Effects of Iron Supplements on Heme Scavengers in Pregnancy

In malaria endemic countries, anemia in pregnant women occurs as a result of erythrocyte destruction by Plasmodium infections and other causes including malnutrition. Iron supplementation is recommended as treatment of iron-deficiency anemia. Erythrocyte destruction results in increased release of cytotoxic free heme that is scavenged by haptoglobin (Hp), hemopexin (Hx) and heme oxygenase-1 (HO-1). Paradoxically, iron supplementation in pregnant women has been reported to enhance parasitemia and increase levels of free heme. The relationship between free heme, heme scavengers, and birth outcomes has not been investigated, especially in women who are on iron supplementation. We hypothesized that parasite-infected pregnant women on routine iron supplementation have elevated heme and altered expression of heme scavengers. A cross-sectional study was conducted to determine the association between plasma levels of free heme, HO-1, Hp, Hx, and malaria status in pregnant women who received routine iron supplementation and their birth outcomes. Heme was quantified by colorimetric assay and scavenger protein concentration by ELISA. We demonstrated that iron-supplemented women with asymptomatic parasitemia had increased free heme (mean 75.6 µM; interquartile range [IQR] 38.8–96.5) compared with nonmalaria iron-supplemented women (mean 34.9 µM; IQR 17.4–43.8, P < 0.0001). Women with preterm delivery had lower levels of Hx (mean 656.0 µg/mL; IQR 410.9–861.3) compared with women with full-term delivery (mean: 860.9 µg/mL; IQR 715.2–1055.8, P = 0.0388). Our results indicate that iron supplementation without assessment of circulating levels of free heme and heme scavengers may increase the risk for adverse pregnancy outcomes.

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Screening for Iron Deficiency Anemia and Iron Supplementation in Pregnant Women to Improve Maternal Health and Birth Outcomes: U.S. Preventive Services Task Force Recommendation Statement

Annals of Internal Medicine ◽

10.7326/m15-1707 ◽

2015 ◽

Vol 163 (7) ◽

pp. 529 ◽

Cited By ~ 37

Author(s):

Albert L. Siu

Keyword(s):

Maternal Health ◽

Iron Deficiency ◽

Pregnant Women ◽

Birth Outcomes ◽

Iron Deficiency Anemia ◽

Iron Supplementation ◽

Task Force ◽

Preventive Services ◽

Deficiency Anemia

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Pengaruh Umur Ibu Hamil Dan Dukungan Keluarga Terhadap Kepatuhan Mengkonsumsi Tablet Besi (Fe) Dan Anemia Pada Ibu Hamil Di Puskesmas Kota Wilayah Selatan Kota Kediri

Jurnal Ilmu Kesehatan MAKIA ◽

10.37413/jmakia.v4i1.28 ◽

2017 ◽

Vol 4 (1) ◽

Author(s):

Dina Dewi Anggraini

Keyword(s):

Pregnant Women ◽

Health Center ◽

Family Support ◽

Random Sampling ◽

Maternal Age ◽

Sampling Technique ◽

Deficiency Anemia ◽

Third Trimester ◽

Regional Health ◽

Cross Sectional

ABSTRAKPerdarahan merupakan prosentase tertinggi penyebab terjadinya kematian ibu. Dan anemia zat besi merupakan penyebab utama terjadinya perdarahan. Pencegahan anemia gizi besi dilakukan melalui pemberian tablet besi dengan dosis pemberian sebanyak 1 tablet berturut-turut minimal selama 90 hari selama kehamilan. Pada kecamatan dan Puskesmas Kota Kediri 2014, cakupan Fe1 dan Fe3 yang terendah adalah pada Kecamatan Kota, yaitu Puskesmas Kota Wilayah Selatan, dengan Fe1 sebesar 69,81% dan Fe3 sebesar 66,29%. Penelitian dilakukan untuk menganalisis pengaruh umur ibu hamil dan dukungan keluarga terhadap kepatuhan mengkonsumsi tablet besi dan anemia pada ibu hamil di Puskesmas Kota Wilayah Selatan Kota Kediri 2016. Metode pada penelitian ini dengan observasi analitik dan rancang bangun cross sectional. Populasi pada penelitian ini 63 orang ibu hamil trimester III dan sampelnya 34 orang ibu hamil trimester III yang telah mendapatkan 90 tablet besi (Fe), dengan teknik simpel random sampling. Data diperoleh dari kuesioner, buku Kesehatan Ibu dan Anak, dan wawancara yang mendalam. Analisis data yang dilakukan dengan menggunakan regresi ordinal dan regresi logistik. Hasil uji didapatkan nilai p = 0,000 0,05 untuk variabel umur ibu hamil 20 tahun terhadap kepatuhan mengkonsumsi tablet besi (Fe), nilai p = 0,238 0,05 untuk variabel dukungan keluarga terhadap kepatuhan mengkonsumsi tablet besi (Fe), dan nilai p = 0,012 0,05 untuk variabel kepatuhan yang cukup dalam mengkonsumsi tablet besi (Fe) terhadap anemia pada ibu hamil. Semakin tinggi faktor risiko umur pada ibu hamil, maka semakin cenderung ibu hamil untuk patuh mengkonsumsi tablet besi (Fe) pada masa kehamilan. Semakin tinggi tingkat kepatuhan ibu hamil dalam mengkonsumsi tablet besi (Fe), maka semakin tinggi pula kecenderungan ibu hamil untuk tidak terkena anemia pada masa kehamilan. Kata kunci: Umur, Dukungan Keluarga, Kepatuhan, Anemia. ABSTRACTBleeding is the highest percentage of the causes of maternal mortality. And iron anemia is a major cause of bleeding. Prevention of iron deficiency anemia is done through the provision of iron tablets with doses as much as 1 tablet in a row for a minimum of 90 days during pregnancy. In the town of Kediri district and health center in 2014, Fe1 and Fe3 coverage is lowest in the City District, the Southern Regional Health Center, with Fe1 amounted to 69,81% and amounted to 66,29% Fe3. The study was conducted to analyze the effect of maternal age and family support for adherence to consume iron tablets and anemia in pregnant women in the South Regional Health Center of Kediri, 2016. The method in this study with analytic observation and cross sectional design. The population in this study 63 third trimester pregnant women and the sample 34 third trimester pregnant women who have received 90 tablets of iron (Fe), with a simple random sampling technique. Data obtained from questionnaires, books Maternal and Child Health, and in-depth interviews. Data analysis was performed using ordinal regression and logistic regression. The test results obtained value of p = 0,000 0,05 for the variable maternal age 20 years of adherence to consume tablets of iron (Fe), p = 0,238 0,05 for the variable of family support for adherence to consume tablets of iron (Fe), and p = 0,012 0,05 for the variable adherence sufficient to consume iron tablet (Fe) against anemia in pregnant women. The higher the risk factors of age in pregnant women, pregnant women, the more it tends to stick to consume tablets of iron (Fe) during pregnancy. The higher the level of adherence of pregnant women consume iron tablet (Fe), the higher the tendency of pregnant women not exposed to anemia during pregnancy. Keywords: Age, Family Support, Adherence, Anemia.

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Perbedaan Kadar Brain Derived Neurotropic Factor Neonatus Dari Ibu Hamil Normal Dan Anemia Defisiensi Besi

Jurnal Endurance ◽

10.22216/jen.v3i3.3706 ◽

2018 ◽

Vol 3 (3) ◽

pp. 568

Author(s):

Ainal Mardiah ◽

Arni Amir ◽

Andi Friadi ◽

Ellyza Nasrul

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Community Health ◽

Health Center ◽

Iron Deficiency Anemia ◽

Community Health Center ◽

Deficiency Anemia ◽

Cross Sectional ◽

Consecutive Sampling ◽

Neurotropic Factor

Iron deficiency anemia is anemia caused by iron deficiency in the blood. Maternal iron deficiency affects the low iron reserves in neonates and it also influences on Brain Derived Neurotropic Factor (BDNF) which affects cognitive function. The purpose of this study was to determine the difference mean of BDNF in neonates from normal pregnant women and pregnant women with iron deficiency. The design of this research was Cross Sectional design. This research was conducted in Community Health Center of Lubuk Buaya, Ambacang Community Health Center, Community Health Center of Ikur Koto Health Center and Biomedical Laboratory of Andalas University on February 2017 to April 2018. There were 42 pregnant women was selected as sample e of this research. The samples were chosen by Consecutive Sampling. Then, the sample is divided into two groups: normal pregnant women and pregnant women with iron deficiency anemia. BDNF are examined by the ELISA. Next, the data were analyzed by using T test. The levels of BDNF neonates in normal pregnant group was 3.65(ng/ml) and the anemia pregnant group was 1.74(ng/ml) (p <0.05). There was significant difference of BDNF levels in neonates from normal pregnant women and pregnant women with iron deficiency anemia. The conclusion of this study is there is a difference of average BDNF in neonates from normal pregnant women and pregnant women with iron deficiency. Anemia defisiensi besi adalah anemia yang disebabkan karena kekurangan zat besi dalam darah. Defisiensi besi maternal berdampak pada rendahnya cadangan besi pada neonatus dan berdampak terhadap ekspresi Brain Derived Neurotropic Factor (BDNF) yang berpengaruh pada fungsi kognitif. Tujuan penelitian ini adalah untuk mengetahui perbedaan rerata kadar BDNF pada neonatus dari ibu hamil normal dan ibu hamil defisiensi besi. Desain penelitian ini adalah Cross Sectional. Penelitian dilakukan di Puskesmas Lubuk Buaya, Puskesmas Ambacang, Puskesmas Ikur Koto dan Laboratorium Biomedik Universitas Andalas pada bulan Februari 2017 – Juli 2018. Sampel Penelitian adalah ibu hamil sebanyak 42 orang yang dipilih secara Consecutive Sampling, sampel dibagi menjadi dua kelompok yaitu ibu hamil normal dan ibu hamil anemia defisiensi besi. BDNF diperiksa dengan metode ELISA. Data dianalisa menggunakan uji T test. Kadar BDNF neonatus pada ibu kelompok normal adalah 3,65(ng/ml) dan kelompok ibu anemia adalah 1,74(ng/ml) (p<0,05). Terdapat perbedaan bermakna kadar BDNF pada neonatus dari ibu hamil normal dan ibu anemia defisiensi besi.

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Hubungan Pengetahuan Dan Kepatuhan Ibu Hamil Konsumsi Tablet Tambah Darah Dengan Kejadian Anemia Di Kecamatan Leitimur Selatan Dan Teluk Ambon

Jurnal Epidemiologi Kesehatan Komunitas ◽

10.14710/jekk.v6i1.10180 ◽

2021 ◽

pp. 229-236

Author(s):

Elpira Asmin ◽

Armando Salulinggi ◽

Christiana Rialine Titaley ◽

Johan Bension

Keyword(s):

Pregnant Women ◽

Iron Supplementation ◽

Analytical Study ◽

Cross Sectional ◽

Iron Supplements ◽

Nutritional Problem ◽

Women's Knowledge ◽

The Relationship ◽

Women’S Knowledge ◽

Prevalence Of Anemia

Background: Anemia is a public health nutritional problem, especially for pregnant women. Anemia in pregnancy can adversely affect the morbidity and mortality of both mother and baby. According to the WHO, the prevalence of anemia in Indonesia was 40.5% in 2015, and 42% in 2016. One of the government's efforts to reduce the rate of anemia is the provision of iron tablets. In Indonesia, the coverage of giving at least 90 tablets during pregnancy in 2017 reached 80.81%. However, in Maluku Province, the coverage of iron supplementation (47.35%) was included amongst the four lowest provinces. This study aims to examine the relationship between pregnant women's knowledge and consumption of iron tablets and anemia in the Districts of South Leitimur and Teluk Ambon. Methods: This research is an analytical study with a cross-sectional approach. The subjects of this study were 165 pregnant women who were taken by purposive sampling.Result: The results showed 50.3% of pregnant women had anemia and only 21.8% complied with taking iron tablets. We found that there was no statistically significant association between pregnant women's knowledge of iron supplementation (p=0.443), as well as compliance with taking iron supplements (p=0.135), and anemia. Nevertheless, the percentage of women with anemia was lower in pregnant women who complied with taking iron supplements than those who did not comply. Conclusion : This study shows that efforts are still required to reduce the prevalence of anemia in Ambon City, including increasing women's compliance to take iron tablets.

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Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

Current Developments in Nutrition ◽

10.1093/cdn/nzz120 ◽

2019 ◽

Vol 3 (12) ◽

Cited By ~ 5

Author(s):

Djibril M Ba ◽

Paddy Ssentongo ◽

Kristen H Kjerulff ◽

Muzi Na ◽

Guodong Liu ◽

...

Keyword(s):

Pregnant Women ◽

Iron Supplementation ◽

Population Based ◽

Sub Saharan Africa ◽

Deficiency Anemia ◽

Demographic And Health Surveys ◽

Factors Associated ◽

Sub Saharan ◽

Ssa Countries ◽

Antenatal Visits

ABSTRACT Background Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. Objectives To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. Methods This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. Results The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y. Conclusions Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

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Vitamin A and Nutritional Anaemia

Food and Nutrition Bulletin ◽

10.1177/156482659601700103 ◽

1996 ◽

Vol 17 (1) ◽

pp. 1-3 ◽

Cited By ~ 10

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.

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Analysis of the iron profile and the incidence of iron deficiency anemia in the third-trimester pregnant women in the coendemic areas of Bengkulu City, Indonesia

Journal of Public Health in Africa ◽

10.4081/jphia.2019.1197 ◽

2019 ◽

Author(s):

Mohammad Zulkarnain ◽

Rizka Muliani ◽

Rico Januar Sitorus ◽

Nurlaili Nurlaili

Keyword(s):

Iron Deficiency ◽

Pregnant Women ◽

Iron Deficiency Anemia ◽

Total Sample ◽

Deficiency Anemia ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Third Trimester ◽

Cross Sectional ◽

The Third

Pregnant women are at risk for iron deficiency anemia especially pregnant women in malaria-endemic areas. This study aimed to analyze the profile of iron in the third trimester pregnant women with iron deficiency anemia in co-endemic area of Bengkulu city. This study was cross-sectional study with a total sample of 66 pregnant women who met the inclusion criteria. Examination profile of iron in pregnant women is done by taking blood specimen through the vena cubity. Profile iron includes examination sTfR levels, hepcidin, transferrin were examined by ELISA. Determination of iron deficiency anemia is based on the results of Hb, serum iron and TIBC. The results showed 39.4% of pregnant women experience iron deficiency anemia. There is an average difference between hepcidin levels with the incidence of iron deficiency anemia (p-value 0.031). Based on binary logistic regression analysis profile iron with irondeficiency anemia in pregnant women, hepcidin levels are predictors factors on the incidence of iron deficiency anemia (p-value 0.000, 95% CI .296-.709).

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