Maternal Hemoglobin Levels Research Articles

Association of iron status indicators with thyroid hormone concentrations during pregnancy: a systematic review and meta-analysis

BackgroundMaternal thyroid hormones play a vital role in fetal development, and imbalances can lead to adverse outcomes. Iron deficiency may impair thyroid function due to iron’s essential role in iodine oxidation during thyroid hormone synthesis. This review examines the relationship between various indicators of maternal iron status and thyroid function during pregnancy.MethodsWe conducted a systematic search in MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library for studies published up to 2023. Meta-analyses determined pooled thyroid hormone levels in patients with and without iron deficiency, using serum ferritin (cut-off = 30 µg/L) and hemoglobin (cut-off = 11 g/dL). Meta-regression analyses examined linear relationships between iron status indicators and thyroid hormones.ResultsForty-seven studies involving 53,152 pregnant women were included. Meta-analysis showed no significant difference in thyroid-stimulating hormone, free T4, or total T4 when considering serum ferritin levels in iron-deficient versus iron-sufficient individuals. However, regarding hemoglobin levels, iron deficiency was associated with higher thyroid-stimulating hormone (2.31 mIU/L vs. 1.75 mIU/L) and lower free T4 (10.7 pmol/L vs. 13.3 pmol/L), but not total T4. Meta-regression revealed no significant associations between serum ferritin and thyroid hormones. Conversely, maternal hemoglobin levels were inversely associated with thyroid-stimulating hormone (P-value = 0.009) and directly associated with free T4 (P-value < 0.001), with no significant link to total T4.ConclusionsMaternal hemoglobin levels are more strongly correlated with thyroid function than serum ferritin levels. This suggests that monitoring hemoglobin could enhance the early detection and management of thyroid dysfunction during pregnancy.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD4202451820.

Intramuscular methylergonovine to decrease blood loss during cesarean delivery for twins: A triple‐blinded placebo‐controlled randomized trial

AbstractObjectiveOur objective was to evaluate whether prophylactic administration of intramuscular (IM) methylergonovine after cord clamping reduces blood loss during planned cesarean delivery (CD) of twin pregnancies.MethodThis single‐center randomized placebo‐controlled triple‐blinded trial compared the effects of IM methylergonovine versus saline placebo control on maternal blood loss at CD. Pregnant individuals with twin gestations at ≥ 34 weeks of gestation undergoing planned CD were enrolled. Methylergonovine or saline placebo was administered immediately after umbilical cord clamping of the second twin in addition to standard oxytocin prophylaxis. The primary outcome was a change in mean maternal hemoglobin (Hgb) level from preoperative to postoperative day 1 (POD 1). Secondary outcomes include intraoperative blood loss, additional uterotonic use, and rates of postpartum hemorrhage and transfusion. We planned to enroll 66 patients to detect a standard deviation (SD) greater drop in postoperative maternal Hgb, assuming −1.40 (± 0.83) g/dL Hgb difference after planned CDs (90% power, alpha 0.05). Pearson chi‐square test, Fisher's exact test, t‐test, and Wilcoxon rank sum test with intent‐to‐treat principles were performed as appropriate. A linear regression model was performed on the primary outcome.ResultsA total of 66 patients (33 methylergonovine and 33 placebo) were randomized. There were no demographic differences between methylergonovine and placebo groups. Median gestational age at delivery was 37 weeks for both groups. Mean Hgb drop on POD 1 was 1.1 g/dL (SD 0.7 g/dL) for methylergonovine and 2.1 g/dL (SD 0.9 g/dL) for placebo (p < 0.001). Quantitative blood loss was significantly lower in patients receiving prophylactic methylergonovine (891 vs. 1017 mL, p = 0.003). Postpartum hemorrhage rates were lower in the methylergonovine group (18.2% vs. 54.5%, p = 0.002). There were seven cases of unblinding due to hemorrhage in the placebo group compared to no cases in the methylergonovine group (p = 0.01); all unblinded subjects received methylergonovine.ConclusionProphylactic IM methylergonovine administered after umbilical cord clamping during twin CD significantly reduced intraoperative blood loss and hemoglobin drop on POD 1. These data support further study of methylergonovine as a preventative treatment strategy at the time of twin CD.

Assessing the Impact of Intermittent Preventive Treatment in Reducing Malaria Incidence among Pregnant Women in High-Risk Areas

Malaria poses significant health risks for pregnant women, especially in high-transmission areas such as sub-Saharan Africa. Physiological and immunological changes during pregnancy increase vulnerability to malaria-related complications, including maternal anemia, low birth weight, and preterm delivery, which can severely impact maternal and neonatal health. To combat these risks, the World Health Organization (WHO) recommended Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) as a proactive measure to reduce malaria incidence in this population. IPTp-SP, administered at regular intervals starting from the second trimester, has shown promising outcomes, such as reduced malaria prevalence, improved maternal hemoglobin levels, and lower incidence of placental malaria. This narrative review synthesized current literature on IPTp’s effectiveness, challenges, and future directions, analyzing studies across multiple high-risk regions to highlight both successes and barriers in IPTp implementation. Key challenges identified include rising SP resistance, limited healthcare infrastructure, and socio-cultural obstacles impacting adherence. To address these, alternative strategies such as introducing alternative antimalarial drugs like dihydroartemisinin-piperaquine (DP), expanding antenatal care (ANC) services, and utilizing community health workers (CHWs) to improve IPTp delivery are examined. Emerging mobile health (mHealth) tools are also explored as potential solutions for enhancing adherence. Recommendations for policy included investment in ANC infrastructure, community-based outreach, and increased support for research on SP alternatives. The findings underscored IPTp’s essential role in protecting maternal and child health, while highlighting areas for innovation and policy reform to optimize its impact in malaria-endemic regions. Keywords: Intermittent Preventive Treatment (IPTp), Malaria, Pregnant Women, Sulfadoxine-Pyrimethamine (SP), Public Health.

Maternal hair lead and cytokine pro-inflammatory effects in preterm birth

This case-control study analyzed the lead (Pb), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels in pregnant women with preterm birth (PTB) in Central Java, Indonesia. Hair samples from 72 pregnant women were collected non-invasively. The prenatal exposure to Pb was determined with the total reflection X-ray fluorescence (TXRF) method. Serum IL-6 and TNF-α were examined using enzyme-linked immunosorbent assays (ELISA). The Pb concentration in hair was slightly higher in women with PTB than those without PTB; however, this difference was not statistically significant. An elevated hair Pb level was not associated with increased PTB risk (OR 24.69, 95% CI 0.93–653.82, p>0.05). A serum TNF-α level ≥27 pg/ml, a serum IL-6 level ≥9 pg/ml, and the spouse’s smoking frequency were significantly associated with increased PTB risk (TNF-α OR 42.25, 95% CI 5.26–339.61; IL-6 OR 22.33, 95% CI 3.12–158.54; spouse’s smoking frequency OR 1.28, 95% CI 1.09–1.5), while the maternal hemoglobin concentration significantly decreased PTB risk (OR 0.43, 95% CI 0.2–0.927). This study demonstrates that maternal hair Pb concentration has no significant relationship with PTB. Serum TNF-α, IL-6, and the spouse’s smoking frequency potentially increased PTB risk, while the maternal hemoglobin level is a protective factor.

Impact of maternal anemia on neonatal outcomes

Background: Maternal anemia can have adverse neonatal outcomes like low birth weight, prematurity, lower APGAR scores, lower cord blood hemoglobin, and neonatal mortality. This study aims to estimate the association of maternal anemia with demographics and the outcomes of newborns. i.e. birthweight, gestational age, APGAR score, and cord blood hemoglobin. Methods: A cross-sectional study on 384 pregnant women and their newborns was done at Hind Institute of Medical Sciences, Sitapur over 18 months. A complete blood count sample of the pregnant women followed by a cord blood hemoglobin sample of the newborn was collected. Neonates' gestational age, birth weight, length, and APGAR score were noted. Data analysis (descriptive statistics, Chi-square test, Pearson’s correlation) was done using statistical package for the social sciences (SPSS) software. P value <0.05 was considered significant. Results: Working mothers had lower chances of being anemic (p<0.00001) while mothers with vegetarian diets had higher chances of anemia (p<0.00001). A significant association of maternal anemia was found with lower educational status (p=0.003), alcohol abuse (p=0.003), and smoking/tobacco abuse (p=0.021). Babies born to non-anemic mothers had higher birth weights than those born to anemic mothers (p<0.0001) but maternal anemia did not significantly impact the gestational age outcome (p=0.404). A positive correlation was established between maternal and cord blood hemoglobin levels (r=0.230). Conclusions: Monitoring and addressing maternal hemoglobin levels are essential strategies for preventing anemia in the newborn and promoting healthy development in neonatal life.

Assessment of fetal cardiac function in pregnant women with anemia: prospective case-control study.

To compare fetal cardiac function in pregnant women with iron deficiency anemia (IDA) vs healthy pregnant controls. This was a single-center, prospective, case-control study conducted in a tertiary hospital between November 2022 and September 2023. Women diagnosed with IDA who attended as outpatients at the pregnancy follow-up clinic at 30-34 weeks' gestation or who were hospitalized for intravenous iron treatment owing to profound anemia were included. The control group consisted of randomly selected gestational-age-matched pregnant women with no obstetric complications or comorbidities and who did not have anemia. Patients underwent two-dimensional imaging, followed by pulsed-wave Doppler and M-mode and tissue Doppler imaging (TDI) to evaluate fetal cardiac function. A fetal cardiac score was calculated using systolic, diastolic and global hemodynamic function parameters, and was compared between patients with IDA and those without. The fetal cardiac score was also assessed according to the severity of anemia in the IDA group. A total of 150 patients, comprising 50 patients with IDA and 100 healthy pregnant women at 30-34 weeks' gestation, were included in the study. Of the patients with IDA, 20 had mild, 18 had moderate and 12 had severe anemia. The fetal myocardial performance index and isovolumetric relaxation time were significantly higher in the IDA group compared with the control group (P < 0.0001 for both), while isovolumetric contraction time was similar. Among the fetal tricuspid and mitral valve diastolic parameters, the E, A and E/A values were significantly lower in the IDA group (P < 0.05 for all). Mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursions were significantly lower in the IDA group (P < 0.05 for both). The IDA group also had significantly lower values for the TDI parameters mitral and tricuspid E', A', S' and E'/A' ratio and a significantly higher E/E' ratio (P < 0.05 for all). Among the IDA subgroups, a significant decrease was observed in the tricuspid and mitral A, E and E/A ratio in fetuses whose mothers had severe anemia (P = 0.001). M-mode Doppler analysis revealed significantly lower fetal TAPSE and MAPSE in the patient group with severe maternal anemia (P = 0.001 for both). According to the subgroup comparison of TDI findings, the fetuses of mothers with severe anemia had significantly lower tricuspid and mitral E', A', S' and E'/A' ratio values and a significantly higher E/E' ratio (P < 0.05 for all). The fetal cardiac score was significantly higher in the maternal IDA group compared with the control group (P < 0.001). A significant negative correlation was found between maternal hemoglobin level and fetal cardiac score (P < 0.001). We observed differences in fetal systolic and diastolic cardiac function in pregnancies with maternal IDA. Fetal cardiac function was affected more among patients with severe anemia. This study found an increased E/E' ratio in the fetuses of pregnant women with IDA, suggesting decreased fetal heart maturation. Prenatal fetal cardiac evaluation, especially in women with severe anemia, can facilitate a more seamless transition to the postnatal period for these newborns. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Study of placenta histopathology in low birth weight deliveries: A prospective cross-sectional study at Nobel Medical College Teaching Hospital

Background: Placenta is the most important organ that represents the status of the mother and fetus. Its examination on gross and microscopy can reveal varied pregnancy-related diseases, decreasing future adverse pregnancy outcomes. This study aims to examine the placenta histopathologically among low birth weight pregnancies. Materials and methods: A prospective case-control study was conducted in the Department of Pathology over one year. The placenta of low birth weight (weight &lt; 2.5 kg) term pregnancies were histopathologically examined. The maternal demographics, co-morbidity, gravida, and hemoglobin levels were recorded. Descriptive statistics, and student t-test or Chi-square test were used for two-group analysis. Results: Thirty-two consecutive patients enrolled in each group. A significant proportion of the patients in the study group were anemic (9.2 vs. 11.5 gm/dl; p=0.03). Pregnancy-induced hypertension rate was significantly higher in the study group (31% vs. 9%; p = 0.042). Gross observations in low birth weight pregnancies were sub-chorionic fibrin deposition (75%), calcification (37%) and infarction (31%). On microscopy, chorionic vessel thrombosis was significantly higher in the study group (56% vs. 6%; p= 0.003). Furthermore, chorioamnionitis (34%) and placental floor infarction (12%) were also observed in a significantly higher number of placentas in the study group. Conclusions: Anemia and pregnancy-induced hypertension are important associated factors for low birth weight pregnancies. Pathological examinations reveal higher fibrin deposition, infarction, calcification, sub-chronic vessel thrombosis, and chorioamnionitis in low birth weight placenta.

Variables Associated With Favorable Obstetrical Outcomes in Early Pregnancy Bleeding in the Emergency Department.

Background Vaginal bleeding in early pregnancy is a frequent emergency department presentation and is associated with various obstetrical outcomes. Despite this, there has been limited research on the variables that predict less-than-preferred obstetrical outcomes in these cases. This study aims to identify predictors of preferred obstetrical outcomes for women presenting to the emergency department with early pregnancy bleeding. Methods We conducted a retrospective review of health records from an emergency department at a Canadian tertiary care center. Pregnant females presenting with vaginal bleeding before 20 weeks gestation were included. Variables analyzed included maternal age, gravidity, parity, hemoglobin levels, Rh status, cramping, socioeconomic status, and ultrasound findings. The primary outcome was a preferred outcome, defined as a full-term live birth (≥37 weeks). Less-preferred outcomes included miscarriage, preterm birth, and stillbirth. Point-of-care ultrasound and radiology ultrasound findings were also evaluated. Results A total of 422 patients were screened, and 180 were included in the analysis. Overall, 75 (41.7%) patients had a preferred outcome, while 105 (58.3%) had a less-preferred outcome. The strongest predictor of a preferred outcome was the presence of a live intrauterine pregnancy with fetal heartbeat onultrasound, with a preferred outcome rate of 74.5% (56/76) (95% CI 59.8-88.7; p < 0.01) on point-of-care ultrasound (POCUS), and 100% (65/65); p = 0.04 for radiology-performed ultrasound. In contrast, 80.8% (21/26) of patients with findings other than a live intrauterine pregnancy onPOCUS, and 100% (88/88) on radiology-performed ultrasound had a less-preferred outcome. Cramping with bleeding was associated with a higher rate of less-than-preferred outcomes (62.1%, 77/124; 95% CI 54.2-71.1; p = 0.07). Socioeconomic status was not a significant predictor, with similar outcomes above and below the poverty line. Anemia was associated with a 100% non-live birth rate, although only 5 patients were anemic. Conclusion Identification of a live intrauterine pregnancy onultrasound is a strong predictor of a preferred outcome in early pregnancy bleeding. POCUS has the advantage of being immediately available, whereas radiology-performed ultrasound may be more definitive as a predictor. Cramping and anemia may also be associated with less-preferred outcomes, though further research is needed to confirm these findings. These predictors may help guide clinical decision-making and improve counseling for patients presenting to the emergency department with early pregnancy bleeding.

Safety and efficacy of praziquantel in pregnant women infected with Schistosoma haematobium in Lambaréné, Gabon – Clinical results from the randomized, single-blinded, controlled freeBILy-Gabon trial

ObjectivesDespite evidence of praziquantel's (PZQ) safety for treating schistosomiasis in pregnancy, many countries withhold treatment. Only two randomized controlled trials have investigated PZQ in pregnancy, none involving Schistosoma haematobium. MethodsPregnant women during the second trimester in Lambaréné (Gabon) were screened for S. haematobium infection using urine microscopy and circulating anodic antigen detection. Participants positive for either test were randomized (3:1) to single-dose PZQ 40 mg/kg during pregnancy versus no treatment during pregnancy. Investigators were blinded for allocation. Primary outcomes were reduction of egg (egg reduction rate [ERR]) and antigen production (infection reduction rate [IRR]) while explorative outcomes included assessment of cure rate, adverse events, maternal hemoglobin levels, maternal anemia prevalence at delivery, pregnancy outcomes, and newborn anthropometric parameters. ResultsOf 761 women screened 165 were eligible and randomized (intervention n = 124, control n = 41). Of them, 124 completed the study (n = 90 and n = 34, respectively). Treatment led to a significantly higher ERR (95.0% [91-97%] vs 27.0% [−42-63%]) and IRR (95% [91-97%] vs 56% [14-78%]). Common adverse events were dizziness, nausea, and vomiting. Maternal anemia at delivery was significantly lower in the intervention group (odds ratio: 0.40 [0.16;0.96], P = 0.04). No increased risk for adverse pregnancy outcomes was observed. ConclusionsThis first randomized controlled trial investigating PZQ in pregnant women with S. haematobium found PZQ to be safe, effective, and reducing maternal anemia. We recommend treating confirmed infections to prevent morbidity in pregnant women.

Maternal hemoglobin drop in multiple pregnancy is associated with higher gestational age at birth and birthweight.

This retrospective study investigated the hypothesis that maternal hemoglobin (Hb) levels in twin pregnancy fall between the first and second trimesters and that higher falls are associated with higher gestational age at birth and higher birthweight (BW). The study population was defined as pregnant women with twin pregnancies delivering two live, phenotypically normal neonates, after 24+0 weeks of gestation, between October 2009 and September 2021 at an inner London maternity unit. Maternal Hb and mean corpuscular volume (MCV), at ≤14+0 weeks of gestation (Hb1) and again at 20+0-30+0 weeks gestation (Hb2) were recorded from the Hospital's perinatal database. MCV was used as a possible indicator of iron deficiency anemia. The association of Hb drop, defined as [Hb1(adjusted for gestational age) - Hb2], and MCV values with gestational age at birth, BW of both twins and delivery of small for gestational age (SGA) neonates, defined as BW <10th percentile for gestation, was evaluated. 923 pregnant women with twin pregnancies were included. Maternal Hb1 did not correlate with any outcomes measured. However, a lower Hb2 and a larger Hb drop was associated with a higher gestational age at birth (p < 0.001), a larger BW of twin 1 and 2 (p < 0.001 for both) and a reduction in the incidence of delivering one or two SGA neonates (p < 0.001 for both). MCV values did not correlate significantly with these outcomes. This study showed that in twin pregnancy, a larger maternal Hb drop from the first to the second trimester is associated with a higher gestational age at birth and a larger BW. This change may represent a larger plasma volume expansion.

Relationship between ferritin and maternal hemoglobin levels with those of newborns in a public hospital in Lima, Peru

Relationship between ferritin and maternal hemoglobin levels with those of newborns in a public hospital in Lima, Peru

Association of Maternal Lifestyle Factors and Hemoglobin with Low Birth Weight

Background: Low birth weight (LBW) is a major global public health problem and a leading cause of neonatal mortality, as well as a significant risk factor for infant and under-five morbidity and mortality. Objective: The study aimed to determine the association between maternal lifestyle factors and low birth weight, and to investigate the relationship between maternal hemoglobin levels and LBW infants. Methods: A total of 518 samples were included in the study, comprising 259 cases and 259 controls. Data were collected using a standard questionnaire administered through interviews and medical record reviews. The questionnaire covered maternal lifestyle factors and hemoglobin levels. Logistic regression was employed to analyze the associations between maternal lifestyle risk factors, hemoglobin levels, and low birth weight. Descriptive statistics were calculated for each variable, and statistical relationships were assessed using IBM SPSS version 25, with a significance level set at 0.05. Results: The study found that maternal hemoglobin levels (OR=0.742, 95% CI: 0.644-0.855, p&lt;0.001) and gestational age (OR=0.776, 95% CI: 0.696-0.866, p&lt;0.001) were inversely associated with low birth weight. Conversely, previous pregnancies (OR=5.043, 95% CI: 2.004-12.689, p=0.001 for one previous pregnancy), low maternal income (OR=7.156, 95% CI: 2.369-21.617, p&lt;0.001), specific occupations (OR=2.354, 95% CI: 1.416-3.914, p=0.001), and being underweight (OR=26.829, p&lt;0.001) were positively associated with low birth weight. Conclusion: These findings emphasize the importance of considering various socio-economic and health factors in the prevention and management of low birth weight, with a particular focus on maternal occupational status, income, previous pregnancies, gestational age, pregnancy complications, and maternal hemoglobin levels.

Phenotypic changes of γδ T cells in Plasmodium falciparum placental malaria and pregnancy outcomes in women at delivery in Cameroon.

Depending on the microenvironment, γδ T cells may assume characteristics similar to those of Th1, Th2, Th17, regulatory T cells or antigen presenting cells. Despite the wide documentation of the effect of Th1/Th2 balance on pregnancy associated malaria and outcomes, there are no reports on the relationship between γδ T cell phenotype change and Placental Malaria (PM) with pregnancy outcomes. This study sought to investigate the involvement of γδ T cells and its subsets in placental Plasmodium falciparum malaria. In a case-control study conducted in Yaoundé, Cameroon from March 2022 to May 2023, peripheral, placental and cord blood samples were collected from 50 women at delivery (29 PM negative: PM- and 21 PM positive: PM+; as diagnosed by light microscopy). Hemoglobin levels were measured using hemoglobinometer. PBMCs, IVBMCs and CBMCs were isolated using histopaque-1077 and used to characterize total γδ T cell populations and subsets (Vδ1+, Vδ2+, Vδ1-Vδ2-) by flow cytometry. Placental Plasmodium falciparum infection was associated with significant increase in the frequency of total γδ T cells in IVBMC and of the Vδ1+ subset in PBMC and IVBMC, but decreased frequency of the Vδ2+ subset in PBMC and IVBMC. The expression of the activation marker: HLA-DR, and the exhaustion markers (PD1 and TIM3) within total γδ T cells and subsets were significantly up-regulated in PM+ compared to PM- group. The frequency of total γδ T cells in IVBMC, TIM-3 expression within total γδ T cells and subsets in IVBMC, as well as HLA-DR expression within total γδ T cells and Vδ2+ subset in IVBMC were negatively associated with maternal hemoglobin levels. Furthermore, the frequency of total γδ T cells in PBMC and PD1 expression within the Vδ2+ subset in CBMC were negatively associated with birth weight contrary to the frequency of Vδ1-Vδ2- subset in PBMC and HLA-DR expression within the Vδ2+ subset in IVBMC which positively associated with maternal hemoglobin level and birth weight, respectively. The data indicate up-regulation of activated and exhausted γδ T cells in Plasmodium falciparum placental malaria, with effects on pregnancy outcomes including maternal hemoglobin level and birth weight.

Dietary micronutrients intake and its effect on haemoglobin levels of pregnant women for clinic visit in the Mount Cameroon health area: a cross-sectional study.

Nutritional deficiencies and its consequences such as anaemia are frequent among pregnant women residing in under resource settings. Hence, this study sought to investigate specific dietary micronutrient inadequacy and its effect on maternal haemoglobin levels. This institution based cross-sectional survey enrolled 1,014 consenting pregnant women consecutively. Data on socio-demographic, economic and antenatal characteristics were recorded using a structured questionnaire. Minimum dietary diversity for women (MDD-W) was assessed using the 24-h recall method and haemoglobin (Hb) concentration (g/dL) determined using a portable Hb metre. Significant levels between associations was set at p < 0.05. Among those enrolled, 40.9% were anaemic while 89.6% had inadequate dietary nutrient intake. In addition, uptake of blood supplements, haem iron, plant and animal-based foods rich in vitamin A were 71.5, 86.2, 35.5 and 12.6%, respectively. Moreover, anaemia prevalence was significantly (p < 0.05) lower in women who took iron-folic acid along with food groups rich in haem iron (38.5%) or both plant and animal vitamin A (29.0%). Besides, mean maternal Hb levels was significantly (p < 0.001) higher in women who consumed haem iron (11.08 ± 1.35) and vitamin A food groups (11.34 ± 1.30) when compared with their counterparts who did not consume haem iron (10.54 ± 1.19) and vitamin A food groups (10.74 ± 1.31). Dietary uptake of foods rich in haem-iron and vitamin A significantly improves Hb levels in Cameroonian pregnant women. Our findings underscore the importance of improving maternal nutritional awareness and counselling during antenatal period to reduce the anaemia burden.

Effect of HIV and substance use disorder comorbidity on the placenta, fetal and maternal health outcomes: systematic review and meta-analysis protocol

BackgroundSubstance use disorders and HIV infection have a bidirectional relationship. People who use illicit drugs are at increased risk of contracting HIV/AIDS, and people living with HIV/AIDS are at increased...

Intravenous Iron Supplementation in Pregnancy: Comparisons of Dosage and Latency of Infusion Based on a Quality Improvement Project on Maternal Transfusion Reduction [ID 2683380

INTRODUCTION: Optimal dosing of intravenous iron supplementation (IVFe) and latency of the infusion for pregnant patients with iron deficiency anemia has been minimally evaluated. We analyzed the effects of specific IVFe dosage parameters as part of an institution-based protocol on maternal peripartum hemoglobin (Hb) levels stratifying by time of infusion to delivery. METHODS: We reviewed average changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by IVFe dosage forms (800 mg) and infusion latency (by 2-week increments). We excluded patients with known antepartum blood transfusion. Maternal demographics and all comparison groups were analyzed among each other using GraphPad Prism software. RESULTS: Two hundred ninety-five patients met inclusion criteria. Demographics of maternal age, body mass index (BMI), nulliparity, and ferritin levels were similar in all groups. We found a statistically significant difference in improved pre-delivery Hb with larger IVFe doses (P=.002) and longer infusion-delivery periods (P=.049). A Tukey post-hoc test revealed that the highest yield on mean delta Hb was after 6–8 weeks or longer of latency with doses greater than 800 mg versus less than 2 weeks at doses of 800 mg or lower (2.6–3.1 g/dL; P&lt;.0001). CONCLUSION: Latency periods of at least 6 weeks with IVFe dosages of 800 mg or greater, regardless of maternal BMI or starting ferritin, may markedly improve pre-delivery Hb levels and ultimately reduce maternal morbidity hemorrhage complications.

The Interplay of Anemia and Cardiovascular Disease in Pregnant Women and APGAR Scores of their Newborn: A Retrospective Study in Pregnant Women

Objectives: The implications of maternal anemia extend beyond the immediate physiological consequences; moreover, the consequences of maternal anemia are not limited to the mother alone. It may lead to low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores. It, further, adds up to higher incidence of morbidity rates in neonates. The objective of the study is to assess the prevalence and severity of anemia during pregnancy, to establish a correlation between maternal hemoglobin (Hb) levels and APGAR scores in newborns, and determine the association between cardiovascular disease and severity of anemia. Materials and Methods: A retrospective study was conducted at a private medical college in Bareilly from March 2022 to March 2023. The study focused on pregnant females aged 15–49 years who were admitted and delivered within the facilities of the private medical college during this period. Pregnant females with pre-existing chronic conditions affecting Hb levels were excluded from the study. A total of 130 subjects were included in the study, and their Hb levels and APGAR scores at 1 min were considered for analysis. Results: The results show a spearmen rank correlation coefficient (r) = 0.575 between maternal Hb levels and APGAR scores at 1 min, indicating a significant positive relationship (P &lt; 0.05). Infants born to mothers with moderate anemia exhibited the highest prevalence of low APGAR scores (&lt;4), highlighting the potential impact of maternal anemia on immediate neonatal well-being. No significant association was found between cardiovascular diseases in pregnancy and severity of anemia. Conclusion: The findings indicate that the optimization of maternal Hb levels is a critical intervention to ensure a healthier start for the neonate. This study provides a crucial foundation for evidence-based practices in maternal healthcare and neonatal well-being. Focus on improving maternal Hb provides multifaceted benefits both in mothers and neonates.

The Effect of Bangun-Bangun Leaf Juice on Hemoglobin Levels for Postpartum Mother in The Working Area of Puskesmas Talun Kenas

During the puerperium, anemia can occurs in mothers who had lower than nor-mal hemoblobin levels. This condition could caused iron loss, onterfere with the lactatio process, anda cause the uterus to fail to contract because not enough blood enters oxygen to the uterus. The strongest factor causing post partum ane-mia was blood loss during delivery, both moderate and large. Events that cause the mother to lose moderate to large amounts of blood, nameli interventions dur-ing labor such as episiotomy, delivery using a vacuum; third or fourth degree perineal laceration; and caesarean section. The provision of non-drug therapy that can be given to increase hemoglobin levels was to provide iron containing nutrients. The research aim to determine the effect of bangun-bangun leaf juice on hemoglobin levels for postpartum mother in the Working area of Puskesmas Talun Kenas. This research was a type of quantitative research that is quasi-experiment. The population of this study is all postpartummothers in the work area of Puskesmas Talun Kenas. The samples obtained were 25 people with accidental sampling technique. The statistical test used was the paired sample t test, with a 95% confidence level (? = 0,05). The results of this study indicate that there is an effect of bangun-bangun leaf juice on hemoglobin levels in postpartum mothersin the working area of Puskesmas Talun Kenas (p vaue 0,000). So it was expected that the health center could informed the mother about the benefits of bangun-bangun leaf juice in increasing maternal hemoglobin levels during the postpartum period which can informed during antenatal care visits or during home visits for postpartum mother.

Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study.

The University Hospital Basel implemented delayed umbilical cord clamping of 30-60 s in all laboring women on April 1, 2020. This practice has been widely researched showing substantial benefit for the neonate. Few studies focused on maternal blood loss. The objective of our retrospective comparative study was to assess the impact of immediate vs. delayed cord clamping on maternal blood loss in primary scheduled cesarean sections. We analyzed data of 98 women with singleton gestations undergoing primary scheduled cesarean section at term. Data from procedures with early cord clamping (ECC) were compared to those after implementation of delayed cord clamping (DCC). Primary outcomes were perioperative change in maternal hemoglobin levels, estimated and calculated blood loss. Secondary outcomes included duration of cesarean section and neonatal data. There was a statistically significant difference in the mean perioperative decline of hemoglobin of 10.4 g/L (SD=7.92) and 18.7 g/L (SD=10.4) between the ECC and DCC group, respectively (p<0.001). The estimated (482 mL in ECC vs. 566 mL in DCC (p=0.011)) and the calculated blood loss (438 mL in ECC vs. 715 mL in DCC (p=0.002)) also differed significantly. Secondary outcomes showed no significant differences. In our study DCC resulted in a statistically significant higher maternal blood loss. In our opinion the widely researched neonatal benefit of DCC outweighs the risk of higher maternal blood loss in low-risk patients. However, maternal risks must be minimized, improvements to preoperative blood management and operative techniques are required.

Prevention of Malaria in Pregnant Women and Its Effects on Maternal and Child Health, the Case of Centre Hospitalier de Kingasani II in the Democratic Republic of the Congo.

This study aimed to evaluate scientific evidence of the benefit of the use of insecticide-treated nets (ITNs) and Intermittent preventive treatment (IPT) on the birth weight of newborns and the hemoglobin level of the mother when used to prevent malaria during pregnancy. This cross-sectional analytical study was conducted on 467 hospitalized women in the Maternity Ward of Centre Hospitalier de Kingasani II, in the Democratic Republic of the Congo. Data were collected using a structured questionnaire that was pre-tested during a face-to-face interview. Apart from basic statistics, the chi-square test was used to compare proportions. Multivariate analysis (logistic regression) was used to identify variables significantly associated with the 95% confidence interval (CI). The ITN ownership rate was 81% (95% CI: 77-84) and the ITN use rate was 66% (95% CI: 62-70). Sixty-five percent (95% CI: 60-69) reported having received at least three doses of IPT during pregnancy with sulfadoxine-pyramethemine (IPTp-SP). There was a statistically significant difference in hemoglobin levels between hospitalized women who did not use the ITN (9.4 g/dL IIQ: 8.7-9.9) and those who did (11 g/dL IIQ: 9.8-12.2). The non-use of the ITN was associated with low birth weight (aOR = 3.6; 95% CI: 2.1-6.2; p < 0.001) and anemia in pregnant women (cOR = 2.41; 95% CI: 1.16-5.01; p = 0.018). The use of ITN and taking at least three doses of ITP during pregnancy are associated with good birth weight. The number of doses of IPTp received during antenatal care is associated with the maternal hemoglobin level in the third trimester of pregnancy.