Maternal Hemoglobin Levels Research Articles

MATERNAL RISK FACTORS OF LOW BIRTH WEIGHT (LBW): SYSTEMATIC REVIEW

Abstract Background: Low Birth Weight Babies (LBW) accounts for 60 - 80% of all neonatal deaths in the world. Not the only major predictor of mortality and morbidity in neonates, individuals with a history of LBW have a greater risk of experiencing various diseases such as hypertension, heart disease, and diabetes later in life. This systematic review study aims to identify maternal risk factors that contributing to LBW Method: Articles published between 2015 - 2020 in the Science Direct, Scopus and Cochrane library databases are systematically reviewed. Eleven articles that met the inclusion and exclusion criteria were included as samples for further review. Results regarding maternal risk factors for LBW events are synthesized systematically .Results: From the search results, there were 818 articles, after the screening process, the final results were 11 articles. Risk factors that are significantly related to LBW incidence in the article, are grouped in the subtheme, include: maternal age (<20 years, and each increase in age), parity (primipara and grandemultipara), low maternal upper arm circumference, hemoglobin levels less than 11 gr / dl, gestational age below 37 weeks, and complications during pregnancy. Conclusion: maternal age, parity, arm circumference, hemoglobin level, gestational age, and complications during pregnancy were significaly found to be maternal risk factors for LBW.

The Impact of Multiple Micronutrient Supplementation on Hemoglobin Concentration in Pregnant and Neonatal Birth Wight

Background: Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. Global data shows that 56% of pregnant women in low- and middle-income countries have anemia. Every year more than 20 million infants are born with low birth weigh t(LBW) worldwide.
 Objective: To analyze the impact of Multi Micronutrients (MM) supplementation on hemoglobin (Hb) levels of pregnant women and infant birth weight.
 Method: The databases used to obtain the literature were PubMed, ScienceDirect, MEDLINE, and PubMed Central. The keywords used were Multiple Micronutrien Supplementation, Hemoglobin, Pregnant and Neonatal Birth Weght in studies published from 2010 to 2020. A total of 14 articles were used in this review.
 Results: Seven articles obtained about the effects of multiple micronutrients on hemoglobin levels in pregnant women. Six studies support that MM supplementation increases hemoglobin levels or prevents pregnant women from anemia. One study showed a significant increase in serum ferritin One study reported ferritin levels in the MM group as well as the fe-folic acid group did not experience a significant decrease. There is only one study that shows the opposite results, which the mean maternal hemoglobin level significantly decreased during study, being the lowest in second trimester. Ferritin and serum iron levels were decreased at trimester one and two, also the zinc and vitamin D level declined. Seven articles show the effect of MM supplementation on pregnancy outcomes is better than Fe-folic acid supplementation. This can be seen in the results reported from various studies that have been carried out, which are reduce the incidence of LBW, small for gestational age, preterm labor. stillbirths, and NTD anomaly.
 Conclusion: Various empirical evidence that has been described in this paper confirms the plausibility that the provision of micronutrient supplementation in the periconceptional period is more important than only given during advanced pregnancy. Multi micronutrient administration increases hemoglobin levels in pregnant women and improves pregnancy outcomes

Low-Hemoglobin Levels During Pregnancy with Low-Birth Weight: A Systematic Review and Meta-Analysis

Introduction: Low birth weight (LBW) is one of the main risk factors for neonatal morbidity and mortality. Anemia in developing countries is still quite high compared to developed countries. Low hemoglobin levels in pregnancy can affect the birth of low birth weight babies.Methods: This study used a systematic review method. Studies published between 2015 and 2019. Search for articles was reviewed systematically through Scopus, ScienceDirect, Cochrane, and PubMed databases. The final results obtained 10 articles following the inclusion and exclusion criteria. Calculation result using Meta-Analysis with help of Comprehensive Meta-Analysis (CMA) software.Results: Compare the odds ratio and confidence interval of hemoglobin levels compared to low birth weight events. The results obtained OR 1.449 (95% CI 0.964 – 2.177) and p-Value 0.074 so that there is no relationship of hemoglobin levels in pregnant women ≤ 11gr / dL with the incidence of low birth weight babies. In the heterogeneity test results, I-Squared results obtained by 79.191%, which indicates the value of I-squared heterogeneity> 50% so that the sample used is heterogeneous. Maternal age less than 20 years or more than 35 years, number of parity, pregnancy spacing, and number of problems in the assessment of pregnancy and previous labor.Conclusion: There is no correlation between low maternal hemoglobin levels with the incidence of low birth weight because there are other factors that can affect outcomes such as different respondent characteristics, number of samples, different research countries, different trimester of pregnancy and other factors that can cause research bias.

HUBUNGAN USIA IBU DENGAN TINGKAT HEMOGLOBIN WANITA HAMIL TRIMESTER KETIGA DAN BERAT LAHIR DI RSAL DR. R. OETOJO SORONG TAHUN 2019

Relationship Between Maternal Age and Hemoglobin Levels of Third Trimester Pregnant Women And Birth Weight In RSAL Dr. R. Oetojo Sorong In 2019 Background: The Sustainable Development Goals (SDGs) in the health and welfare sector (SDGs 3), have a target to be achieved in 2030 to reduce the Infant Mortality Rate to 24 per 1,000 live births. Most cases of infant mortality occurred in the City of Sorong with 36 cases of infant mortality in 2018. Birth weight is an indicator of newborn health. Several factors affect birth weight, including age and hemoglobin levels of pregnant women. Objective : This study was to determine the relationship between maternal age and hemoglobin levels of third trimester pregnant women with birth weight at RSAL dr. R Oetojo Sorong in 2019. Methods: This study used a cross sectional design, a sample size of 173 respondents, the sampling technique used the simple random sampling method. Master table research instrument with data analysis using the chi square statistical test. Results: It showed that 14 mothers (35.0%) of reproductive age were at risk of giving birth to babies with abnormal birth weight. Analysis of the relationship between maternal age and birth weight (p = 0.000). Analysis of the relationship between hemoglobin levels of third trimester pregnant women with birth weight (p = 0.335). Conclusion: There is a relationship between maternal age and birth weight. There is no correlation between hemoglobin levels of third trimester pregnant women and birth weight at RSAL dr. R Oetojo Sorong in 2019.

Prevalence of Asymptomatic Bacteriuria among Pregnant Women At Damietta Governorate, Egypt

Background:Asymptomatic bacteriuria during pregnancy is a main health problem, which is related to an increased risk of maternal and fetal morbidity. Aim of the Work:To estimate incidence of asymptomatic bacteriuria among pregnant females at Damietta Governorate, Egypt. Patients and Methods:Five hundred randomly selected pregnant females attending antenatal care units at Damietta Governorate during the period July, first, 2019 – January 31st, 2021. All participants were subjected to full history taking, complete blood count as well as urine culture and bacterial count. Result:A relatively high incidence of asymptomatic bacteriuria [13.8%] was revealed among participants in whom the most causative organism was Escherichia coli. The rate was lower among pregnant women with a high social standard and during the first trimester. Maternal age, parity, education level, or hemoglobin level, on the other hand, had no significant relationship . Conclusion: Screening of asymptomatic bacteriuria in pregnancy must be added to routinely antenatal care investigations and doing another studies on a wider scope are recommended.

Risk factors associated with spontaneous abortion in Dr. Soetomo General Hospital Surabaya: a case-control study

The Maternal Mortality Ratio (MMR) in Indonesia is still fairly high. One of the top three causes of maternal death is bleeding. Spontaneous abortion is an early pregnancy problem leading to the occurrence of bleeding and direct maternal death. The causes of spontaneous abortion vary and can be caused by multiple factors. Early identification of risk factors is necessary to reduce mortality and morbidity due to spontaneous abortion and its complications. This study's objective was to identify the risk factors of spontaneous abortion in Dr. Soetomo General Hospital. This study was an observational analytic with a case-control approach. The population was all pregnant women hospitalized at the Obstetrics and Gynaecology Department in Dr. Soetomo General Hospital from January 2017 to December 2018. The samples were 120 in total, included 40 cases and 80 controls taken by consecutive sampling. The data were analyzed using univariate and bivariate analysis with the Chi-square test. The results based on the bivariate analysis showed history of previous abortion (p <0.001), chronic maternal disease (p <0.001), hemoglobin levels (p = 0.020), maternal age (p= 0.026), gravidity (p= 0.036), and infection (p= 0.037) had significant correlation with spontaneous abortion. In conclusion, risk factors associated with spontaneous abortion in Dr. Soetomo General Hospital were history of previous abortion, chronic maternal disease, anemia, advanced maternal age, multigravidity, and infection. Positive pregnancy outcomes are expected to play a role in reducing MMR in Indonesia. Therefore, high-risk pregnant women are suggested to carry out regular Antenatal care recommendations with intensive supervision.

Early versus delayed cord clamping in term neonates.

Objective: To compare mean hemoglobin levels of neonates after early and late cord clamping. Study Design: Randomized Controlled Trial. Setting: Department of Obstetrics & Gynaecology at Nishtar Hospital Multan. Period: June 2019 to December 2019. Material & Methods: A total of 60 women booked and unbooked were included in study. Selected patients randomized into group A and B, each group comprising of 30 patients depending upon the envelope with assigned treatment (either early or delayed cord clamping) picked up by the patient. Results: In present study, two groups were made. Group A consisted of 30 neonates in whom early cord clamping was done while in group B delayed clamping was done in 30 neonates. Mean age of mothers was 28.4±0.4 vs. 28.6±0.5 years in group A and B respectively. There were 25 mothers (83.3%) in group A and 21 mothers (70%) in group B between 25–30 years. There were 5 mothers (16.7%) in group A and 8 mothers (26.7%) in group B between 31–35 years of age. While none of the mother in group A and 1 mother (3.3%) in group B was between 36–40 years of age. Mean parity of the mothers was 1.1±0.2 vs. 1.4±0.2 in group A and B respectively. Eight mothers (85.4%) in group A and 7 mothers (82.5%) in group B were primipara. While 22 mothers (14.6%) in group A and 23 mothers in group B (17.5%) were para 1–3. Gestational age was 37–38 weeks in 13(43.3%) vs. 19(63.3%) women in group A and B respectively. While there were 17(56.7%) vs. 11(36.7%) women in group A and B respectively of the gestational age 39–40 weeks. Pre-delivery maternal mean hemoglobin levels was 11.9±0.1 gm/dl vs. 12.3±0.1 gm/dl in group A and B respectively. Pre-delivery maternal hemoglobin levels were 10–10.9 g/dl in 2 mothers (6.7%) vs. 1 mother (3.3%) in group A and B respectively. Neonatal mean hemoglobin levels were 16.8±0.2 g/dl vs. 17.7±0.1 g/dl in group A and B respectively. Out of the 31 booked mothers, neonatal mean hemoglobin level was 16.8±0.2 g/dl vs. 17.9±0.1 g/dl in group A and B respectively. While out of the 29 unbooked mothers, neonatal mean hemoglobin level was 16.7±0.2 g/dl vs. 17.5±0.1 g/dl in group A and B respectively. When compared the neonatal mean hemoglobin levels, there was significant difference between mean hemoglobin levels of neonates between the two groups (p=0.000). Conclusion: Delayed cord clamping in term neonates for a minimum of 2 minutes at birth is beneficial to the newborn in terms of improved hemoglobin levels. There is no significant difference seen in pre-delivery maternal hemoglobin levels and neonatal hemoglobin either in delayed cord clamping group or in early cord clamping group.

A COMPARATIVE STUDY BETWEEN GENERAL AND SPINAL ANESTHESIA REGARDING MATERNAL BLOOD INDICES CHANGES AFTER LOW RISKY ELECTIVE CEASAREAN SECTION (A PROSPECTIVE CONTROLLED RANDOMIZED STUDY)

ABSTRACT Background: Delivery by ceasarean section is one of the most common surgical procedures nowadays. However, Choosing of anesthesia is a matter of controversy among obstetrician. Objective: To study the effect of two types of anesthesia on maternal hemoglobin and hematocrit level after elective cesarean section. Patients and methods: This was a randomized controlled study done at Sayed Galal University hospital and private centers (Tbarak Private Hospital Group) including 100 pregnant women underwent elective first time ceasarean section for variables causes. Changes in maternal hemoglobin and hematocrit indices were measured. Result: There was statistically significant difference between both groups after 48th hour post ceasarean section. Mean 48 hours postoperative hemoglobin and hematocrit parameter differences were significantly lower in the group with spinal anesthesia. Conclusion: Spinal anesthesia was better and has a greater advantage for maternal condition than general anesthesia as regard post-operative blood indices changes. So, whenever it is not contraindicated, spinal anesthesia should be recommended for elective ceasarean section.

Maternal iron status during early pregnancy and school‐age, lung function, asthma, and allergy: The Generation R Study

BackgroundIron deficiency during early life could affect the developing lung and immune system, and influence child's respiratory or allergy outcomes in later life.ObjectiveTo examine the associations of maternal iron status during early pregnancy with child's lung function, asthma, inhalant allergic sensitization, and physician‐diagnosed inhalant allergy at school‐age.MethodsIn a population‐based cohort study, among 3825 mother–child pairs, ferritin, transferrin concentrations, and transferrin saturation were measured from maternal venous blood samples during early pregnancy. In children at the age of 10 years, spirometry was used to determine child's lung function, current asthma and physician‐diagnosed inhalant allergy were assessed by questionnaires, and inhalant allergic sensitization was measured by skin prick tests. We used multivariable regression models to examine the associations.ResultsAfter adjustment for gestational age at maternal iron status measurement and sociodemographic or lifestyle‐related confounders, a higher maternal transferrin concentration was associated with a higher risk of physician‐diagnosed inhalant allergy (odds ratio [95% confidence interval]: 1.13 [1.01 to1.26]), but not with lung function, asthma, or inhalant allergic sensitization. This association did not attenuate after further adjustment for maternal hemoglobin levels or early growth factors. We observed no consistent association of maternal ferritin concentrations or transferrin saturation with child's respiratory or allergy outcomes.ConclusionHigher maternal transferrin concentrations during pregnancy, reflecting lower serum iron levels, were associated with an increased risk of child's physician‐diagnosed inhalant allergy but not lung outcomes. Underlying mechanisms and clinical implications need to be explored.

Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study.

Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a HemoCue Hb201+ system. Birth weight, placental weight, one- and five-minute APGAR scores, American Society of Anesthesiologists physical state classification, maternal age, and maternal height were also recorded. Relationships between maternal and cord blood hemoglobin levels with placental weight, birth weight, and birth weight to placental weight ratio were the main outcome measures. Results: A total of 182 subjects were included in the analysis. Regression analysis showed that cord blood hemoglobin, but not maternal hemoglobin, was inversely related with placental weight (β = −2.4, p = 0.001) and positively related with the birth weight to placental weight ratio (β = 0.015, p = 0.001 and p = 0.63, respectively). Conclusions: Our findings suggest that measuring cord blood hemoglobin levels, rather than maternal hemoglobin levels, may provide important diagnostic information about in utero fetal adaptation to suboptimal placental function and neonatal health.

Association of Hemoglobin and Hematocrit Levels during Pregnancy and Maternal Dietary Iron Intake with Allergic Diseases in Children: The Japan Environment and Children's Study (JECS).

Few epidemiologic studies have examined the role of maternal iron status in allergic diseases in offspring and findings have been inconsistent. We used a large birth cohort in Japan to explore the association of the markers for maternal iron status (maternal hemoglobin, hematocrit and dietary iron intake during pregnancy) with allergy development in offspring during early childhood. We analyzed information on children age 0–3 years from the Japan Environment and Children’s Study (JECS). We used logistic models and generalized estimating equation models to evaluate the effect of maternal hemoglobin and hematocrit levels and dietary iron intake on allergies in children. Models were also fitted with propensity score-matched datasets. Data were collected for a total of 91,247 mother–child pairs. The prevalence (95% confidence interval) of low hemoglobin and hematocrit was 14.0% (13.7–14.2%) and 12.5% (12.3–12.8%), respectively. After adjusting confounders, low hemoglobin and hematocrit during pregnancy were not associated with childhood allergic outcomes. Findings from models with propensity score-matched datasets also indicated that children born to mothers with low hemoglobin or hematocrit levels during pregnancy did not have a higher risk of developing allergic conditions at 3 years old. We found no meaningful associations between low energy adjusted maternal dietary iron intake and allergies in children. In conclusion, using birth cohort data, we found no evidence supporting an association of low maternal hemoglobin, hematocrit and low dietary iron intake with allergy symptoms during early childhood. Further studies with more suitable proxy markers for blood iron status are needed.

Maternal haemoglobin levels in pregnancy and child DNA methylation: a study in the pregnancy and childhood epigenetics consortium

ABSTRACT Altered maternal haemoglobin levels during pregnancy are associated with pre-clinical and clinical conditions affecting the fetus. Evidence from animal models suggests that these associations may be partially explained by differential DNA methylation in the newborn with possible long-term consequences. To test this in humans, we meta-analyzed the epigenome-wide associations of maternal haemoglobin levels during pregnancy with offspring DNA methylation in 3,967 newborn cord blood and 1,534 children and 1,962 adolescent whole-blood samples derived from 10 cohorts. DNA methylation was measured using Illumina Infinium Methylation 450K or MethylationEPIC arrays covering 450,000 and 850,000 methylation sites, respectively. There was no statistical support for the association of maternal haemoglobin levels with offspring DNA methylation either at individual methylation sites or clustered in regions. For most participants, maternal haemoglobin levels were within the normal range in the current study, whereas adverse perinatal outcomes often arise at the extremes. Thus, this study does not rule out the possibility that associations with offspring DNA methylation might be seen in studies with more extreme maternal haemoglobin levels.

Impact of placental malaria on maternal, placental and fetal cord responses and its role in pregnancy outcomes in women from Blue Nile State, Sudan

BackgroundThe sequestration of Plasmodium falciparum infected cells in the placenta results in placental malaria (PM). It activates the mother's immune cells and induces secretion of inflammatory cytokines, which might influence pregnancy outcomes. This study aims to investigate the cytokines (levels IL-4, IL-6, IL-10, IL-17A, and INF γ) in maternal peripheral, placental, and umbilical cord blood in response to PM and the extent to which this may influence maternal haemoglobin levels and birth weight.MethodsA total of 185 consenting Sudanese women from Blue Nile State were enrolled at delivery time in a cross-sectional study conducted between Jan 2012-Dec 2015. Malaria infection in the collected maternal peripheral, placental, umbilical cord samples was determined microscopically, and ELISA was used to measure the plasma levels IL-4, IL-6, IL-10, IL-17A, and INF γ in the collected positive and negative malaria samples.ResultsElevated levels of IL-4 and IL-10 and reduced levels of IL-6 were detected in the malaria positive samples in comparison to the negative ones in the three types of the samples investigated. Maternal, IL-4 and IL-10 were significantly higher in the samples collected from the PM infected group compared to the non-infected control (P < 0.001). While the absence of PM was significantly associated with the IL-6 and maternal IFN-γ levels, maternal IL-17A, placental and umbilical cord IFN-γ levels showed no significant difference (P = 0.214, P = 0.065, P = 0.536, respectively) due to infection. Haemoglobin level and birth weight were increased in the group with high levels of IL-6 and IL-17A, but not in the group with IL-4 and IL-10 levels. While significantly negative correlation was found between IFN-γ levels and birth weight for all three types of samples, only maternal peripheral IFN-γ level was significantly positively correlated with maternal haemoglobin (r = 0.171, P = 0.020).ConclusionThese results suggest that PM induces mother’s immune response and impairs her cytokine profile, which might alter maternal haemoglobin levels and the baby's birth weight.

Can requirement for blood transfusion be predicted before delivery? Analysis of risk factors for blood transfusion in patients with postpartumhemorrhage

Background: The most frequent cause of maternal deaths in developing countries is severe postpartum hemorrhage. We aimed to determine the risk factors affecting blood and/or blood product transfusion in patients with postpartum hemorrhage who were admitted to intensive care unit and to reveal clinical outcomes. Methods: After local ethics committee approval, this retrospective study included patients monitored due to postpartum hemorrhage in the 2nd stage intensive care between 1 January 2019–1 January 2020. Patients were divided into two groups as those requiring transfusion (n = 156) and those not requiring transfusion (n = 162). Patients data such as age, blood group, pregnancy week, gravida, parity, previous cesarean history, maternal comorbidity were recorded. The form of delivery, trial of labor, cesarean type, indications, anesthesia type, multiple pregnancy, placental anomalies and predelivery hemoglobin were noteded. The amount of blood products used were identified. Results: High parity (P = 0.002), normal vaginal delivery rate (P &lt; 0.001), primary cesarian delivery (P &lt; 0.001), pre-delivery maternal comorbidity rate (P &lt; 0.001) and low prepartum blood hemoglobin levels (P &lt; 0.001) were statistically significant factors for transfusion. The rates of those with trial of labor, instrumental delivery, intrauterine fetal death, emergency cesarean and general anesthesia were high in blood transfusion group (P values 0.018, 0.024, 0.015, 0.001 and &lt;0.001 respectively). In multivariate logistic regression analysis, positive correlations were identified between parity (aOR: 0.258), gravida (aOR: 1.452) and general anesthesia (aOR: 3.113) with postpartum blood transfusion. Antenatal hemoglobin level (aOR: 0.506) had negative correlation with blood transfusion. Conclusions: Among patients with postpartum hemorrhage, we were able to identify risk factors which predispose peripartum blood transfusion and developed a prediction model with good discrimination.

Maternal Effects of Immediate versus Delayed Umbilical Cord Clamping: A Randomized Clinical Trial

OBJECTIVE: To compare maternal preoperative and postoperative hemoglobin variation after cord clamping. METHODS: Randomized clinical trial performed in Porto Alegre, RS from January to December 2012. It was included 356 women with habitual risk gestations. In the immediate cord clamping group, the umbilical cord section was realized between 0 and 60 s (group 1) while in the delayed cord clamping group it was realized >60 s (group 2). RESULTS: The mean (±standard deviation [SD]) preoperative hemoglobin was 12.13 ± 1.06 in the group 1 and 12.13 ± 1.11 in the group 2. The mean (±SD) postoperative day 2 hemoglobin level was 10.19 ± 1.46 in the group 1 and 10.24 ± 1.42 in the group 2. CONCLUSIONS: Delayed umbilical cord clamping resulted in a similar maternal hemoglobin level reduction at postoperative day 2.

HUBUNGAN KADAR HEMOGLOBIN IBU HAMIL DENGAN BERAT BAYI LAHIR

Weight is an indicator of a newborn baby. Lower and excess newborn weight has higher risk of getting problems. The cause is nutritional problems; one of them is nutritional experienced by pregnant women with the lower hemoglobin level in the blood. The research was conducted at Independence Midwifery Practice of Dr. Putu Mastiningsih, S.ST., M.Biomed in Blahkiuh, Abiansemal, Badung, Bali. This research was descriptive analytical research with cross sectional design to investigate the correlation between maternal hemoglobin level and newborn weight. The subject of this research was maternal mother who did regular examination until having labor in 2019. The collected data were maternal hemoglobin level and newborn weight. The result of this research showed the characteristics of the respondents based on age, education, and occupation in 2019 was 97 respondents (78.9%) were in the age of 20 – 35 years old, 56 respondents (45.4.%) had middle-level of education, and 78 respondents (63.4%) were working. The bivariate analysis showed that there was a correlation between hemoglobin level and newborn weight by using Chi-square test and obtained p (0.000) &lt; ? (0.05).

Do Antibodies to Malaria Surface Antigens Play a Role in Protecting Mothers From Maternal Anemia?

Pregnancy-associated malaria (PAM) caused by Plasmodium falciparum can result in detrimental outcomes for both mother and infant, including low infant birth weight, preterm birth, maternal anemia, spontaneous abortion, and maternal and/or infant mortality. Maternal anemia is a particularly complex outcome, as the body must both maintain erythropoiesis and tolerance of the growing fetus, while directing a Th1 response against the parasite. Underlying the pathogenesis of PAM is the expression of variant surface antigens (VSAPAM) on the surface of infected red blood cells (iRBC) that mediate sequestration of the iRBC in the placenta. Naturally acquired antibodies to VSAPAM can block sequestration and activate opsonic phagocytosis, both associated with improved pregnancy outcomes. In this review, we ask whether VSAPAM antibodies can also protect mothers against malarial anemia. Studies were identified where VSAPAM antibody titres and/or function were associated with higher maternal hemoglobin levels, thus supporting additional protective mechanisms for these antibodies against PAM. Yet these associations were not widely observed, and many studies reported no association between protection from maternal anemia and VSAPAM antibodies. We discuss the epidemiological, biological and technical factors that may explain some of the variability among these studies. We appraise the current evidence of these complex interactions between PAM-specific immunity and maternal anemia, propose potential mechanisms, and discuss knowledge gaps.

Maternal Hemoglobin Concentration and Pregnancy Outcome in a Sample of Iraqi Women

Aim of study: To analyze the maternal and perinatal outcome in varying degree of anemia and assess whichlevel of hemoglobin concentration has best pregnancy outcome in Iraqi women.Patients and Method: A cohort study that was conducted at Al-Elwiya Maternity Teaching Hospital duringthe period from 1st of Dec 2017 till end of Dec 2019. It included 500 pregnant women who were followedup in labor until delivery and their maternal and perinatal outcome were noted. Hemoglobin and MCV ofeach pregnant woman were measured at late second and third trimester. Hemoglobin groups were relatedto the maternal characteristics, delivery characteristics and pregnancy outcome. The patients underwent acomplete blood count, blood film examination and hematocrit estimation.Results: In this study, 33.4 % of study participants had mild anemia and 22% of them had normal hemoglobinand MCV. Incidence of adverse perinatal outcome was 32.6% and adverse maternal outcome was 11.8%.Maternal hemoglobin and MCV levels are significantly affected by mother’s age. Hemoglobin level is alsoaffected by parity while MCV level doesn’t. Low maternal hemoglobin was associated with increased riskof poor birth outcomes including LBW, preterm birth and adverse maternal health outcomes, includingcesarean section and induction of labor.Conclusion: Maternal anemia is strongly associated with several different types of maternal morbidity andperinatal morbidity.

Maternal nutritional status during pregnancy as a predictor of Ponderal index and body proportionality at birth, in term neonates

Background: It is well established that maternal body mass index (BMI) and haemoglobin (Hb) level has an impact on foetal growth. Various studies have concluded that intrauterine growth as reflected by the Ponderal index (PI) is strongly influenced by various maternal factors. Therefore, we undertake this study to address the evidence gap to establish the strength of association between maternal nutritional status as indicated by her pre-pregnancy BMI and haemoglobin levels and neonatal PI.Methods: A hospital based cross-sectional, observational study was conducted that included 236 normal newborns and their mothers. A predesigned questionnaire was used to collect relevant socio-demographic data and obstetric history. Details regarding the maternal pre-pregnancy weight were collected from antenatal records, maternal height was measured and BMI was calculated. Neonatal birth weight and recumbent length was measured. PI was calculated and co-related with the maternal BMI and haemoglobin values.Results: 11.9% of the mothers were underweight and 51.3% had normal BMI. Majority of the mothers (62.7%) had normal Hb levels and 0.4% were found to have severe anemia (Hb &lt;7 mg/dl). We saw a significant positive correlation (p&lt;0.05) between BMI and birth weight, BMI and PI that is, with decrease in BMI there was a significant decrease in the birth weight and PI of the newborn. There was no significant correlation between haemoglobin level and PI.Conclusions: Our study showed a positive association between maternal pre-pregnancy BMI and birth weight, BMI and PI. Therefore, interventions aimed at improving the nutritional status of the mother have a direct impact on the foetal growth outcomes.

The Effect of Application Anemia Management Module On Improving Maternal Behaviors and Hemoglobin Level among Pregnant Women with Anemia

Lack of knowledge of mothers on the importance of iron tablet consumption impact on compliance. So that the iron requirement is not fulfilled and the effect of anemia. Countermeasures to raise awareness and behavior to increase hemoglobin levels. Educational modules consisted of information regarding pregnancy and the importance of anemia Fe tablet consumption. The study aimed to examine the effect of the anemia management module to change mothers' behavior in improving hemoglobin levels. A quasi-experimental study pretest-posttest with a non-equivalent control group was applied in this study, with a purposive sampling technique, where the intervention and control groups, respectively, 14 people. The data were analyzed using an independent t-test. Furthermore, to determine the effect of continued modules using linear regression. The intervention effect on knowledge, attitudes, actions by the p-value of 0.00, but it does not directly influence HB's p-value 0.231 (&gt; 0.05). With its application for 30 days with biweekly visits, the anemia management module effectively changes the mother's behavior to improve knowledge, attitudes, actions, and modules that do not directly influence Hb's increase. Use of the anemia management module as companion media education of health workers, especially in the range of PHC