The challenge of defining and treating anemia and iron deficiency in pregnancy: A study of New Zealand midwives' management of iron status in pregnancy and the postpartum period

Calje, Esther; Skinner, Joan

doi:10.1111/birt.12282

Cited by 11 publications

(17 citation statements)

References 39 publications

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“…In particular, the conflicting biological rationales, stated earlier, have made the clinical practice challenging and evidence-based recommendations are not readily available. [ 23 24 25 ] In summary, our findings may have three important implications for weight management and the use of iron supplements. First, our findings clearly emphasize, on top of other studies investigating adverse effects of excessive weight gain, that fast weight gain during pregnancy is undesirable.…”

Section: Discussionmentioning

confidence: 90%

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy

Tan

et al. 2018

Chinese Medical Journal

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Background:The effect of maternal weights on the risk of iron deficiency anemia (IDA) during pregnancy remains unclear. The study aimed to investigate the association between maternal weight indicators and IDA during pregnancy.Methods:We conducted a cohort study to examine the association between maternal weight indicators, including prepregnancy body mass index and the rate of gestational weight gain (GWG), and the risk of IDA among Chinese pregnant women. Data about new-onset IDA at different trimesters from a national cross-sectional survey were collected; information regarding baseline variables and rate of GWG from women participating in the survey were retrospectively collected. Tested IDA and reported IDA were documented. Multilevel logistic regression to examine the association between maternal weight indicators and the risk of IDA after adjusting for potential confounders was conducted.Results:This study enrolled 11,782 pregnant women from 24 hospitals from September 19, 2016, to November 20, 2016. Among those, 1515 (12.9%) IDA events were diagnosed through test (test IDA); 3915 (33.3%) were identified through test and patient reporting (composite IDA). After adjusting for confounders and cluster effect of hospitals, underweight pregnant women, compared with normal women, were associated with higher risk of test IDA (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.17–1.57 and composite IDA (aOR: 1.35, 95% CI: 1.21–1.51); on the contrary, overweight and obese women had lower risk of test IDA (aOR: 0.68, 95% CI: 0.54–0.86 overweight; aOR: 0.30, 95% CI: 0.13–0.69 obese) and composite IDA (aOR: 0.77, 95% CI: 0.67–0.90 overweight; aOR: 0.34, 95% CI: 0.21–0.55 obese). The higher rate of GWG was associated with higher risk of IDA (test aOR: 1.86 95% CI: 1.26–2.76; composite aOR: 1.54, 95% CI: 1.16–2.03).Conclusions:Pregnant women who are underweight before pregnancy and who have faster GWG are more likely to develop IDA. Enforced weight control during pregnancy and use of iron supplements, particularly among underweight women, may be warranted.

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Section: Discussionmentioning

confidence: 90%

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy

Tan

et al. 2018

Chinese Medical Journal

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“…Although anaemia is associated with increased risk for significant morbidity and mortality 23,24 , there are no clear recommendations for postpartum anaemia testing 25 . Risk factors for postpartum anaemia were shown to be anaemia during the third trimester of pregnancy, postpartum haemorrhage, younger maternal age, and inadequate iron supplementation during the postpartum period 26,27 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of postpartum anaemia screening to improve anaemia diagnosis and patient care: A prospective non-randomized before-and-after anaemia screening protocol implementation study

Yefet

Suleiman

Garmi

et al. 2019

Sci Rep

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We assessed the efficacy of a screening protocol for postpartum anaemia diagnosis and treatment in the maternity ward. A prospective non-randomized before-and-after anaemia screening protocol implementation study during two consecutive periods was conducted. Women who were scheduled for vaginal birth were tested for haemoglobin (Hb) before delivery. During the first period (June 29–October 10, 2015; N = 803) Hb was measured postpartum for women with anaemia-related symptoms, postpartum haemorrhage, or pre-delivery severe anaemia (Hb < 8 g/dL; “symptoms” group). During the second period (October 11, 2015–January 27, 2016; N = 755) Hb was also measured in all women with pre-delivery anaemia [i.e., Hb < 10.5 g/dL] (“screening” group). The primary outcomes were the rates of women with (1) postpartum anaemia diagnosis (Hb < 10 g/dL) and (2) administration of parenteral iron sucrose (indicated for postpartum Hb ≤ 9.5 g/dL). The detection rate of postpartum anaemia was higher in the screening group compared with the symptoms group (140 (19%) versus 100 (12%), OR adjusted 2.2 95%CI [1.6–3.0], respectively). The iron sucrose treatment rate was also higher (110 (15%) versus 88 (11%), OR adjusted 2.0 95%CI [1.4–2.7], respectively). A total of 122 women were diagnosed with moderate-severe anaemia in the screening group, 27 of whom (22%) were diagnosed solely due to the screening protocol. The results demonstrated that a routine screening of women with predelivery anaemia for postpartum anaemia led to increased anaemia diagnosis and consequently better medical care.

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“…No studies reporting the frequency of iron deficiency and iron deficiency anemia in pregnant women in African countries were found. Research performed in Oceania showed no consensus regarding maternal anemia indicators [37][38][39]. Betwen 1999 and 2005, the occurrence of maternal anemia in southern Australia was 7.1% [37].…”

Section: Prevalence Of Maternal and Iron Deficiency Anemiamentioning

confidence: 99%

“…Betwen 1999 and 2005, the occurrence of maternal anemia in southern Australia was 7.1% [37]. In New Zealand, 2013 data indicate a frequency of maternal anemia of 54.5%; however, only 6.3% and 5.8% of the pregnant women had iron deficiency and iron deficiency anemia, respectively [39]. Another relevant indicator for this hematological disorder concerns the severity of maternal anemia [1].…”

Section: Prevalence Of Maternal and Iron Deficiency Anemiamentioning

confidence: 99%

Maternal Anemia and Iron Deficiency Anemia: Similarities and Singularities

Acmg¹,

Filho²,

Rb³

et al. 2018

Health Care Current Reviews

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Maternal anemia is a major global public health problem, and although widely discussed, there are few studies investigating the condition in pregnant women. In this article, issues related to the diagnosis, biological mechanism and prevalence of maternal anemia. In addition, iron deficiency anemia will be considered a proxy for maternal anemia. In previous studies, the concepts of maternal anemia have been controversial. It is also noted that isolated actions are not sufficient to combat this disease, and policies to address the primary causes of the associated nutritional deficiencies are necessary. Maternal Search strategiesMesh and similar terms were combined using Boolean operators (AND, OR), and the search strategy below was primarily used for Studies selectionAfter duplicate removal, titles and abstracts were screened for eligible articles independently by two reviewers (ACMGF and SSC). Two reviewers selected articles by reading titles and abstracts. During the process of selecting the articles the researchers were not aware of the decisions made by their colleague. After that, full text articles were assessed for eligibility. Discordant events were resolved by consensus. Data extractionData extraction was performed independently by two researchars (ACMGF and RBS) and discordant events resolved by consensus. We used a standardized electronic spreadsheet to extract the following information: author's name, year of publication, year of data collection and geographic region, study design, sample size, anemia diagnosis criteria, frequency of maternal anemia and iron deficiency anemia. Authors were contacted for additional information considered important for this review.

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The challenge of defining and treating anemia and iron deficiency in pregnancy: A study of New Zealand midwives' management of iron status in pregnancy and the postpartum period

Abstract: There was a wide range in the midwives' practice. Maternal iron status was difficult to categorize, because of inconsistent testing. This study indicates the need for an evidence-based clinical guideline for New Zealand midwives and maternity care providers.

Cited by 11 publications

References 39 publications

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy

Evaluation of postpartum anaemia screening to improve anaemia diagnosis and patient care: A prospective non-randomized before-and-after anaemia screening protocol implementation study

Maternal Anemia and Iron Deficiency Anemia: Similarities and Singularities

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