Maternal anemia and severe maternal morbidity in a US cohort

Harrison, Rachel; Lauhon, Samantha R.; Colvin, Zachary; McIntosh, Jennifer

doi:10.1016/j.ajogmf.2021.100395

Cited by 34 publications

(39 citation statements)

References 41 publications

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“…Finally, clinicians should note that administration of IV iron is not recommended in the first trimester because of the lack Abbreviations: CBC, complete blood count with platelets; Hb, hemoglobin. Sources: Smith et al (2019), 5 Juul et al (2019), 1 Garzon et al (2020), 22 Means (2020), 6 American College of Obstetricians and Gynecologists (2021), 15 Harrison (2021), 7 Teichman (2021). 35 of data available on safety parameters during this key time of fetal development.…”

Section: Iron Therapymentioning

confidence: 99%

“…Abbreviations: CBC, complete blood count with platelets; Hb, hemoglobin. Sources: Smith et al (2019), 5 Juul et al (2019), 1 Garzon et al (2020), 22 Means (2020), 6 American College of Obstetricians and Gynecologists (2021), 15 Harrison (2021), 7 Teichman (2021) 35 …”

Section: Types Of Anemiamentioning

confidence: 99%

“…3 Multiple studies demonstrate the risks of iron deficiency anemia on maternal health and fetal development. 1,[4][5][6][7] Clinicians routinely screen for anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth and initiate treatment with oral iron supplementation when anemia is identified. 8 Although this diagnostic and treatment approach is standard practice, it provides inadequate monitoring of maternal tolerance and repletion prior to birth.…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies demonstrate the risks of iron deficiency anemia on maternal health and fetal development 1,4–7 . Clinicians routinely screen for anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth and initiate treatment with oral iron supplementation when anemia is identified 8 .…”

Section: Introductionmentioning

confidence: 99%

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Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Elmore

Ellis

2022

J Midwife Womens Health

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Iron deficiency anemia is the most prevalent form of anemia worldwide. In the United States, clinicians routinely screen for iron deficiency anemia upon initiation of prenatal care, at the start of the third trimester, and prior to birth. Treatment of iron deficiency anemia generally begins with oral supplementation of elemental iron, which is associated with adverse gastrointestinal effects. These adverse effects can decrease adherence, leading to subtherapeutic treatment. Newer evidence highlights the benefits of early screening for iron deficiency before the onset of anemia, as well as the use of intravenous iron to expedite the treatment of iron deficiency anemia. More research is needed on the potential consequences of over-supplementation and iron deficiency without anemia to guide treatment. This article reviews the evidence for best practices for screening, treatment, and continued monitoring of iron deficiency anemia during pregnancy and postpartum. Maternal, fetal, and neonatal implications are reviewed, as well as the risks and benefits of treatment options. Finally, an evidence-based algorithm is proposed to guide clinicians on continued monitoring after treatment.

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Section: Iron Therapymentioning

confidence: 99%

Section: Types Of Anemiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Elmore

Ellis

2022

J Midwife Womens Health

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“…Although some degree of dilutional anemia is part of normal physiology during gestation, maternal iron deficiency anemia (IDA) can lead to adverse pregnancy and newborn outcomes. These outcomes include severe maternal morbidity ( 3 ), as well as cognitive defects, stillbirth, low birth weight, and infant mortality ( 4 – 8 ). Physiological conditions of pregnancy can promote IDA, with the maximum absorption of iron from the diet less than the body's requirements for iron, resulting in the risk of iron deficiency ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Food-derived bioactive oligopeptide iron complexes ameliorate iron deficiency anemia and offspring development in pregnant rats

et al. 2022

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This study aimed to investigate anemia treatment and other potential effects of two food-derived bioactive oligopeptide iron complexes on pregnant rats with iron deficiency anemia (IDA) and their offspring. Rats with IDA were established with a low iron diet and then mated. There were one control group and seven randomly assigned groups of pregnant rats with IDA: Control group [Control, 40 ppm ferrous sulfate (FeSO4)]; IDA model group (ID, 4 ppm FeSO4), three high-iron groups (H-FeSO4, 400 ppm FeSO4; MCOP-Fe, 400 ppm marine fish oligopeptide iron complex; WCOP-Fe, 400 ppm whey protein oligopeptide iron complex) and three low-iron groups (L-FeSO4, 40 ppm FeSO4; MOP-Fe, 40 ppm marine fish oligopeptide iron complex; WOP-Fe, 40 ppm whey protein oligopeptide iron complex). Rats in each group were fed the corresponding special diet during pregnancy until the day of delivery. After different doses of iron supplement, serum hemoglobin, iron, and ferritin levels in rats with IDA were significantly increased to normal levels (P < 0.05). Serum iron levels were significantly lower in two food-derived bioactive oligopeptide low-iron complex groups than in the low FeSO4 group (P<0.05). Liver malondialdehyde levels were significantly increased in the three high-iron groups compared with the other five groups (P < 0.05), and hemosiderin deposition was observed in liver tissue, indicating that the iron dose was overloaded and aggravated the peroxidative damage in pregnant rats. Liver inflammation was reduced in the three low-iron groups. Tumor necrosis factor α secretion was significantly decreased in all groups with supplemented oligopeptide (P < 0.05), with the concentration of tumor necrosis factor α declining to normal levels in the two whey protein oligopeptide iron complex groups. In the marine fish oligopeptide iron complex groups, body length, tail length, and weight of offspring were significantly increased (P < 0.05) and reached normal levels. Therefore, food-derived bioactive oligopeptide (derived from marine fish skin and milk) iron complexes may be an effective type of iron supplement for pregnancy to improve anemia, as well as reduce the side effects of iron overload, and improve the growth and nutritional status of offspring.

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Anemic Data for Preventive Screening and Supplementation to Address Iron Deficiency Anemia in Pregnancy

Duryea,

Spong

2024

JAMA

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The US Preventive Services Task Force (USPSTF) recently released a Recommendation Statement examining the data to support screening for iron deficiency anemia in pregnancy and finding them lacking. 1 It also found insufficient evidence to make a clear recommendation for or against preventive iron supplementation in pregnancy, 2,3 which has been a routine practice for decades, with up to 77% to 89% of patients reporting supplement use. 4 As highlighted previously by the USPSTF and others, there is an urgent need for studies and clinical trials to support evidence-based medicine in the obstetric population, and this can only be accomplished by ceasing paternalistic approaches that have led to the exclusion of pregnant patients in research. [5][6][7][8][9][10][11] All of this remains true, and there is still so very far to go.In the updated USPSTF review, an additional 5 randomized clinical trials (RCTs) were included with the 12 RCTs carried forward from the 2015 review. The USPSTF determined that the availability of good-and fair-quality RCTs was sufficient; observational studies were included only for the association questions. However, it is important to acknowledge that while RCTs provide rigor and purity for evaluating medical interventions, they may not always be the best study design for all clinical questions. Indeed, the many traditional RCT designs and implementation approaches limit real-world applicability, discourage involvement and thus applicability to marginalized and underserved populations, and decrease the likelihood that the effect on rare outcomes such as severe maternal morbidity will be detected. Large, populationbased studies provide additional useful evidence when examining uncommon outcomes with a high impact such as severe maternal morbidity and mortality, transfusion, and death. An RCT examining such rare outcomes may be costprohibitive and thus an ineffective method to approach several aspects of the question at hand.Importantly, it is vital to ensure that the outcomes assessed in studies are physiologically plausible. Some of the outcomes reviewed by the USPSTF, such as gestational diabetes, hypertensive disorders, and cesarean delivery, have been associated with iron deficiency anemia in observational studies but not in RCTs. It is more likely that the association in observational studies was due to confounders such as nutritional status, body mass index, healthy lifestyle choices, socioeconomic status, and systemic racism rather than iron defi-

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Maternal anemia and severe maternal morbidity in a US cohort

Cited by 34 publications

References 41 publications

Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Screening, Treatment, and Monitoring of Iron Deficiency Anemia in Pregnancy and Postpartum

Food-derived bioactive oligopeptide iron complexes ameliorate iron deficiency anemia and offspring development in pregnant rats

Anemic Data for Preventive Screening and Supplementation to Address Iron Deficiency Anemia in Pregnancy

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