scholarly journals Iron Deficiency Project in Pregnancy: Maternal Iron Optimization (IRON MOM)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4893-4893
Author(s):  
Jameel Abdulrehman ◽  
Grace Tang ◽  
Rosane Nisenbaum ◽  
Jessica Petrucci ◽  
Katerina Pavenski ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Clinical Pathways ◽  
Reproductive Age ◽  
Psychomotor Development ◽  
Long Term Effects ◽  
Post Intervention ◽  
One Year ◽  
Maternal Iron ◽  
In Pregnancy

Abstract Background Iron deficiency (ID) is the most common and widespread nutritional deficiency in the world and is found predominantly in women of reproductive age. The prevalence of ID is even higher in pregnancy, as maternal iron requirements increase to accommodate the expansion of maternal red blood cell (RBC) mass, development of the placenta and fetus, and the loss of blood associated with labor and delivery. When ID leads to anemia (IDA), it is associated with preterm delivery, cesarian delivery, RBC transfusions, low birth weight, five minute Apgar score < 7, neonatal intensive care unit admission and long term effects on mental and psychomotor development in the child. Although ID in pregnancy is simple to diagnose and treat, it often goes undiagnosed and untreated, due to low awareness of its implications and multiple competing priorities. Objectives Our primary objective was to increase awareness of ID in pregnant women, measured by a process metric which compared the monthly rate of ferritin testing pre- versus post-initiative. Our secondary objective was to decrease the incidence of IDA in pregnant women, measured by comparing the proportion of women to ever have an antepartum hemoglobin (HB) ≥ 100g/L pre- versus post- initiative. Methods Using a multidisciplinary and sequential quality improvement approach, we developed the IRON MOM toolkit for use at our institution, St. Michael's Hospital (SMH), Toronto, Canada. The toolkit included educational resources for clinicians and patients, clinical pathways to guide management of ID in pregnancy, adjusted laboratory requisitions and providing standardized iron prescriptions in the prenatal clinic. The initiative was formally reviewed by institutional authorities and was deemed to neither require Research Ethics Board approval nor written informed consent from participants. Data was collected from the electronic patient record to compare pre-intervention data (January 1, 2012 to December 31, 2016) to post-intervention data (January 1, 2017 to December 31, 2017). SAS software was used for statistical analysis. The monthly ferritin rates were calculated by dividing the number of ferritin tests by the number of outpatient HB tests, at each month and year and multiplying by 100. For the proportion of women to have ever had an antepartum HB ≥100g/L, as some women may have been in both the pre and post intervention groups, generalized estimating equations were used, with binomial distribution and logit link, to test for differences between pre and post periods. Results IRON MOM was launched at SMH on January 1, 2017. The pre-intervention five year period included 1292 outpatient ferritin tests, and 16,603 antepartum HB values belonging to 15,019 women and the post-intervention one year period included 2400 outpatient ferritin tests and 3282 antepartum HB values belonging to 3280 women. The monthly rate of ferritin testing increased dramatically post-initiative, 81.0 (Standard Deviation [SD] 6.3) compared to 8.4 (SD 4.4) pre-initiative. Please see figure 1 for details. There was a statistically significant increase in the proportion of women to have ever had an antepartum HB ≥ 100g/L, 89.5% (2936/3280) (95% confidence interval (CI) 88.3% to 90.4%) in the post-initiative, compared to 87.8% (13184/15,019)(95%CI 87.2% to 88.3%) in the pre-initiative period (p<0.01). Conclusions The IRON MOM toolkit successfully increased awareness of ID in pregnant women. The implementation of educational materials and simple process changes dramatically increased the rate of ferritin testing by almost 10x. Although there were statistically significant increases in the proportion of women with antepartum HB greater than 100g/L, post-IRON MOM, these changes were clinically insignificant. This was expected as this assessment was limited to one year (52 weeks) post intervention, and a full term pregnancy is 40 weeks. Therefore, only the women giving birth in the last 12 weeks of the year would have participated in the initiative throughout their entire pregnancy. We conclude that the practical changes involved in the IRON MOM tool kit have the potential for clinically meaningful impact. Future directions include simplification and digitization of the tool kit, which aim to maximize adherence to the protocols and further empower the pregnant patient. Disclosures Lausman: Ferring: Other: gave a talk.

scholarly journals Iron Status from Early Through Late Pregnancy and Neonatal Anthropometric Measures: Friend or Foe?

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1003-1003
Author(s):  
Anisa Holloman ◽  
Jing Wu ◽  
Mengying Li ◽  
Shristi Rawal ◽  
Ellen Francis ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Gestational Age ◽  
Chronic Conditions ◽  
Iron Status ◽  
Late Pregnancy ◽  
Increased Risk ◽  
Maternal Iron ◽  
In Pregnancy

Abstract Objectives Although iron status in pregnancy is an important factor for fetal growth, associations between maternal iron status and neonatal size are highly conflicting. Further, studies with longitudinal measures of iron status in pregnancy are scarce. This study investigated maternal iron status from early through late pregnancy using comprehensive measures of iron biomarkers (ferritin, hepcidin, soluble transferrin receptor [sTfR], and sTfR: ferritin ratio) in relation to neonatal size. Methods This study included 321 pregnant women without major chronic conditions before pregnancy who were enrolled in the NICHD Fetal Growth Study- Singletons (n = 2802). Plasma iron biomarkers (i.e., ferritin, sTfR, hepcidin) were measured at 4 visits (10–14, 15–26, 23–31, and 33–39 gestational weeks [GW]). We used linear and Poisson regression models adjusted for covariates including pre-pregnancy BMI and C-reactive protein to estimate the association of tertiles (T) of iron biomarkers and clinically defined iron status with neonatal anthropometry, such as birthweight (BW), risk of large and small-for-gestational age (LGA, SGA) and macrosomia. Results Iron deficiency (i.e., ferritin &lt;12 ug/L) at 10–14 GW was related to increased risk of macrosomia and LGA; adjusted RR (95% confidence interval (CI)) were 3.64 (1.45, 9.17), and 14.2 (5.49, 36.4), respectively. At 15–26 GW, iron deficiency was also related to increased risk of LGA with a RR of 3.58 (1.13, 11.4). In contrast, at 33–39 GW, iron deficiency was related to lower risk of macrosomia with a RR of 0.06 (0.01, 0.36). The CIs were wide, largely due to small sample size of macrosomia cases. In addition, at 10–14 GW, lower iron status (indicated by higher sTfR levels) was related to greater BW; highest vs. lowest T mean BW was 3385 g vs. 3251 g with an adjusted p-value for difference &lt;0.05. Conclusions Our findings among U.S. pregnant women without major chronic conditions before pregnancy suggest that the relation of maternal iron status to neonatal size may vary by gestational age and lower iron status in early pregnancy is generally related to heavier neonates. Funding Sources Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH).

scholarly journals High burden of anemia among pregnant women in Tanzania: a call to address its determinants

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bruno F. Sunguya ◽  
Yue Ge ◽  
Linda Mlunde ◽  
Rose Mpembeni ◽  
Germana Leyna ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Gis Mapping ◽  
Demographic And Health Surveys ◽  
Health Coverage ◽  
Nutritional Knowledge ◽  
Women Of Reproductive Age ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Abstract Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery.

scholarly journals Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2221
Author(s):  
Hugo G. Quezada-Pinedo ◽  
Florian Cassel ◽  
Liesbeth Duijts ◽  
Martina U. Muckenthaler ◽  
Max Gassmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Child Health ◽  
Methodological Quality ◽  
Iron Status ◽  
Meta Analysis ◽  
Child Health Outcomes ◽  
Maternal Iron ◽  
In Pregnancy

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.

scholarly journals Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Gayani Shashikala Amarasinghe ◽  
Thilini Chanchala Agampodi ◽  
Vasana Mendis ◽  
Krishanthi Malawanage ◽  
Chamila Kappagoda ◽  
...  
Keyword(s):  
Public Health ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Blood Count ◽  
First Trimester ◽  
Full Blood Count ◽  
Red Cell ◽  
Middle Income ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Abstract Background The Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure. Methods All first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing. Results Among 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed. Conclusion Even though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

scholarly journals Treatment of Anemia of Chronic Disease with True Iron Deficiency in Pregnancy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Gabriela Amstad Bencaiova ◽  
Alexander Krafft ◽  
Roland Zimmermann ◽  
Tilo Burkhardt
Keyword(s):  
Chronic Disease ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
Anemia Of Chronic Disease ◽  
Human Erythropoietin ◽  
Anemia Treatment ◽  
In Pregnancy

Objective.We assess and compare the efficacy of anemia treatment in pregnant women with anemia of chronic disease with true iron deficiency and in women with iron deficiency anemia.Study Design.Fifty patients with moderate anemia (hemoglobin 8.0–9.9 g/dl) and iron deficiency (ferritin < 15 μg/l) were treated in the Anemia Clinic at the Department of Obstetrics.Results.All patients showed stimulation of erythropoiesis as evidenced by an increase in reticulocyte count at day eight of therapy and showed an increase in hemoglobin and hematocrit at the end of therapy (p<0.001). The target hemoglobin (≥10.5 g/dl) was achieved in 45/50 women (90%). 12 patients showed anemia of chronic disease with true iron deficiency (12/50; 24%). Seven women (7/12; 59%) with anemia of chronic disease and iron deficiency responded well to anemia treatment. 50% of women with anemia of chronic disease and iron deficiency (3/6) responded well to intravenous iron, and 67% (4/6) responded well to the combination of intravenous iron and recombinant human erythropoietin.Conclusion.Because of frequent true iron deficiency in pregnant women with anemia of chronic disease, anemia of chronic disease in pregnancy is often falsely diagnosed as iron deficiency anemia.

scholarly journals Modest and Severe Maternal Iron Deficiency in Pregnancy are Associated with Fetal Anaemia and Organ-Specific Hypoxia in Rats

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Andrew G. Woodman ◽  
Alison S. Care ◽  
Yael Mansour ◽  
Stephana J. Cherak ◽  
Sareh Panahi ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Organ Specific ◽  
Maternal Iron ◽  
In Pregnancy

scholarly journals The impacts of maternal iron deficiency and being overweight during pregnancy on neurodevelopment of the offspring

2017 ◽  
Vol 118 (7) ◽  
pp. 533-540 ◽  
Author(s):  
Staffan K. Berglund ◽  
Francisco J. Torres-Espínola ◽  
Luz García-Valdés ◽  
Mª Teresa Segura ◽  
Cristina Martínez-Zaldívar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iron Deficiency ◽  
Gestational Diabetes ◽  
Observational Study ◽  
Pregnant Women ◽  
Prospective Observational Study ◽  
Infant Neurodevelopment ◽  
Spanish Women ◽  
Independent Effects ◽  
Maternal Iron

AbstractBoth maternal Fe deficiency (ID) and being overweight or obese (Ow/Ob, BMI≥25 kg/m2) may negatively affect offspring brain development. However, the two risk factors correlate and their independent effects on infant neurodevelopment are unclear. PREOBE is a prospective observational study that included 331 pregnant Spanish women, of whom 166 had pre-gestational Ow/Ob. Fe status was analysed at 34 weeks and at delivery, and babies were assessed using Bayley III scales of neurodevelopment at 18 months. In confounder-adjusted analyses, maternal ID at 34 weeks was associated with lower composite motor scores at 18 months (mean 113·3 (sd 9·9) v. 117·1 (sd 9·2), P=0·039). Further, the offspring of mothers with ID at delivery had lower cognitive scores (114·0 (sd 9·7) v. 121·5 (sd 10·9), P=0·039) and lower receptive, expressive and composite (99·5 (sd 8·6) v. 107·6 (sd 8·3), P=0·004) language scores. The negative associations between maternal ID at delivery and Bayley scores remained even when adjusting for maternal Ow/Ob and gestational diabetes. Similarly, maternal Ow/Ob correlated with lower gross motor scores in the offspring (12·3 (sd 2·0) v. 13·0 (sd 2·1), P=0·037), a correlation that remained when adjusting for maternal ID. In conclusion, maternal ID and pre-gestational Ow/Ob are both negatively associated with Bayley scores at 18 months, but independently and on different subscales. These results should be taken into account when considering Fe supplementation for pregnant women.

scholarly journals Serum and urine vitamin D metabolite analysis in early preeclampsia

2018 ◽  
Vol 7 (1) ◽  
pp. 199-210 ◽  
Author(s):  
J A Tamblyn ◽  
C Jenkinson ◽  
D P Larner ◽  
M Hewison ◽  
M D Kilby
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Vitamin D Metabolites ◽  
Serum Concentrations ◽  
Control Serum ◽  
Significant Difference ◽  
Paired Serum ◽  
In Pregnancy ◽  
Serum And Urine

Vitamin D deficiency is common in pregnant women and may contribute to adverse events in pregnancy such as preeclampsia (PET). To date, studies of vitamin D and PET have focused primarily on serum concentrations vitamin D, 25-hydroxyvitamin D3 (25(OH)D3) later in pregnancy. The aim here was to determine whether a more comprehensive analysis of vitamin D metabolites earlier in pregnancy could provide predictors of PET. Using samples from the SCOPE pregnancy cohort, multiple vitamin D metabolites were quantified by liquid chromatography–tandem mass spectrometry in paired serum and urine prior to the onset of PET symptoms. Samples from 50 women at pregnancy week 15 were analysed, with 25 (50%) developing PET by the end of the pregnancy and 25 continuing with uncomplicated pregnancy. Paired serum and urine from non-pregnant women (n = 9) of reproductive age were also used as a control. Serum concentrations of 25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 24,25(OH)2D3 and 3-epi-25(OH)D3 were measured and showed no significant difference between women with uncomplicated pregnancies and those developing PET. As previously reported, serum 1,25(OH)2D3 was higher in all pregnant women (in the second trimester), but serum 25(OH)D2 was also higher compared to non-pregnant women. In urine, 25(OH)D3 and 24,25(OH)2D3 were quantifiable, with both metabolites demonstrating significantly lower (P < 0.05) concentrations of both of these metabolites in those destined to develop PET. These data indicate that analysis of urinary metabolites provides an additional insight into vitamin D and the kidney, with lower urinary 25(OH)D3 and 24,25(OH)2D3 excretion being an early indicator of a predisposition towards developing PET.

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