Non-anemic Women Research Articles

Study the Incidence, Types of Anemia and Associated Risk Factors in Pregnant Women

Background: Anemia is a global public health problem affecting both developing and developed countriesand more prevalent among pregnant women. Worldwide the main cause of anemia during pregnancy is irondeficiency, if remain untreated it might leads to increased risk for perinatal morbidity and mortality.Aim of the study: is to find an incidence of anemia among pregnant women along with types and severityto assess the association of various maternal characteristics with anemia forms.Materials and methods: One hundred twenty eight pregnant women were enrolled in this study. Seventyfive pregnant women were diagnosed with anemia while fifty three pregnant women without anemiaincluded in this study as a control subjects. Blood samples were collected to determine hemoglobin leveland complete blood counts (CBC).Results: The mean age was 27.76 years for 75 anemia pregnant women and mean of 26.08 years for 53control non- anemic pregnant women with no statically significant differences (P>0.05). Most of anemicpregnant women had a pregnancy gap ? 1 year (51%) while most of non-anemic pregnant women had a gapof > 3 years (62%) with highly significant differences between both groups (P<0.01). Approximately halfof anemic pregnant women surveyed found to had a moderate anemia (Hb 7- 9.9 g/dl), one third (32%) ofpregnant women is multigravida with moderate anemia type and (62%) of anemic pregnant women foundto had Microcytic& Hypochromic anemia. In the present study (80%) of pregnant women receiving ironsupplementation, also (73%) receiving folic acid supplement. Only (20%) receiving blood transfusion forsevere anemia type.Conclusion: The results of this research support the idea that the incidence of anemia is still high amongpregnant women and iron deficiency anemia is the most prevalent type with anemia became more pronouncedat third trimester of pregnancy and mostly with moderate severity type.

Anemic Women are More at Risk of Injectable Contraceptive Discontinuation Due to Side-Effects in Ethiopia

Background: This paper investigates the importance of women’s physiological condition for predicting the risk of discontinuing using the injectable contraceptive due to side-effects in Ethiopia, where unmet need for family planning is substantial. Methods: Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analyzed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Findings: In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anemia were twice more at risk of DSE compared with non-anemic women, while anemia status was not associated with DOR. The association between anemia and the experience of side-effects is likely driven by iron-deficiency anemia: having not taken iron supplements during last pregnancy increased the risk of DSE. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE. Interpretation: Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects. To reduce side-effects and thereby unmet needs, family planning programs might benefit from providing hormonal contraception as part of an integrated package addressing anemia. Funding Statement: No specific funding was obtained for this research. RS is undertaking graduate study, funded by both an Economic and Social Research Council studentship and a Clarendon scholarship, as part of which, she conducted this research. Declaration of Interests: There are no conflict of interests. Ethics Approval Statement: Procedures and questionnaires for standard DHS surveys have been approved by the ICF Institutional Review Broad (IRB) and the specific Ethiopian protocol by IRBs in Ethiopia.

The TMPRSS6 variant (SNP rs855791) affects iron metabolism and oral iron absorption - a stable iron isotope study in Taiwanese women.

Genome wide studies have associated TMPRSS6 rs855791 (2321 C>T) with iron status and hepcidin. It is unclear whether this polymorphism affects iron absorption. We administered standardized ricebased test meals containing 4 mg of labeled 57Fe or 58Fe as FeSO4 on alternate days in non-anemic Taiwanese women (n=79, 44 TT variant, 35 CC variant). Fractional iron absorption was measured by erythrocyte incorporation of the tracers 14 days after administration. Compared to the CC variant, iron and transferrin saturation were lower (P=0.001; P<0.001, respectively) and serum hepcidin/transferrin saturation and serum hepcidin/serum iron ratios were higher (P=0.042; P=0.088, respectively) in the TT variant. Serum hepcidin did not differ between the groups (P=0.862). Geometric mean (95% Confidence Interval [CI]) fractional iron absorption, corrected to a serum ferritin of 15 μg/L, was 26.6% (95% CI: 24.0-29.5) in the CC variant and 18.5% (95% CI: 16.2-21.1) in the TT variant (P=0.002). Overall, predictors of iron absorption were: serum ferritin (P<0.001); genetic variant (P=0.032); and hepcidin (P<0.001). In the models by variant, in the CC variant the model explained 67-71% of variability in absorption and serum ferritin was the only significant predictor (P<0.001); while in the TT variant, the model explained only 35-43% of variability, and hemoglobin (P=0.032), soluble transferrin receptor (P=0.004) and hepcidin (P<0.001) were significant predictors. Women with the TMPRSS6 rs855791 (2321 C>T) polymorphism show altered iron homeostasis which affects oral iron absorption and may increase their risk for iron deficiency. The trial was registered as clinicaltrials gov. Identifier: NCT03317873, and funded by the Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, (grant CMRPG8F0721) and ETH Zurich, Switzerland.

A cross-sectional study in non-anaemic pregnant women in Turkey to assess necessity of iron supplementation.

Iron deficiency is the most common cause of anaemia in pregnancy. Guidelines recommend different threshold values for iron supplementation. To determine trimester-specific reference ranges for haematological values (haemoglobin, hematocrit and ferritin) in healthy pregnant women who have not used any iron supplementation during pregnancy to guide future iron treatment. A prospective cross-sectional study was carried out on 168 pregnant women aged 18-45 years, with singleton pregnancies in the first trimester, Hb ≥ 11 g/dL and ferritin ≥ 12 μg/L, and not using iron supplementation. Multiple pregnancies, pregnancies with obstetric complications and smokers were excluded from the study. Mean haemoglobin (Hb) and ferritin values, trimester-specific reference ranges and percentile values of Hb and ferritin were determined for each trimester. The normality of the variables was tested using the Kolmogorov-Smirnov test. Mean Hb decreased significantly between trimesters from 12.6 to 11.9 and then 11.5 g/dL. In addition, Hb, hematocrit and ferritin decreased significantly from the first to the second trimester (P < 0.001 for all) but stayed comparable between the second and third trimesters (P = 0.246, P = 0.575, P = 0.408, respectively). The lower reference value for Hb was calculated as 10.67, 10.08 and 9.18 g/dL for 10-14, 20-24 and 30-34 gestational weeks respectively. This pioneer study allows us to understand that iron supplementation may not be needed as any decrease is due to physiological haemodilution. These results may prevent unnecessary iron prescription during pregnancy.

A Study of Socioeconomic Determinants of Anemia among Expecting Mothers in Khyber Pakhtunkhwa Pakistan

One of the instrumental factors contributing towards the GDP of any country is human capital and for a progressive human capital, the main resource is physical and mental health. Females constitute approximately 48% of population of Pakistan, out of which a great number suffer from nutritional deficiency anemia at their reproductive age, which results in an unhealthy child. This study is designed to find the socioeconomic factors that lead to anemia among expecting women. The research design for this study is case control where data was collected from two groups; control group (non-anemic pregnant women) and case group (anemic pregnant women) registered in the Basic Health Unit (BHU) from different areas of Peshawar. Collected data was analyzed using binary logistic regression. Findings revealed that monthly income of household, independent members or number of employed members of the family, gap between children, non-staple food consumption and supplements continuity have significant inverse relationship with anemia, indicating that increase in mentioned variables will decrease the prevalence of anemia in pregnant women of rural areas. The study concluded that anemia being a common grievance amongst pregnant women is mostly caused by low level of monthly income, family size with lower number of employed members, low frequency of non-staple food consumption per week, lack of continuity of iron supplements and poor health seeking behavior. Awareness regarding attainment of education irrespective of gender, government focus on health promotion interventions and more job opportunities can improve health conditions and socioeconomic status of women in Khyber Pakhtunkhwa.

Relationship between zinc content and carbonic anhydrase activity in blood of anemic pregnant women in Turkey.

Carbonic anhydrase (CA) in pregnancy plays an important part in gaseous exchange across the placenta. The aim of our study was to determine the relationship between zinc content and the CA activity in blood of anemic and normal pregnant women in their third trimester, in Turkey. The patients with hemoglobin values below 11 g/dL were accepted as anemic. CA enzyme activity and zinc levels in erythrocyte of anemic and non-anemic pregnant women were carried out in 27 non-anemic pregnant women and 31 anemic pregnant women. Mean corpuscular volume (MCV) levels of the participants were also tested. Zinc levels were lower in the anemic group compared to the non-anemic group (P = 0.049). Total CA enzyme activity was also lower in the anemic group (P = 0.044). MCV levels were found to be lower in the anemic group (P = 0.007). The decrease in these values was statistically significant (P < 0.05). This is the first study to evaluate the zinc content in red blood cells of anemic pregnant women in the third trimester and its relationship with carbonic anhydrase activity. CA isoenzymes to work healthily, providing iron and zinc supports is important for fetal development.

Effect of iron and folate supplementation on Pb levels in pregnant anemic women: a prospective study

There are few reports revealing association between iron intake and environmental lead exposure during pregnancy. Therefore, the present study was undertaken to investigate the effect of iron supplementation on biochemical modulation of certain lead toxicity markers associated with pregnancy. Iron and folic acid supplementations were given to 250 pregnant anemic women (mild = 100, moderate = 100 and severe = 50) and 100 age matched nonanemic pregnant women as controls for 100 days. Lead (Pb) toxicity markers, enzymatic and nonenzymatic antioxidant were estimated as per standard protocols. The levels of Pb, serum transferrin receptors (sTfR), zinc protoporphyrin (ZPP), δ-aminolevulinic acid (δ-ALA, both in blood and urine) were found significantly increased in all pretreated subjects and these were decreased after oral iron supplementation. Iron-deficient pregnant women reflected a significant increase in lipid peroxide levels (LPO) and protein carbonyl levels (PC) which were found to be further increased after iron supplementation. The levels of iron (Fe), haemoglobin (Hb), ferritin, delta aminolevulinic acid dehydratase (δ-ALAD), catalase (CAT), superoxide dismutase (SOD), and reduced glutathione levels (GSH) were significantly decreased in pretreated groups and these parameters were found significantly increased in all supplemented subjects after treatment. Antioxidant vitamins viz. C and E were found significantly decreased in all post treated groups. Our observation suggests that recommended iron dose is not only effective for blood indices parameters, but it also decreases Pb concentrations in the blood during pregnancy. However, further studies with larger sample size are needed to confirm these findings.

Efficacy of a High-Iron Dietary Intervention in Women with Celiac Disease and Iron Deficiency without Anemia: A Clinical Trial.

Background and Aim. Iron deficiency without anemia (IDWA) is a common finding in celiac disease (CD) and can also persist in case of good compliance and clinical response to a strict gluten-free diet (GFD). This scenario usually presents in CD women of child-bearing age in whom the imbalance between menstrual iron loss and inadequate iron intake from their diet plays the major role. A recommended approach to this condition is yet to be established. This study aimed to compare, in this subset of patients, the efficacy of a dietary approach consisting of an iron-rich diet against the traditional pharmacological oral-replacement therapy. Material and Methods. Between February and December 2016, consecutive CD female patients of child-bearing age as referred to our outpatient center with evidence of IDWA (ferritin <15 ng/mL or 15–20 ng/L with transferrin saturation <15%) were enrolled. After the completion of a 7-day weighed food intake recording to assess the usual iron dietary intake, the patients were randomized in two arms to receive a 12-week iron-rich diet (iron intake >20 mg/die) versus oral iron supplementation with ferrous sulfate (FS) (105 mg/day). Blood tests and dietary assessments were repeated at the end of treatment. The degree of compliance and tolerability to the treatments were assessed every month by means of specific questionnaires and symptoms evaluation. Results. A total of 22 women were enrolled and divided in the diet group (n = 10, age 37 ± 8 years) and in the FS group (n = 12, age 38 ± 10 years). The food intake records demonstrated an inadequate daily intake of iron in all the enrolled subjects. At the end of the treatments, ferritin levels were higher in the FS group (8.5 (5) versus 34 (30.8), p = 0.002). Compliance and tolerability were similar in both treatment groups (89% versus 87%, p = ns). Conclusions. These findings did not support any equivalent efficacy of an iron-rich diet compared to a FS supplementation in non-anemic iron-deficient women affected by CD. However, the diet appeared a well-tolerated approach, and adequate dietary instructions could effectively increase the daily iron consumption, suggesting a role in the long-term management of IDWA, especially in patients who do not tolerate pharmacological supplementation.

Iron status is associated with worker productivity, independent of physical effort in Indian tea estate workers.

Iron deficiency is the most common nutrient deficiency in the world, affecting roughly 40% of women in nonindustrialized countries. Iron is the essential element in hemoglobin, the major carrier of blood oxygen and oxidative metabolism that supports physical and cognitive performance. The relationship between iron and physical work capacity suggests that iron deficient individuals could experience reduced work output. Participants were 138 experienced tea pluckers aged 18-55 years from the Panighatta Tea Estate in Darjeeling District of northern West Bengal, India. Hemoglobin, serum ferritin, and soluble transferrin receptor were measured from venous blood. Energy expenditure was estimated from accelerometry and heart rate, and plucking productivity was measured as amount of tea plucked during the morning work session when temperature and rainfall conditions are optimal. At a given level of energy expenditure, iron deficient, anemic, and iron deficient anemic women plucked less tea during a 3-h period. The results warrant further research as to whether interventions providing supplemental iron might improve worker productivity and work efficiency. Further study should examine evidence of economic incentives for policies and programs targeting nutritional deficiencies. Novelty Anemia predicts up to 2.02 kg (9.1%) less tea plucked per 3 h, or 4.0% lower wage per 3 h, compared with nonanemic women, controlling for physical effort. An increase of 1.0 g/L in hemoglobin concentration predicts 0.71 kg (3.3%) more tea plucked over 3 h. An increase of 1.0 g/L in hemoglobin concentration predicts a 1.6% wage increase.

A comparison between extract Moringa oleifera and iron tablet on prevention low birth weight in pregnant mothers in Makassar, Indonesia

Compare the effect of Moringa oleifera (MO) leaf extract and iron tablets on pregnant women on low birth weight. This study used a Randomized Double-Blind design controlled by using a sample of non-anemic pregnant women. Birth weight was measured using a digital scale electrically after delivery. Analysis of data using two independent samples t-test. Overall, there were no significant different between intervention and control group in terms of birth weight (3104.57±52 vs. 3022.29±53g), birth length (48.06±2.4 vs. 48.68±2.6cm), and head circumference (33.72±1.50 vs. 33.55±1.47cm). The number of low birth weight infants in the intervention group of 8.6% and 11.4% of control. There is no difference in birth weight between the intervention with the control group (p=0.365). M. oleifera (MO) leaf extract supplement has similar effect to iron folate supplement in terms of low birth weight incidence. It is recommended for the government to use MO supplement, as local source supplement, replacing iron-folic supplement in improving pregnancy outcomes. A further study is necessary to see the effect of MO supplement to other pregnancy outcomes, including maternal and child mortality.

Food Knowledge and Practices Related to Anemic Conditions among Pregnant Women in Kuala Terengganu, Malaysia

Anaemia is defined as a condition indicated by the deficiency of red blood cells (RBCs) or haemoglobin (Hb), and anaemia is still said to be the most prevalent nutritional deficiency during pregnancy. It is a huge contributor to maternal mortality. During pregnancy anaemia not only affects the mother but also the growing foetus, which makes it more dangerous. It has been estimated that nearly half of pregnant women around the world are estimated to be anaemic. Previous studies done in Malaysia found the overall prevalence of anaemia among pregnant women to be 35%. Knowledge in regard to anaemia and food practice are factors that contribute to anaemia. This study aims to determine the relationship between food practices, knowledge in regard to anaemic conditions among pregnant women in Kuala Terengganu. The study was based on samples gathered from 96 pregnant women from Hiliran Health Clinic in Kuala Terengganu. Data collected was based on self-administered questionnaire and twenty-four-hour diet recall. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. The prevalence of anaemia was found to be 40.9% and no association was found between anaemia and sociodemographic factors among pregnant women in Kuala Terengganu. Anaemic pregnant women achieved a higher average score of knowledge regarding anaemia as compared to non-anaemic pregnant women. In conclusion findings of this study suggests that there is average knowledge of anaemia among the given population. Findings also suggest that the overall population had good food practice. Furthermore, implications of the study findings, limitations, and directions for future research were also discussed.

Erythropoiesis and Red Cell Indices Undergo Adjustments during Pregnancy in Response to Maternal Body Size but not Inflammation.

During human pregnancy, iron requirements gradually increase, leading to higher amounts of erythropoietin (EPO) and reticulocytes, and changes in erythrocyte size and density. Women with pregestational obesity experience “obesity hypoferremia” during pregnancy, which alters iron homeostasis. In this study we aimed to describe the relationship between EPO and iron nutrition status during nonanemic pregnancy, and to explore whether obesity and inflammation influence erythropoiesis and red cell indices. We conducted a secondary analysis of a cohort followed throughout pregnancy. Participants were nonanemic women assigned to two study groups based on pregestational body mass index (pgBMI): adequate weight (AW, n = 53) or obesity (Ob, n = 40). All received a multivitamin supplement. At gestational ages (GA) 13, 21, 28 and 34, we measured hemoglobin and red cell indices with an ACT-5DIFF hematology counter, and reticulocyte percentage by manual cell counting. EPO, interleukin (IL–6) and markers of iron status, i.e., hepcidin, serum transferrin receptor (sTfr) and ferritin, were measured by ELISA. Bivariate correlations showed that EPO was positively associated with pgBMI, GA, sTfr and IL-6, but negatively associated with hepcidin, ferritin and hemoglobin, and unrelated to iron intake. Generalized linear models adjusted for confounding factors showed that EPO and erythrocyte concentrations were significantly higher in women in the Ob group, while mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW) were lower; reticulocytes and mean corpuscular hemoglobin concentration (MCHC) were not different. Differences were not altered when controlling for inflammation (IL–6). These changes suggest that, in addition to altering iron metabolism, a larger maternal body size during pregnancy results in higher erythropoiesis without increasing hemoglobin, which is exhibited in the latter being distributed among more and smaller erythrocytes.

Differences in the response to iron supplementation on oxidative stress, inflammation, and hematological parameters in nonanemic and anemic pregnant women

Background Iron supplementation is widely recommended for all pregnant women, irrespective of their iron status. But providing excess iron to nonanemic pregnant women can result in iron overload, which may lead to oxidative stress and inflammation. Objectives To assess the differential effect of iron supplementation on hematological parameters, oxidative stress, and inflammation in nonanemic and anemic pregnant women. Methods Forty nonanemic and forty anemic pregnant women were recruited at 12 weeks of gestation. The study subjects were supplemented with iron (60 mg/day for nonanemic pregnant women and 120 mg/day for anemic pregnant women). Fasting state blood samples were collected at 12 and 28 weeks of gestation. Results Malondialdehyde (MDA)/total antioxidant status (TAS) ratio (MDA/TAS) and high-sensitivity C-reactive protein (hsCRP) were significantly higher in anemic pregnant women before iron supplementation. Iron supplementation to the anemic pregnant women resulted in significant improvement in the hematological profile and ferritin levels. Further, the iron supplementation caused a significant reduction in hsCRP levels although the MDA/TAS ratio remained unaltered. Iron supplementation to nonanemic pregnant women resulted in a significant increase in the levels of MDA/TAS ratio and hsCRP, but there were no changes in hematological profile and serum ferritin levels. Conclusion Prophylactic iron supplementation in nonanemic pregnant women increased oxidative stress and inflammation. However, in anemic pregnant women, iron supplementation was found to be beneficial as it improved hematological status and decreased inflammation without affecting oxidative stress.

Efficacy of Medications in Anaemic Women of Reproductive Age

Background: Anaemia, most common due to iron deficiency affects all ages in many populations and has become major public health global concern. Attempts continue to prevent. Objective: was to know efficacy of allopathic, ayurvedic medication, nutritional advice on women with mild, moderate anaemia with no obvious disorders which could cause anaemia. Material Methods: Institute based study was carried out after taking ethics committee’s approval. Study subjects were women of 15 to 49 years from outpatient of obstetrics gynaecology. They had disorders but not those which could have caused anaemia. Volunteers, relatives or friends of patients, were explained, included after looking into inclusion criteria. No one refused and 75% were patients. After checking haemoglobin women with mild, moderate anaemia were given medication monthly for 6 months. Nutritional advocacy was done using booklet. Total 904 anaemic women were divided in 4 groups randomly, group A Allopathic medication, group An Allopathic medication with nutritional advice, group B: Ayurvedic medication, group Bn: Ayurvedic medication with nutritional advice. Results: 1330 women screened, 904(67.96%), 168(18.6%), moderately and 736(81.41%) were mildly anaemic. Of them only 562(62.2%) women took medication though provided free, 104(61.90%) of moderately anaemic 458(62.22%), mildly anaemic. After 180 days of 104 moderately anaemic 72(69.21%) became nonanaemic, 32(30.8%) mildly anaemic and of 458 mildly anaemic, 430(93.9%) became non-anaemic women. 28(6.1%) remained mildly anaemic. Subjective analysis revealed feeling very good in most, no change in few. No one talked of negative effects. Some had side effects. Conclusion: It is essential to find ways of appropriate iron intake to prevent anaemia. In very small numbers anaemia did not change in spite of giving iron which needs research. Research on behavioural aspect is needed as noncompliance was in large numbers even with free medication.

Novel genetic variants of transferrin receptor 2 exon 4 and cytokines profile of anemic and nonanemic pregnant women in Central Java, Indonesia

Objective: To assess the association between genetic variants of transferrin receptor 2 (TFR2) exon 4 and anemia status and to describe the expression levels of several cytokines, hepcidin, soluble transferrin receptor and erythropoietin. Methods: Institutional based comparative study was done randomly to recruit 106 pregnant women who attended antenatal care in three different health centers in Boyolali Regency, Central Java from May 2015 to September 2015. DNA was extracted from peripheral blood samples of selected pregnant women and sequencing was done for TFR2 exon 4. Furthermore, enzyme-linked immunosorbent assay was conducted to measure the expression levels of interleukin 6, interleukin 4, transforming growth factor β and iron-metabolism related proteins such as hepcidin, soluble transferrin receptor, and erythropoietin. Gene alignment was performed by using a CLUSTAL W program. Collected data were analyzed statistically by using parametric and nonparametric tests with Statistical Product and Service Solutions (SPSS) 20.0 for Windows. Results: Three novel genetic variants from TFR2 exon 4 (position 603, 605 and 606) were associated with anemia status. Moreover, the expression levels of interleukin 6, interleukin 4, transforming growth factor β and erythropoietin were higher in anemic pregnant women than those of nonanemic pregnant women but only erythropoietin level reached statistical significance. These results were followed by decreases of hepcidin and soluble transferrin receptor levels. Conclusions: Various factors contribute to anemia prevalence among pregnant women in Boyoali Regency, Central Java, Indonesia. Our novel findings showed that TFR2 exon 4 has 3 mutational sites in position 603, 605 and 606. These novel genetic variants may provide a new insight into the role of TFR2 in anemia.

Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes.

Objectives:Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes.Materials and Methods:This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels.Results:We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl–16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels.Conclusions:We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.

A cross-sectional study in non-anaemic pregnant women in Turkey to assess necessity of iron supplementation

A cross-sectional study in non-anaemic pregnant women in Turkey to assess necessity of iron supplementation

Prevalence, Aetiology, Maternal and Neonatal Outcome of Term Mothers with Anaemia, Presenting to a Tertiary Care Unit for Confinement in Sri Lanka

Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonatal outcome among term mothers with anaemia compared to non-anaemic pregnant women at a tertiary care centre in Sri Lanka. Method: A comparative cross-sectional study was performed by recruiting anaemic and non-anaemic term mothers who delivered at the Teaching Hospital Peradeniya during the period March 2018-March 2019. Pregnant mothers whose haemoglobin level was less than 10.5 g/dl were considered as anaemic and compared with the mothers whose haemoglobin level was above this level. With written consent, demographic data, etiological factors, maternal and neonatal outcomes of term mothers were evaluated by an interview and blood samples were withdrawn to carry out anaemia related investigations. Results: Among 2854 pregnancies, a total of 234 (8.19%) term pregnant mothers were anaemic and they were and compared with 199 non-anaemic mothers. Out of the anaemic mothers (Hb < 105 g/l), 133 (56.76%) had moderate anaemia, 100 (42.79%) had mild anaemia and 1 mother (0.45%) had severe anaemia. Low monthly family income was significantly associated with the incidence of anaemia. Anaemia was also associated with low weekly consumption of red meat (OR 8.994; 95% CI, 5.74 - 14.09, p < 0.05) and high weekly tea intake (OR 0.217; 95% CI 0.144 - 0.327, p < 0.05). Among anaemic mothers, 215 (67.44%) had low serum ferritin (<30 ng/mL) while most of them were diagnosed with iron deficiency anaemia (58.24%) (n = 113) based on haemoglobin. Most anaemic mothers had undergone elective caesarean section (46.26%) while vaginal deliveries (33.33%) were common among non-anamic group. Conclusions: A moderate prevalence of anaemia among term pregnant women in Peradeniya, Sri Lanka was observed and was associated with low socio economic status, low consumption of tea and poor nutrition lacking in red meat.

Single vs. Double Dose Iron Supplementation for Prevention of Iron Deficiency Anemia in Twin Pregnancy: A Randomized Controlled Clinical Trial

Introduction: It is estimated that about 18% of pregnant women suffer from iron deficiency anemia throughout their whole pregnancy. In twin pregnancy, owing to the relatively greater feto-placental requirements and greater expansion in maternal plasma volume and red cell mass, iron requirements are magnified 1.8 times compared to singleton pregnancies. However, for prevention of iron deficiency in twin pregnancy, only sparse data exist regarding the sufficiency of the standard antenatal iron supplementation dose used in singleton pregnancies to meet the increased iron demand. In this study, we investigate the effect of single and double dose iron supplementation for prevention of iron deficiency anemia in twin pregnancy. Methods: A randomized controlled clinical trial was conducted at our center in the period between February 2019 and October 2020, and included 450 eligible healthy non-anemic women aged 18 - 35 years, with twin pregnancy at 12 - 16 weeks of gestation. After informed consent, eligible women were randomized to receive either single dose 27 mg, or double dose 54 mg elemental iron supplementation. Monitoring of hemoglobin concentration was done at fixed time points during gestation: at enrollment, 24 weeks, 32 weeks and before delivery. The primary outcome of the study was the incidence of iron deficiency anemia during follow up until delivery. Results: The incidence of iron deficiency anemia in the two groups did not differ significantly between the single dose group (19.1%) and the double dose group (24.0%). In women who did not develop Iron Deficiency Anemia, hemoglobin concentration varied significantly along the different gestational ages during the follow up period. In contrast, they did not show an overall statistically significant difference in the hemoglobin concentrations between the single or double dose groups. Conclusion: This clinical trial did not demonstrate an added benefit for doubling prophylactic iron supplementation dose in non-anemic women with twin pregnancy.

Dietary and Plasma Carboxymethyl Lysine and Tumor Necrosis Factor-α as Mediators of Body Mass Index and Waist Circumference among Women in Indonesia.

Dietary and plasma carboxymethyl lysine (dCML, pCML) and plasma tumor necrosis factor-α (pTNF-α) may be associated with obesity in affluent society. However, evidence in women from low-middle income countries with predominantly traditional diets is lacking. We investigated the mediator effects of dCML, pCML and pTNF-α on body mass index (BMI) and waist circumference (WC) among Indonesian women. A cross-sectional study was conducted among 235 non-diabetic, non-anemic and non-smoking women aged 19–50 years from selected mountainous and coastal areas of West Sumatra and West Java. Dietary CML, pCML, pTNF-α were obtained from 2 × 24-h recalls, ultra-performance liquid chromatography-tandem mass spectrometry and enzyme-linked immunosorbent assay, respectively. Between-group differences were analyzed by the Chi-square or Mann-Whitney test and mediator effects by Structural Equation Modeling. The medians and interquartile-ranges of dCML, pCML and pTNF-α were 2.2 (1.7–3.0) mg/day, 22.2 (17.2–28.2) ng/mL and 0.68 (0.52–1.00) IU/mL, respectively, and significantly higher in the WC ≥ 80 cm than in the WC < 80 cm group, but not in BMI ≥ 25 kg/m2 compared to BMI < 25 kg/m2 group. Plasma CML and pTNF-α were positively and directly related to WC (β = 0.21 [95% CI: 0.09, 0.33] and β = 0.23 [95% CI: 0.11, 0.35], respectively). Dietary CML that correlated with dry-heat processing and cereals as the highest contributions was positively related to WC (β = 0.33 [95% CI: 0.12, 0.83]). Ethnicity, level of education, intake of fat, and intake of energy contributed to dCML, pCML and pTNF-α, and subsequently affected WC, while only ethnicity contributed to BMI through dCML, pCML and pTNF-α (β = 0.07 [95% CI: 0.01, 0.14]). A positive direct effect of dCML on pCML and of pCML and pTNF-α on WC was seen among Indonesian women. Dietary CML seems to have several paths that indirectly influence the increases in WC if compared to BMI. Thus, intake of CML-rich foods should be reduced, or the foods consumed in moderate amounts to avoid the risk of central obesity in this population.