scholarly journals Anemia Prevalence and Iron Supplementation Practices Among Pregnant Women in Vancouver, Canada

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 733-733
Author(s):  
Kelsey Cochrane ◽  
Rajavel Elango ◽  
Angela Devlin ◽  
Jennifer Hutcheon ◽  
Crystal Karakochuk
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Microcytic Anemia ◽  
Clinical Practices ◽  
Ferritin Concentration ◽  
Supplement Use ◽  
Prenatal Vitamins ◽  
Additional Iron

Abstract Objectives Health Canada recommends supplementation with 16–20 mg iron during pregnancy to maintain adequate iron stores and reduce the prevalence of iron deficiency. Most prenatal vitamins contain 27 mg iron (the recommended dietary allowance). In the case of diagnosed iron deficiency (typically defined as a ferritin concentration < 15–50 µg/L), some pregnant women may be recommended to take additional iron. Iron is an essential nutrient and adequate intake is needed for a healthy pregnancy; however, excess iron can also be harmful. We aimed to evaluate the hematological profile, prevalence of anemia, and iron supplementation practices of healthy pregnant women in Vancouver, Canada. Methods As part of an ongoing clinical trial, 40 healthy pregnant women (aged 19–42 years) received prenatal vitamins containing 27 mg iron over 16 weeks of pregnancy, starting at 9–21 weeks gestation. A complete blood count was measured at baseline and endline. Anemia was defined as hemoglobin < 110 g/L in the first/third trimesters and < 105 g/L in the second trimester. Microcytic anemia (most commonly caused by iron deficiency) was defined as having both anemia and a MCV concentration < 80 fL. Participants reported other supplement use throughout the study, including additional iron prescribed for treatment of iron deficiency and/or anemia. Results At baseline and endline, the mean ± SD of hemoglobin was 124 ± 9 g/L and 127 ± 11 g/L; and for MCV was 89 ± 3 fL and 91 ± 3 fL, respectively. Based on hemoglobin (trimester-specific) and MCV thresholds, no participants were classified as having anemia or microcytic anemia at either timepoint, respectively. At endline, a total of n = 8 women (20%) reported that following their baseline visit (during the intervention period) they were informed by their health care provider to increase their supplemental dose of iron up to 300 mg, in addition to the 27 mg in the study prenatal vitamin. Conclusions Whether recommendation for additional iron was warranted in 20% of women is unclear, as none had microcytic anemia based on hemoglobin and MCV values. Measurement of ferritin is warranted for the definitive diagnosis of iron deficiency, and to elucidate if there is a need for improved clinical practices for recommending additional iron supplementation. Funding Sources Healthy Starts Catalyst Grant (BC Children's Hospital Research Institute, Vancouver, Canada).

scholarly journals Prevalence of iron deficiency states and risk of haemoconcentration during pregnancy according to initial iron stores and iron supplementation

2013 ◽  
Vol 16 (8) ◽  
pp. 1371-1378 ◽  
Author(s):  
Victoria Arija ◽  
Blanca Ribot ◽  
Núria Aranda
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Lower Risk ◽  
Iron Supplementation ◽  
Logistic Models ◽  
Late Pregnancy ◽  
Supplement Use ◽  
Nutritional Advice ◽  
Initial Iron

AbstractObjectiveTo describe the prevalence of iron depletion (ID), iron-deficiency anaemia (IDA) and risk of haemoconcentration during pregnancy and at delivery and to assess the influence of initial Fe stores and Fe supplementation on that prevalence.DesignLongitudinal study.SettingHospital Universitari Sant Joan de Reus (Catalonia, Spain).SubjectsTwo hundred and eighty-five pregnant women. Serum ferritin and Hb were measured in the first, second and third trimesters and at delivery. Women were classified according to initial Fe stores as ID or no ID (serum ferritin ≥12 μg/l) and according to Fe supplement use as supplemented or non-supplemented.ResultsInitial ID was 16·2 %. At delivery, 45·7 % had ID, 13·5 % IDA and 13·3 % had risk of haemoconcentration. Initial ID and non-supplemented groups had significantly higher prevalences of ID and IDA and lower risk of haemoconcentration at delivery than the other groups. In the multiple logistic models, no initial ID and Fe supplementation exerted a protective effect against ID at delivery (adjusted OR = 0·28; 95 % CI 0·13, 0·58 and adjusted OR = 0·39; 95 % CI 0·22, 0·69, respectively). Moderate Fe supplementation did not seem to clearly prevent IDA (adjusted OR = 0·91; 95 % CI 0·42, 1·96) or to enhance the haemoconcentration (adjusted OR = 1·42; 95 % CI 0·58, 3·50).ConclusionsThe prevalence of ID and IDA was high in late pregnancy in healthy pregnant women, particularly in those with initial ID and/or those not taking supplements. Starting pregnancy with no ID and/or taking moderate Fe supplementation decreased the likelihood of ID at delivery. The risk of haemoconcentration was high at delivery, but did not seem to be promoted by Fe supplementation. Further research is necessary to determine the most appropriate nutritional advice for pregnant women.

Iron Supplementation in Infancy

1986 ◽  
Vol 8 (6) ◽  
pp. 177-184
Author(s):  
Jerry D. Reeves
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Iron Absorption ◽  
The United States ◽  
Microcytic Anemia ◽  
The Body ◽  
Minimal Risk ◽  
Dietary Practices ◽  
Initial Iron ◽  
The Many

Although dietary practices in the United States have changed in the past decade to include more bioavailable iron in many infant's diets, iron deficiency remains an important problem. Prevalence of iron deficiency is still high, even among economically privileged infants. Not only microcytic anemia but also adverse effects on growth, behavior, intestinal function, energy metabolism, and immune function may result with deficiencies of the many important ironcontaining compounds in the body. Infants are at highest risk for iron deficiency because initial iron endowment is often low, iron needs for growth are high, and foods in infants' diets usually are poor iron sources or impair iron absorption. In addition, the frequent infections typical in infants impair iron absorption when needs remain high. By taking a careful history and using simple laboratory screening procedures, the pediatrician can identify a large proportion of those who will benefit from iron supplementation. Avoiding foods impairing iron absorption, continuing intake of foods with relatively large amounts of bioavailable iron, and giving additional iron supplementation to particularly highrisk infants can further decrease the prevalence of iron deficiency and its potentially serious consequences with minimal risk.

scholarly journals Health outcomes of iron supplementation and/or food fortification in iron-replete children aged 4–24 months: protocol for a systematic review and meta-analysis

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Dominic J. Hare ◽  
Sabine Braat ◽  
Bárbara R. Cardoso ◽  
Christopher Morgan ◽  
Ewa A. Szymlek-Gay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Iron Supplementation ◽  
Meta Analysis ◽  
High Income ◽  
Dietary Iron ◽  
Food Fortification ◽  
Iron Intake ◽  
Theses And Dissertations ◽  
Additional Iron

Abstract Background Direct supplementation or food fortification with iron are two public health initiatives intended to reduce the prevalence of iron deficiency (ID) and iron deficiency anaemia (IDA) in 4–24-month-old infants. In most high-income countries where IDA prevalence is < 15%, the recommended daily intake levels of iron from supplements and/or consumption of fortified food products are at odds with World Health Organisation (WHO) guidelines that recommend shorter-term (3 months/year) supplementation only in populations with IDA prevalence > 40%. Emerging concerns about delayed neurological effects of early-life iron overexposure have raised questions as to whether recommended guidelines in high-income countries are unnecessarily excessive. This systematic review will gather evidence from supplementation/fortification trials, comparing health outcomes in studies where iron-replete children did or did not receive additional dietary iron; and determine if replete children at study outset were not receiving additional iron show changes in haematological indices of ID/IDA over the trial duration. Methods We will perform a systematic review of the literature, including all studies of iron supplementation and/or fortification, including study arms with confirmed iron-replete infants at the commencement of the trial. This includes both dietary iron intervention or placebo/average dietary intakes. One reviewer will conduct searches in electronic databases of published and ongoing trials (Medline, Web of Science, Scopus, CENTRAL, EBSCO [e.g. CINAHL Complete, Food Science and Technology Abstracts], Embase, ClinicalTrials.gov, ClinicalTrialsRegister.eu and who.it/trialsearch), digital theses and dissertations (WorldCat, Networked Digital Library of Theses and Dissertations, DART-Europe E-theses Portal, Australasian Digital Theses Program, Theses Canada Portal and ProQuest). For eligible studies, one reviewer will use a data extraction form, and a second reviewing entered data for accuracy. Both reviewers will independently perform quality assessments before qualitative and, if appropriate, quantitative synthesis as a meta-analysis. We will resolve any discrepancies through discussion or consult a third author to resolve discrepancies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement will be used as the basis for reporting. Discussion Recommended iron supplementation and food fortification practices in high-income countries have been criticised for being both excessive and based on outdated or underpowered studies. This systematic review will build a case for revisiting iron intake guidelines for infants through the design of new trials where health effects of additional iron intake in iron-replete infants are the primary outcome. Systematic review registration PROSPERO CRD42018093744.

scholarly journals Vitamin A and Nutritional Anaemia

1996 ◽  
Vol 17 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Djoko Suharno ◽  
Muhilal
Keyword(s):  
Placebo Group ◽  
Iron Deficiency ◽  
Vitamin A ◽  
Pregnant Women ◽  
Iron Supplementation ◽  
Ferrous Sulphate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vitamin A Status

A cross-sectional study of the prevalence of iron and vitamin A deficiencies in 318 pregnant women revealed that 50.7% had iron deficiency and 21.3% had marginally deficient or deficient vitamin A status. Based on results, the influence of vitamin A and iron supplementation was studied in 305 anaemic pregnant women in west Java, in a randomized, doubleblind, placebo-controlled field trial. The women with a haemoglobin between 80 and 109 g/L were randomly allocated to four groups: vitamin A (2.4 mg retinol) and placebo iron tablets; iron (60 mg elemental iron as ferrous sulphate) and placebo vitamin A; vitamin A and iron; and both placebos, all daily for eight weeks. Maximum haemoglobin was achieved with both vitamin A and iron supplementation (12. 78 g/L, 95% Cl 10.86 to 14.70), with one-third of the response attributable to vitamin A (3.68 g/L, 2.03 to 5.33) and two-thirds to iron (771 g/L, 5.97 to 9.45). After supplementation, the proportion of women who became non-anaemic was 35 % in the vitamin Asupplemented group, 68% in the ironsupplemented group, 97% in the group supplemented with both, and 16% in the placebo group. We conclude that improvement in vitamin A status may contribute to the control of anaemia in pregnant women.

scholarly journals Iron-Supplementation Programmes: Compliance of Target Groups and Frequency of Tablet Intake

1996 ◽  
Vol 17 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Werner Schultink
Keyword(s):  
Developing Countries ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Large Scale ◽  
Iron Supplementation ◽  
Daily Basis ◽  
Original Research ◽  
Target Groups ◽  
Deficiency Anaemia

The prevalence of iron-deficiency anaemia remains especially high in developing countries, despite large-scale iron-supplementation programmes. The reasons for the lack of success of these programmes are discussed based on the results of original research conducted in Indonesia. Studies among pregnant women in rural Sulawesi and urban Jakarta demonstrated that besides insufficient coverage of the target group, women's compliance with tablet intake was a serious problem. Compliance may be improved when it is not necessary to take tablets on a daily basis. Studies among pre-school children and non-pregnant women proved the effectiveness of once-weekly and twice-weekly supplementation. These supplementation schedules should also be investigated in pregnant women.

scholarly journals Is untargeted iron supplementation harmful when iron deficiency is not the major cause of anaemia? Study protocol for a double-blind, randomised controlled trial among non-pregnant Cambodian women

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037232
Author(s):  
Jordie AJ Fischer ◽  
Lulu X Pei ◽  
David M Goldfarb ◽  
Arianne Albert ◽  
Rajavel Elango ◽  
...  
Keyword(s):  
British Columbia ◽  
Iron Deficiency ◽  
Research Ethics ◽  
Iron Supplementation ◽  
Double Blind ◽  
Ferritin Concentration ◽  
Potential Harm ◽  
Research Ethics Board ◽  
Randomised Controlled ◽  
Forms Of Iron

IntroductionThe WHO recommends daily oral iron supplementation for 12 weeks in women and adolescents where anaemia prevalence is greater than 40%. However, if iron deficiency is not a major cause of anaemia, then, at best, untargeted iron supplementation is a waste of resources; at worst, it could cause harm. Further, different forms of iron with varying bioavailability may present greater risks of harm.Methods and analysisA 12-week three-arm, double-blind, randomised controlled supplementation trial was conducted in Cambodia to determine if there is potential harm associated with untargeted iron supplementation. We will recruit and randomise 480 non-pregnant women (ages 18–45 years) to receive one of three interventions: 60 mg elemental iron as ferrous sulfate (the standard, commonly used form), 18 mg ferrous bisglycinate (a highly bioavailable iron amino acid chelate) or placebo. We will measure ferritin concentrations (to evaluate non-inferiority between the two forms of iron), as well as markers of potential harm in blood and stool (faecal calprotectin, gut pathogen abundance and DNA damage) at baseline and 12 weeks. Mixed-effects generalised linear models will be used to assess the effect of iron on ferritin concentration and markers of potential harm at 12 weeks.Ethics and disseminationEthical approval was obtained from the University of British Columbia Clinical Research Ethics Board (H18-02610), the Children's and Women's Health Centre of British Columbia Research Ethics Board (H18-02610) and the National Ethics Committee for Health Research in Cambodia (273-NECHR). Findings will be published in peer-reviewed journals, presented to stakeholders and policymakers globally and shared within participants’ communities.Trial registration numberClinicalTrials.gov Registry (NCT04017598).

High Prevalence of Iron Deficiency In Anemic and Non Anemic Patients with Various Types of Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5145-5145
Author(s):  
Heinz Ludwig ◽  
Georg Endler ◽  
Brigitte Klement ◽  
Wolfgang Hüubl ◽  
Tim Cushway
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Multiple Testing ◽  
Serum Iron ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Clinical Symptoms ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Patients With Cancer

Abstract Abstract 5145 Introduction and aims: Iron deficiency as a major component in the pathogenesis of anemia in cancer is not acknowledged by most oncologists, possibly except when arising from GI blood loss. Iron deficiency is associated with clinical symptoms such as cognitive impairment, fatigue, and reduced exercise performance. New iron formulations are available that allow rapid iron supplementation with single infusions. This treatment could ameliorate symptoms of iron deficiency and correct anemia. Here, we studied iron parameters and their correlation with erythropoiesis and inflammatory markers in a large unselected cohort of patients with cancer. In addition, we investigated the suitability of serum ferritin and transferrin saturation (TSAT) as parameter for assessment of the iron status. Patients and methods: Data from 1627 patients (median age: 66.4 years, range: 20–97 years) presenting sequentially at the Center for Oncology and Hematology, Wilhelminenspital, Vienna between October 01, 2009 and January 26, 2010, have retrospectively been analyzed. Patients were at different stages of their disease or may not have had an established diagnosis at the time of testing. In patients with multiple testing during this period only the first sample taken was included. TSAT (n=1516), serum ferritin (n=887), serum iron, CRP, and complete blood count, were determined by using standard techniques. Commonly used definitions for absolute iron deficiency (AID), [TSAT <20% and serum ferritin <30ng/ml, in case serum ferritin was not available TSAT <10%] and for functional iron deficiency (FID), [TSAT <20% and serum ferritin ≥30ng/ml, in case serum ferritin was not available TSAT between 10 and 20%] have been applied. Fisher's exact test was used for comparison of frequencies and Pearson's product moment correlation coefficient for evaluation of correlation. Results: Table 1 shows the distribution of TSAT and serum ferritin categories in 1627 patients with cancer. AID was found in 116 patients (7.7%) of the 1516 patients for whom TSAT was available. Eighty-three (72%) of the AID patients presented with anemia (defined by hemoglobin <12g/dl). AID was most common in patients with colorectal and pancreatic cancer (12% and 11%, respectively), and not present in patients with testicular and prostate cancer (p=0.013). FID was diagnosed in 530 patients (35%) and 222 (42%) of them were found to be also anemic. Multivariate analysis revealed a statistically significant correlation between TSAT and serum ferritin (R=0.286, p<0.001), serum iron (R=0.874, p<0.001), hemoglobin (R=0.201, p<0.001) and CRP (R=-0.205, p<0.001) (figure 1). Serum ferritin, in contrast, did not correlate with serum iron (R=0.051, p=0.132), but correlated with hemoglobin (R=-0.259, p<0.001), TSAT (R=0.286, p<0.001), and CRP (R=0.396, p<0.001). Conclusion: AID (7.7%) and even more so FID (35%) are frequent co-morbidities in patients with various types of cancer. Seventy-two percent of patients with AID and 42% with FID presented with overt anemia. TSAT correlated closely with serum iron and hemoglobin levels and seems to be the preferred parameter for assessment of iron status in patients with chronic diseases often complicated by increased inflammation. Serum ferritin was found to be an inadequate parameter for assessment and monitoring of iron status. As iron deficiency has been linked with various symptoms, the question arises whether iron supplementation would benefit patients with FID without overt anemia. Future studies should evaluate the role of novel intravenous iron preparations in ameliorating the symptoms of iron deficiency with or without anemia. Disclosures: Klement: Vifor Pharma Ltd: Employment. Cushway:Vifor Pharma Ltd.: Employment.

scholarly journals Justification of Universal Iron Supplementation for Infants 6-12 months in Regions with a High Prevalence of Thalassemia

2021 ◽  
Author(s):  
Phakatip Sinlapamongkolkul ◽  
Pacharapan Surapolchai ◽  
Vip Viprakasit
Keyword(s):  
Iron Deficiency ◽  
Iron Supplementation ◽  
Complete Blood Count ◽  
Iron Status ◽  
Transferrin Saturation ◽  
University Hospital ◽  
Deficiency Anemia ◽  
Increased Risk ◽  
Thalassemia Minor ◽  
Hb E

Abstract Background Many clinicians hesitate adopting a universal infant iron supplementation program due to the risk of increased iron absorption for those with thalassemia. We aimed to determine thalassemia prevalence in 6- to 12-month old infants, along with the iron status of those with and without thalassemia. Procedures: We performed a cross-sectional descriptive study of infants attending the Well Baby Clinic at Thammasat University Hospital for routine checkups. Complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia were evaluated. Results Overall, 97 of 206 (47%) participants had thalassemia minor, the majority having Hb E traits. None had thalassemia intermedia or major. Familial history of anemia or thalassemia presented an increased risk of detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, p = 0.001). There were no statistical differences in transferrin saturation, serum ferritin and hepcidin between iron-replete infants with thalassemia minor and those without. However, one-third of infants with thalassemia minor (31/97) also had iron deficiency anemia (IDA), with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor as compared to controls. Conclusions Both thalassemia and IDA are endemic to Southeast Asia. Infants with thalassemia minor, particularly with Hb E and α-thalassemia traits, are at risk of IDA. Our short-term universal iron supplementation program for 6 to 12-month old infants does not appear to increase the risk of those with thalassemia minor developing iron overload in the future.

scholarly journals Early Screening of Hemoglobinopathy in Indonesia Using Erythrocyte Indices

2017 ◽  
Vol 9 (2) ◽  
pp. 99
Author(s):  
Yenny Surjawan ◽  
Hwee Lian Tan ◽  
Rahajuningsih Dharma Setiabudy ◽  
Wiwik Rositawati
Keyword(s):  
Iron Deficiency ◽  
Sensitivity And Specificity ◽  
High Performance ◽  
Complete Blood Count ◽  
Hemoglobin Concentration ◽  
Early Screening ◽  
Cross Sectional ◽  
Distribution Width ◽  
Ferritin Concentration ◽  
Erythrocyte Indices

BACKGROUND: The mutation spectrums of hemoglobinopathy are different among populations that yield a different result of erythrocyte indices. Calculation of erythrocyte indices with some formula has been reported to differentiate between hemoglobinopathy and non-hemoglobinopathy, but its cut-off should be recalculated specific for each population to gain a better sensitivity and specificity. We aimed to evaluate red blood cell count (RBC), Mentzer index, red cell distribution width (RDW), RDW index (RDWI), Shine and Lal index (S&L) and Green and King index (G&K) to screen hemoglobinopathy in Indonesia.METHODS: A retrospective cross-sectional study was performed on 202 subjects. The diagnosis of hemoglobinopathy was determined based on the results of complete blood count (CBC) data, high-performance liquid chromatography (HPLC) and Hemoglobin H (HbH) inclusion body. The ferritin concentration was checked to determine the status of iron. The erythrocytes indices were analyzed and calculated to predict hemoglobinopathy. RESULTS: A total 202 subjects who met the criteria were involved in this study. Fifty percent showed pure hemoglobinopathy and 4% showed a combination of thalassemia and hemoglobinopathy. The hemoglobin concentration and RBC were significantly higher, and the mean corpuscular volume (MCV) and RDW were significantly lower in hemoglobinopathy compared to iron deficiency. The difference was not significant if the hemoglobinopathy was combined with iron deficiency. By this study's cut-off, the G&K and RDWI showed the highest accuracy, sensitivity, and specificity.CONCLUSION: The new cut-off of erythrocyte index and its calculation to screen hemoglobinopathy in Indonesia showed a higher sensitivity and specificity, especially for G&K and RDWI with cut-off 73 and 228, respectively. The presence of iron deficiency in hemoglobinopathy could decrease the sensitivity.KEYWORDS: hemoglobinopathy, RBC, Mentzer index, RDW, RDWI, S&L, G&K

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