Therefore, GA is a better index of glycemic control than HbA1c in pregnant women with diabetes.

Anemia and iron deficiency in pregnant women in Zaria, Nigeria

Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.

Latent iron-deficiency in pregnant women (etiology, pathogenesis, prevention)

Latent iron-deficiency in pregnant women (etiology, pathogenesis, prevention)

Early gestation screening of pregnant women for iodine deficiency disorders and iron deficiency in urban centre in Vadodara, Gujarat, India

Pregnancy is a special condition where many metabolic changes may occur because of increased requirement of essential micronutrients such as iron and iodine. Foetal thyroid starts producing its own thyroid hormones after 12 weeks of gestation. Therefore, the first trimester is very crucial for meeting thyroid hormone requirements of the mother and foetus. Iodine deficiency and iron deficiency may affect mental and physical growth of the foetus. Hence, it is very important to establish a programme on the screening of pregnant women for thyroid dysfunction tests along with established iron status assessment. Thus, the study was aimed to screen the pregnant women for iodine deficiency disorders and iron deficiency during early gestation, situational analysis on thyroid insufficiency and iron deficiency in pregnant women (gestational age <15 weeks) in urban Vadodara, Gujarat. n = 256 healthy pregnant women with uncomplicated singleton pregnancy were selected. The thyroid hormone was estimated by RIA, UIE using simple microplate technique and haemoglobin (Hb) concentration by acid hematin method. Median thyrotropin (TSH), free thyroxine (FT4), total thyroxine (TT4) and UIE concentrations were 1.88 μIU/ml, 0.83 ng/dl, 10.24 μg/dl and 297.14 mcg/l, respectively. There was a significant correlation between TSH, FT4 and month of gestation. Mean Hb concentration was 9.27 ± 1.09 g/dl. The prevalence of iodine insufficiency (based on UI) was 16.79% and iron deficiency was 91%. Screening programme for iodine deficiency during early gestation should be implemented along with the existing programme of haemoglobin estimation at first prenatal visit. This would help prevent damage to the developing brain and growth of the foetus and also to trace at-risk pregnant women.