Non-anemic Women Research Articles

Determinants of anemia among pregnant women attending antenatal care in Horo Guduru Wollega Zone, West Ethiopia: Unmatched case-control study.

Anemia is a common clinical problem contributing to increased maternal and fetal morbidity and mortality during pregnancy. Anemia can be caused by different factors apart from known diseases. The main aim of this study was to identify determinants of anemia among pregnant women attending antenatal care at the public health facilities of Horo Guduru Wollega Zone, West Ethiopia, 2017. Health facility-based unmatched case-control study was conducted among 191 anemic and 382 non-anemic pregnant women from September 7, 2017, to October 25, 2017, in Horo Guduru Wollega Zone, West Ethiopia. Data were collected using pre-tested questionnaires from nine health facilities. Hemoglobin level determination, hemo-parasite diagnosis, venereal disease research laboratory (VDRL) test, and stool examination were done in the laboratories of the respective health centers. Cleaned and coded data were entered and analyzed using SPSS version 20. Frequency, proportion, mean and standard deviation were computed to summarize the data and presented by tables and bar graphs. Multivariate binary logistic regression analysis was used to determine the association of predictors and response variables at P ≤ 0.05. Adjusted odds ratio with 95% CI was used to show the strength of association between predictors and outcome variables. A total of 573 pregnant women were enrolled in this study. Monthly income < 500 Ethiopian birr (AOR = 9.16, 95% CI: 4.23, 19.82), heavy menstrual bleeding (AOR = 2.38, 95%CI: 1.38, 4.09), taking iron supplement irregularly (AOR = 2.87, 95%CI:1.41, 5.84), Mid-upper Arm Circumference (MUAC) < 23 cm (AOR = 3.42, 95%CI: 2.07, 5.63), low dietary diversity score (AOR = 12.30, 95%CI: 4.64, 32.72), medium dietary diversity score (AOR = 3.40, 95%CI:1.48, 7.84) and intestinal helminthic infections (AOR = 6.31, 95%CI: 3.44, 11.58) were significantly associated with anemia during pregnancy. Average monthly income < 500 Ethiopian birr, heavy menstrual bleeding, low and medium dietary diversity score, taking of iron supplements irregularly, MUAC < 23 cm and intestinal helminthic infections were identified as independent determinants of anemia during pregnancy. Therefore, improving dietary diversity intake, routine deworming and empowering women on taking iron regularly are vital to prevent anemia during pregnancy.

Anemia Prevalence after Iron Supplementation among Pregnant Women in Midwifes Practice of Primary Health Care Facilities in Eastern Indonesia.

Background Iron deficiency anemia (IDA) in pregnant women is common, and iron supplementation is given during pregnancy to reduce birth complication. This study aimed to explore the prevalence of anemia and type of anemia after iron supplementation among pregnant women in the eastern part of Indonesia. Methods A cross-sectional study design was conducted between January and March 2019 in three Primary Health Care (PHC) facilities at Kupang, West Timor. After consent, pregnant women who had taken their iron supplementation for at least 3 months were asked for iron pills intake by using a self-designed questionnaire and by counting the pills leftover. Complete blood count examination was performed, and the type of anemia was assessed using Shine and Lal index (SLI; MCV ∗ MCV ∗ MCH/100) to determine whether anemia was due to iron deficiency or β-thalassemia trait (β-TT). In a subset of iron tablets distributed in the PHCs, Fe-concentration was measured. Results Of 102 pregnant women included, only 25.5% had taken the pills with a pill count of >80%. Interestingly, Fe-concentration in the pills from three different PHC facilities varied between 75% and 100%. After iron supplementation, however, anemia was detected in 34.3%, and based on SLI, 14.7% was suspected because of iron deficiency and 19.6% was suspective of β-TT. Of note, nonanemic pregnant women (17.6%) had also low SLI, suggesting β-TT or other hemoglobinopathies. Conclusion Assessment of Shine and Lal index as the first step to screen the type of anemia in pregnant women from a limited area is of potential value, especially because Indonesia is located in the thalassemia belt area. An integrative approach and counseling among pregnant women with β-TT and their partners will increase thalassemia awareness and optimal birth management.

Borderline anaemia and postoperative outcome in women undergoing major abdominal surgery: a retrospective cohort study.

Pre-operative anaemia is typically diagnosed with a haemoglobin concentration <120g.l-1 for women and <130g.l-1 for men on the basis of limited evidence. This retrospective cohort study stratified women undergoing elective, major abdominal surgery based on pre-operative haemoglobin concentration: anaemic (<120g.l-1 ); borderline anaemic (120-129g.l-1 ); and non-anaemic (>130g.l-1 ). Data from 1554 women were analysed. Women with borderline anaemia had a greater incidence of postoperative complications (55 (16%) vs. 110 (11%); p=0.026), longer duration of hospital stay (median (IQR [range]) 3 (1-6 [0-69]) days vs. 2 (1-5 [0-80]) days; p=0.017) and fewer days alive and out of hospital at postoperative day 30 (median (IQR [range]) 27 (23-29 [0-30]) vs. 28 (25-29 [0-30]) days; p=0.017) compared with non-anaemic women. However, after matched cohort analysis, these outcome differences no longer remained statistically significant. After multivariable adjustment for procedure, Charlson comorbidity index and patient age, a negative relationship between logarithmic pre-operative haemoglobin concentration and duration of stay was found (parameter estimate (standard error) -0.006 (0.003) vs. 0.003 (0.003) for a haemoglobin concentration <130g.l-1 vs. >130g.l-1 , respectively; p=0.03); the difference in duration of stay was approximately 50% greater for women with a haemoglobin concentration of 120g.l-1 compared with those with a haemoglobin concentration of 130g.l-1 . Although the contribution of borderline anaemia to the incidence of postoperative complications is uncertain, the current diagnostic criteria should be re-assessed.

The Association between Iron-deficiency Anemia and Adverse Pregnancy Outcomes: A Retrospective Report from Pakistan.

BackgroundAnemia is one of the most common conditions that affect pregnancies, with dietary iron deficiency being its most common cause. Maternal anemia has been associated with increased risks of both maternal and neonatal adverse outcomes. This study aimed to analyze the maternal and neonatal outcomes in women with third-trimester anemia.MethodsThis was a retrospective report from a Pakistani public hospital. It included data records of the childbirths in the hospital, with at least one record that documented the hemoglobin (Hb) level in women in the first or second trimester and one in the third trimester. The duration of the study was from January 1, 2019 to June 30, 2019. Women with Hb level of <10mg/dL in the third trimester were categorized as anemic, and those with Hb level of >10mg/dL were categorized as non-anemic. Pregnancy outcomes were assessed for both mothers and babies. All data were processed through SPSS version 21.0 for Windows (IBM Corp., Armonk, NY).ResultsThe study evaluated 235 (37.8%) anemic and 387 (62.2%) non-anemic women. Adverse maternal outcomes were compared between the two groups. In anemic women, gestational hypertension (56% vs. 27%; p: <0.0001), preeclampsia (65% vs. 25%; p: <0.0001), antepartum hemorrhage (32% vs. 19%; p: =0.0001), postpartum hemorrhage (79% vs. 28%; p: <0.0001), transfusions (94% vs. 5%; p: <0.0001), prolonged/obstructed labor (49% vs. 20%; p: <0.000), urgent induction of labor (24% vs. 2%; p: <0.0001), and urgent caesarean section (CS) (45% vs. 29%; p: 0.0001) were significantly more common as compared to non-anemic women. Adverse neonatal outcomes such as low birth weight (LBW) (59% vs. 29%; p: <0.0001), small-for-gestational-age (SGA) (73% vs. 23%; p: <0.0001), preterm delivery (39% vs. 15%; p: <0.0001), stillbirth (8% vs. 3%; p: 0.01), and early neonatal death (9% vs. 2%; p: 0.000) were associated more with anemia. There was no report of maternal mortality in either group.Conclusion:Anemia in the third trimester of pregnancy is associated with adverse maternal and neonatal outcomes including neonatal death. Efforts are required to ensure adequate maternal nutritional status in order to prevent poor outcomes.

Hemoglobin levels and low bone mineral density in non-anemic older adults: Secondary analysis of the Korean National Health and Nutrition Examination Survey.

Although, previous studies have reported a positive association between hemoglobin levels and bone mineral density (BMD), the majority of the studies were limited in patients with chronic hypoxemic conditions and findings concerning the association among non-anemic populations are inconclusive. We aimed to examine the association between hemoglobin levels and BMD in non-anemic healthy adults. This cross-sectional study included 3626 non-anemic men and women aged ≥ 60 years who participated in the Korean National Health and Nutrition Examination Survey (KNHANES). The BMD of the lumbar spine and both femurs was measured by dual-energy X-ray absorptiometry (DXA). Participants with T-score for BMD < -1.0 SD were defined as having low BMD. The odds ratios (ORs) and 95% confidence intervals (CIs) for low BMD were calculated using multiple logistic regression analyses across sex-specific hemoglobin quartiles. The prevalence of low BMD gradually decreased in accordance with hemoglobin quartiles in both sexes. Compared with the group in the lowest quartile, the OR (95% CI) for low BMD in the lumbar spine was 0.78 (0.54-0.93) for men and 0.67 (0.50-0.93) for women after adjusting for age, BMI, tobacco smoking, alcohol intake, physical activity, walking difficulty, household income, total calorie intake, calcium intake, iron intake, 25(OH)D, alkaline phosphatase, and parathyroid hormone levels. However, these positive associations were not found in femur after adjusting for the same co-variables. Hemoglobin levels were inversely associated with low BMD in lumbar spine among non-anemic adults.

Salivary Cystatin SN Binds to Phytic Acid In Vitro and Is a Predictor of Nonheme Iron Bioavailability with Phytic Acid Supplementation in a Proof of Concept Pilot Study

ABSTRACTBackgroundAcute phytic acid intake has been found to decrease iron bioavailability; however, repeated phytic acid consumption leads to iron absorption adaptation. Salivary proline-rich proteins (PRPs) have been shown to inhibit iron chelation to tannins and may mediate similar iron absorption adaptation with phytic acid intake.ObjectivesThe objectives of this study were to determine whether salivary proteins bind to phytic acid in vitro, and to explore a proof of concept in a pilot study that examined the impact of 4-wk, daily phytic acid supplementation on individuals’ iron status, bioavailability, and salivary PRP concentrations.MethodsHigh-performance liquid chromatography (HPLC) and matrix-assisted laser desorption/ionization–time of flight were used to characterize in vitro salivary protein–phytic acid interactions. Nonanemic women (n = 7) consumed 350 mg phytic acid supplements 3 times daily for 4 wk, and meal challenges were employed to determine iron bioavailability, iron status, and salivary protein concentrations before and after supplementation periods. Enzyme-linked immunosorbent assay (ELISA) analysis of purified protein fractions and participant saliva identified proteins bound to phytic acid.ResultsIn vitro salivary protein–phytic acid interaction identified cystatin SN, a non–proline rich salivary protein, as the specific bound protein to phytic acid. Iron bioavailability (P = 0.32), hemoglobin (P = 0.72), and serum ferritin (P = 0.08) concentrations were not reduced from week 0 to week 4 after phytic acid supplementation. Basic PRPs and cystatin SN concentrations were positively correlated with iron bioavailability at week 4.ConclusionsOverall, results suggest that phytic acid binds to the non-PRP cystatin SN and that salivary protein production may improve iron bioavailability with phytic acid consumption.

Iron Supplementation Improves Energetic Efficiency During Submaximal Exercise in Iron Deficient Non-anemic Women (P24-042-19)

ObjectivesIt has been estimated that 37–50% of anemia in non-pregnant women of reproductive age (WRA) is associated with iron deficiency (ID). Some of the highest rates of anemia associated with ID have been found in Latin American and Caribbean countries including Mexico. It has been well established that iron deficiency anemia (IDA), characterized by a reduced concentration of hemoglobin, results in a decline in muscular work capacity exhibited by a decrease in aerobic capacity and the ability to perform physical exercise. There is conflicting evidence on the impairment of physical work capacity in the iron deficient non-anemic (IDNA) state that is characterized by low serum ferritin but normal hemoglobin. The purpose of this study was to determine if iron status influences physical work capacity during submaximal exercise in Mexican women 18- to 45-year-old who are marginally iron depleted but not anemic. MethodsThirty-three iron-depleted (serum ferritin < 20 μg/L), non-anemic (hemoglobin > 120 g/L) women (age: 26.5 ± 6.4 yr) received either 10 mg elemental iron as FeSO4 daily (Fe: iron-supplement group, n = 18) or an identical placebo capsule (P: placebo group, n = 15) for 6 wk in a randomized, double-blind controlled trial. The energy cost of performing work during cycle ergometry at 25 and 50 watts were determined from indirect calorimetry at baseline and following the supplementation period. ResultsWe observed increased serum ferritin (P = 0.035) and total body iron (P = 0.001), and decreased serum transferrin receptor (P = 0.028) in the Fe group compared with the P group. Based on mixed model ANOVA for a time-by treatment interaction, at end line participants in the Fe group performed work at both 25 and 50 W with lower mean energy expenditures (EE) compared to the P group (difference in EE at 25 W = 0.28 kcal/min, P = 0.036; difference in EE at 50 W = 0.41 kcal/min; P = 0.017). ConclusionsFindings suggest that marginally iron depleted but non-anemic Mexican women improved their iron status and physical work efficiency following the consumption of supplemental iron. These results are important for WRA whose social, economic and dietary circumstances increase their risk for IDNA and suggest that a large proportion of these women who rely on physical labor as a livelihood may be working harder to achieve the same amount of work output as individuals with normal iron levels. Funding SourcesFunding provided by The College of Human Ecology and Agricultural & Life Sciences, Cornell University.

Maternal Characteristics Affect Fetal Growth Response to Maternal Supplements in the Women First Preconception Trial (WF) (P10-017-19)

ObjectivesDetermine if maternal characteristics modified newborn anthropometric outcomes in the WF trial (ClinicalTrials.govNCT01883193). MethodsSecondary analysis included combined data for all 1465 maternal infant dyads in WF sites in Guatemala, India, and Pakistan who had 1st trimester ultrasounds and newborn anthropometry with the three WF arms maintained: Arm 1 commenced a comprehensive nutrition supplement ≥3 months prior to conception; Arm 2 commenced the same supplement in the 1st trimester, and Arm 3 received no trial supplements. Maternal characteristics included were: baseline, BMI, hemoglobin, age, education, SES, and parity plus newborn sex. Newborn outcomes were Z-scores for length (LAZ), weight (WAZ), and weight-to-length ratio (WLRZ). Mixed effect regression models were fit for each outcome, including treatment arm, effect modifier, and treatment arm x effect modifier interaction as predictors and controlling for study site, maternal characteristics, and newborn sex. ResultsParity, anemia and newborn sex were significant effect modifiers favoring para 0 vs para ≥1, anemia vs non anemia, and newborn male vs female. Effect of Arm 1 vs 3 was significantly larger for para 0 vs ≥1 women on length and weight (Table). Arm 2 vs 3 was not associated with improvements for para 0 in weight (P = 0.273) or WLRZ (P = 0.710). Arms 1 and 2 (vs 3) were associated with significantly higher length, weight, and WLRZ for anemic women.For parity and anemia, effect sizes for Arm 1 were greater than for Arm 2 for WAZ and WLZ (P < 0.05), but not LAZ. Arm 1 and 2 were associated with significantly higher weight and WLRZ for male vs female newborn. ConclusionsIn diverse low resource populations, impaired fetal growth (weight and length) is substantially improved in nulliparous and in anemic women but minimally or not at all in parous and in non-anemic women. Correction of weight decrements is most pronounced with improvement in maternal nutrition commencing prior to conception. Funding SourcesBill & Melinda Gates Foundation; NIH, NICHD and ODS. Supporting Tables, Images and/or Graphs▪

Dielectric spectroscopy of red blood cells in a randomized sample of anemic and non-anemic Egyptian first trimester pregnant and non-pregnant women in the rural district of Alexandria city: a primitive screening approach

In Egypt, iron-deficiency anemia (I.D.A) is the most prevalent public health problem related to socioeconomics and lifestyle. Despite ferritin assay is the gold standard for (I.D.A), it is expensive and can be conflicted with other diseases. Hereby, new screening tools were emerged to monitor I.D.A. A sophisticated physical method depending on the electrical relaxation of R.B.Cs in anemic first trimester pregnant Egyptian women of a rural district in Alexandria was conducted. I.D.A was confirmed in all participant anemic women through calculated ferritin saturation percent. The dielectric permittivity and conductivity curves between control non-anemic non-pregnant and non-anemic pregnant women showed slight significant discrimination. These findings may be a primitive approach for I.D.A screening and further physical parameters will be needed to strengthen the idea.

Study on the Effect of Severity of Maternal Iron Deficiency Anemia on Regulators of Angiogenesis in Placenta

Aims: In this study, we hypothesized that maternal anemia leads to altered expression of angiogenic proteins vascular endothelial growth factor (VEGF), placental growth factor (PLGF), nitrotyrosine (NT) residues, and endothelial nitric oxide synthase (e-NOS) in the placenta. Hence, we study the expression of the abovementioned proteins in the placentas of mothers with different grades of anemia. Materials and methods: Our study was conducted in 48 pregnant women (36–40 weeks of gestation), who were divided into four groups—normal, mild, moderate, and severe anemia. After delivery, the expression of the angiogenic proteins was studied in their placentas by immunohistochemistry. Results: In our study, 58.3% of the pregnant women were anemic, among which 20.83% had mild anemia, 18.75% had moderate anemia, and 18.75% had severe anemia. Immunohistochemical staining intensity for VEGF, PLGF, NT residues, and e-NOS proteins was observed to be higher in the placentas of anemic women when compared with the non-anemic women. Conclusion: Our study showed that there is an increased expression of angiogenic proteins in the placentas of anemic mothers, which probably is an adaptive response leading to changes in placental vessels.

Obesity Is Associated with Changes in Iron Nutrition Status and Its Homeostatic Regulation in Pregnancy.

The influence of obesity on maternal iron homeostasis and nutrition status during pregnancy remains only partially clarified. Our study objectives were (1) to describe how obesity influences broad iron nutrition spectrum biomarkers such as available or circulating iron (serum transferrin receptor (sTfr) and serum iron), iron reserves (ferritin), and functional iron (hemoglobin); and (2) to depict the regulating role of hepcidin. The above was carried out while considering influential factors such as initial iron nutrition status, iron intake, and the presence of inflammation. Ninety three non-anemic pregnant adult women were included, 40 with obesity (Ob) and 53 with adequate weight (AW); all took ≈30 mg/day of supplementary iron. Information on iron intake and blood samples were obtained at gestational weeks 13, 20, 27, and 35. A series of repeated measure analyses were performed using General Linear Models to discern the effect of obesity on each iron indicator; iron intake, hepcidin, and C-reactive protein were successively introduced as covariates. Available and circulating iron was lower in obese women: sTfr was higher (p = 0.07) and serum iron was lower (p = 0.01); and ferritin and hemoglobin were not different between groups. Hepcidin was higher in the Ob group (p = 0.01) and was a significant predictor variable for all biomarkers. Obesity during pregnancy dysregulates iron homeostasis, resembling “obesity hypoferremia”.

Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania.

Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy. In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status. Mean Hb was 123 and 119g/l before conception and during early pregnancy (median gestational age 53days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration. Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.

Increasing Iron Status through Dietary Supplementation in Iron-Depleted, Sedentary Women Increases Endurance Performance at Both Near-Maximal and Submaximal Exercise Intensities

Iron deficiency persists as the most common micronutrient deficiency globally, despite having known detrimental effects on physical performance. Although iron supplementation and aerobic exercise have been examined individually and are known to improve physical performance, the impact of simultaneous iron supplementation and aerobic training remains unclear. The aim of this study was to examine the individual and combined effects of iron supplementation and aerobic training on improving maximal and submaximal physical performance in iron-depleted, nonanemic (IDNA) women. We hypothesized that women receiving iron would improve their endurance performance but not their estimated maximal oxygen consumption (eVO2max). Seventy-three sedentary, previously untrained IDNA (serum ferritin <25 µg/L and hemoglobin >110 g/L) women aged 18-26 y with a body mass index (kg/m2) of 17-25 participated in a double-blind, 8-wk, randomized controlled trial with a 2×2 factorial design including iron supplementation (42 mg elemental Fe/d) or placebo and aerobic exercise training (5 d/wk for 25 min at 75-85% of age-predicted maximum heart rate) or no training. Linear models were used to examine relations between training, supplement, and changes in the primary outcomes of observed maximal oxygen consumption (VO2peak) and eVO2max and ventilatory threshold (absolute oxygen consumption and percentage of maximum). Re-evaluation of a published meta-analysis was used to compare effects of iron supplementation on maximal oxygen consumption (VO2max) and VO2peak. There were significant training-by-supplement interactions for VO2peak, volume of oxygen consumption at the ventilatory threshold, and the percentage of eVO2max where the threshold occurred, with the iron-untrained group performing better than the placebo-untrained group. There was no beneficial effect of iron supplementation for VO2max (mean difference: 0.53; 95% CI: -0.75, 1.81; P=0.42), but a significant benefit was observed for VO2peak (mean difference: 1.87; 95% CI: 0.15, 3.60; P=0.03). Iron supplementation increases endurance performance at submaximal and maximal (VO2peak) exercise intensities in IDNA women. However, increasing iron status does not increase eVO2max. This trial was registered at clinicaltrials.gov as NCT03002090.

Pregnant women with severe anemia reporting in labor: prevalence, socio-demographic and obstetric determinants

Background: Severely anemic women reporting in labor remains one of the most important challenging situation for the obstetrician as well as for the mother and her family due to its adverse feto-maternal outcome. Various socio-demographic and obstetric conditions need to be explored which are important to tackle them, for primary prevention of anemia. The aim and objectives of the study were to estimate prevalence of severe anemia in pregnant women reporting in labor in a tertiary hospital of Delhi and to evaluate various socio-economic and associated obstetric factors associated.Methods: This is a hospital based, prospective, case contol study. Hemoglobin was estimated at the time of labor room admission. Fifty consecutive antenatal women with severe anemia (Group A) and 50 non-anemic women (Group B) were enrolled in early labor. Socio-demographic and obstetric factors, were recorded and analyzed.Results: Prevalence of severe anemia was estimated to be 2.23%. Determinants of severe anemia were found to be socio-economic status (p value 0.001), education (p value 0.001), rural living (p value 0.016), calorie intake (p value 0.001), BMI (p value 0.046), booking status of pregnancy (p value 0.001), gravida (p value 0.024), inter-conception interval (p value 0.002) and regular iron-folic acid intake (p value 0.001).Conclusions: Primary prevention of anemia by targeting these factors at the community/state/ national level, by the policy makers is important. Early booking and screening for anemia in antenatal clinics, providing iron supplements to anemic women for secondary prevention of severe anemia is recommended so that no woman reports with severe anemia in labor.

The opposing effects of acute inflammation and iron deficiency anemia on serum hepcidin and iron absorption in young women.

Hepatic hepcidin synthesis is stimulated by inflammation but inhibited during iron deficiency anemia (IDA). In humans, the relative strength of these opposing signals on serum hepcidin and the net effect on iron absorption and systemic iron recycling is uncertain. In this prospective, 45-day study, in young women (n=46; age 18-49 years) with or without IDA, we compared iron and inflammation markers, serum hepcidin and erythrocyte iron incorporation from 57Fe-labeled test meals, before and 8, 24 and 36 hours (h) after influenza/DPT vaccination as an acute inflammatory stimulus. Compared to baseline, at 24-36 h after vaccination: 1) interleukin-6 increased 2-3-fold in both groups (P<0.001); 2) serum hepcidin increased >2-fold in the non-anemic group (P<0.001), but did not significantly change in the IDA group; 3) serum iron decreased in the non-anemic group (P<0.05) but did not change in the IDA group; and 4) erythrocyte iron incorporation did not change in either of the two groups, but was approximately 2-fold higher in the IDA group both before and after vaccination (P<0.001). In this study, mild acute inflammation did not increase serum hepcidin in women with IDA, suggesting low iron status and erythropoietic drive offset the inflammatory stimulus on hepcidin expression. In non-anemic women, inflammation increased serum hepcidin and produced mild hypoferremia, but did not reduce dietary iron absorption, suggesting iron-recycling macrophages are more sensitive than the enterocyte to high serum hepcidin during inflammation. The study was registered as a prospective observational trial at clinicaltrials.gov identifier: 02175888. The study was funded by the International Atomic Energy Agency.

Postpartum anemia is a neglected public health issue in China: a cross-sectional study.

Anemia impairs the health and wellbeing of women and increases the risk of maternal and neonatal adverse outcomes. The objectives of this study are to determine the prevalence of postpartum anemia among urban lactating women; investigate the predictors of anemia and explore the potential health effects on lactating performance. Multi-stage sampling methods were used to recruit 495 lactating women from 3 cities of China. Blood and breast milk samples were collected to analyze hemoglobin levels and iron content, respectively. The intakes and sources of iron-rich food and nutrients were investigated based on Food Frequency Questionnaire and 24 h dietary recall. The overall prevalence of postpartum anemia was 32.7%; no cases of severe anemia were encountered. Women who living in Guangzhou had a significant higher anemia prevalence. Regards to dietary intake, the amount of iron intake was generally good with a high proportion of heme iron. The animal sources ratio was 23.0%. Total iron intake and the sources of iron were not associated with anemia. Vitamin C intake was significantly higher in non-anemic women (Median (25th, 75 th) was (72.6 (38.4, 130.0) mg/d)) than anemic women (54.7 (30.7, 111.3) mg/d). Other nutrient enhancers were not associated with anemia. There were no significant differences in the iron content of breast milk between women with and without anemia (r=0.047, p=0.302). Postpartum anemia is common in urban Chinese women. A combination of interventions, including managing antenatal anemia and correcting inappropriate dietary habits will help to prevent postpartum anemia.

Role of oxidative stress after routine Iron supplementation in normal and anemic women during pregnancy: Central Indian scenario

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting people of all ages in developed and developing countries. causes dimunition of various antioxidant enzymes like superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase. The objective of the study was to detect impact of iron supplementation in anaemic & non- anaemic pregnant subjects on oxidative stress. Patients are divided into two groups, Control groups (60 non-anemic pregnant women) & Study groups (60 anemic pregnant women). The blood sample (5 ml) was collected from different groups of subjects. In controls groups, a fall in catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase were seen while lipid peroxidase was found to have increased significantly after iron therapy. In study group, and increment in all markers except lipid peroxidase was seen and the level of lipid peroxidase was decreased following iron supplementation which was statistically significant (p<0.001). it may be concluded that iron deficiency anaemia is associated with free radical generation and peroxidation of vital body molecules which implies increased risk for pregnant women.

Frequency of iron deficiency anemia in pregnant and non-pregnant women suffering from restless legs syndrome

ABSTRACTObjectives. Restless Legs Syndrome is a movement disorder characterized by unpleasant sensations in the legs described as a burning, tingling, etc. Symptoms become worse in the evening and are relieved by moving the limbs. The idiopathic form of the disease is associated with a lack of dopamine, and the secondary form is associated with iron deficiency anemia, pregnancy, and kidney disease. The aim of this study was to investigate the incidence of iron deficiency anemia in pregnant women and non-pregnant women suffering from RLS.Methods. The study was conducted on a sample of 231 pregnant women aged 18–50. The pregnant women were interviewed at the outpatient clinic of the Department of Gynaecology and Obstetrics. This study also included a control group of 231 age-compatible non-pregnant women. Women who met the international criteria for diagnosing the syndrome filled in a sociodemographic questionnaire.Results. A statistically significant association between the existence of iron deficiency anemia and RLS in the sample of the examined women was proven (p < 0.001). It was also shown that RLS is more frequent in a sample of anemic pregnant women than non-anemic pregnant women (p = 0.008).Conclusion. Iron deficiency anemia is related with RLS. Pregnant women with RLS are more likely to be anemic than pregnant women without RLS.

Is Iron Deficiency Anemia Associated with Cognitive Functions in Reproductive-Age Women?

Objectives: The aim of the study was to determine whether iron deficiency anemia (IDA) in reproductive-age women affects cognitive functioning, physical functioning, psychiatric morbidity, fatigue and quality of life. Materials and Methods: Thirty-three women aged between 18-50 years with IDA and 32 non-anemic healthy women were included in the study. Laboratory analyses, neuropsychological tests, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), VAS fatigue, Health Assessment Questionnaire (HAQ-DI) and Short Form-36 (SF-36) were assessed. Results: There was no significant difference in demographic characteristics of the patients between groups. Digit Forward/Backward, Digit Span Total, HAQ-DI, BAI, BDI, SF-36, fatigue scores in IDA group were significantly lower than the controls. Correlation analysis revealed that education, serum iron, ferritin, and hemoglobin levels were associated with cognitive test scores and fatigue. Serum iron, ferritin, and hemoglobin levels were found to be associated with HAQ-DI, BAI, BDI, and SF-36 scores. Coclusion: IDA negatively affects cognition, physical functioning, quality of life, fatigue, symptoms of anxiety and depression in reproductive-age women.

The prevalence of serum magnesium and iron deficiency anaemia among Sudanese women in early pregnancy: a cross-sectional study.

Anaemia during pregnancy is associated with adverse maternal and child health. Investigations of anaemia and its predictors among pregnant women are needed for preventive measures. A cross-sectional study was conducted to investigate the prevalence and determinants of anaemia in early pregnancy in Khartoum, Sudan. Clinical characteristics were gathered using a questionnaire. Serum ferritin, magnesium and high-sensitivity C-reactive protein (hs-CRP) were measured using different laboratory methods. Of the 180 women in the study, 65.0% had anaemia (haemoglobin [Hb] <11 g/dl), 0.6% had severe anaemia (Hb <7 g/dl), 38.9% had iron deficiency (serum ferritin <15 μg/l), 30.6% had iron deficiency anaemia (<11 g/dl and serum ferritin <15 μg/l) and 57.2% had magnesium deficiency (<1.80 mg/dl). There was no significant difference in the age, parity, gestational age, body mass index (BMI) and hs-CRP between anaemic and non-anaemic pregnant women. Anaemic pregnant women had significantly lower levels of serum ferritin and serum magnesium. While age, parity, gestational age, BMI and hs-CRP were not associated with anaemia, low serum ferritin (odds ratio [OR] 0.97 [95% confidence interval {CI} 0.96 to 0.99]) and low serum magnesium (OR 0.91 [95% CI 0.84 to 0.99]) were associated with anaemia. There were significant positive correlations between Hb and serum ferritin (r=0.382, p<0.001) and serum magnesium (r=0.192, p=0.010). The role of magnesium as a possible contributing factor to anaemia in pregnancy has important implications for prevention and treatment of these women.