The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

VanderMeulen, Heather; Strauss, Rachel; Lin, Yulia; McLeod, Anne; Barrett, J.F.; Sholzberg, Michelle; Callum, Jeannie

doi:10.1186/s12884-020-02886-z

Cited by 21 publications

(26 citation statements)

References 30 publications

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“…28,29 Furthermore, pregnant patients of lower SES are less likely to receive iron supplementation 30 and are more likely to receive peripartum blood transfusions. 31 To our knowledge, this is the first study to demonstrate an association between SES and the likelihood of ID screening in pregnancy, and thus highlights an important gap in prenatal care. The harms of screening for ID in pregnancy are minor to non-existent.…”

Section: Discussionmentioning

confidence: 72%

Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting

et al. 2021

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Iron deficiency anemia (IDA) in pregnancy is associated with poor maternal and childhood outcomes, yet ferritin testing, the standard test for iron deficiency (ID), is not considered part of routine prenatal bloodwork in Canada. We conducted a retrospective cohort study of 44,552 pregnant patients with prenatal testing at community laboratories in Ontario, Canada to determine the prevalence of ferritin testing over five years. Secondary objectives were to determine the prevalence and severity of ID, and to identify clinical and demographic variables that influence the likelihood of ID screening. 59.4% of patients had a ferritin checked during pregnancy; 71.4% were ordered in the first trimester, when the risk of ID is lowest. Excluding patients with abnormally elevated ferritins, 25.2% were iron insufficient (30-44 µg/L) and 52.8% were iron deficient (≤29 µg/L) at least once in pregnancy. 8.3% were anemic (hemoglobin <105 g/L). The proportion of anemic patients with a subsequent ferritin test in pregnancy ranged from 22% to 67% in the lowest and highest anemia severity categories, respectively. Lower annual household income was negatively associated with the odds of a ferritin test; compared to those in the fifth (i.e. highest) income quintile, the odds of ferritin testing for patients in the first, second, and fourth quintiles were 0.83 (95%CI 0.74-0.91), 0.82 (95%CI 0.74-0.91), and 0.86 (95%CI 0.77-0.97), respectively. These data highlight gaps in prenatal care and issues of health equity that warrant harmonization of obstetrical guidelines to recommend routine ferritin testing in pregnancy.

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Section: Discussionmentioning

confidence: 72%

Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting

et al. 2021

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“…Even women with adequate hemoglobin and iron reserves are at risk of developing an iron deficit later in pregnancy. Iron deficiency anemia is related to an increased risk of blood transfusion, preterm birth, cesarean delivery, and neonatal critical care unit hospitalization if present at delivery [9,10]. Low folate intake before conception raises the chance of neural tube abnormalities in the infant.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Nutritional Supplementation for Iron Deficiency Anemia on Pregnancies Associated with SARS-CoV-2 Infection

et al. 2022

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Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women in terms of infection risk and access to care, we developed a study to determine the impact of nutritional supplementation for iron deficiency anemia in correlation with the status of SARS-CoV-2 infection. In a case-control design, we identified 446 pregnancies that matched our inclusion criteria from the hospital database. The cases and controls were stratified by SARS-CoV-2 infection history to observe the association between exposure and outcomes in both the mother and the newborn. A total of 95 pregnant women were diagnosed with COVID-19, having a significantly higher proportion of iron deficiency anemia. Low birth weight, prematurity, and lower APGAR scores were statistically more often occurring in the COVID-19 group. Birth weight showed a wide variation by nutritional supplementation during pregnancy. A daily combination of iron and folate was the optimal choice to normalize the weight at birth. The complete blood count and laboratory studies for iron deficiency showed significantly decreased levels in association with SARS-CoV-2 exposure. Puerperal infection, emergency c-section, and small for gestational age were strongly associated with anemia in patients with COVID-19. It is imperative to screen for iron and folate deficiency in pregnancies at risk for complications, and it is recommended to supplement the nutritional intake of these two to promote the normal development and growth of the newborn and avoid multiple complications during pregnancy in the COVID-19 pandemic setting.

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“…(24) In addition, accessibility to IVI and approved dosing schemes differ between countries, creating geographic, cultural and social barriers. (4,25) Clinicians lack high quality data on the optimal dose to adequately improve and sustain iron status, and sufficiently protect against adverse obstetric, neonatal or mental health sequelae. We therefore conducted a RCT comparing two doses of IVI (500mg and 1000mg) using an equivalence design.…”

Section: Introductionmentioning

confidence: 99%

Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial

Froessler

Schubert²,

Palm

et al. 2022

Preprint

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Objective To test equivalence of two doses of intravenous iron (ferric carboxymaltose) in pregnancy. Design Parallel, two-arm equivalence randomised controlled trial with an equivalence margin of 5%. Setting Single centre in Australia. Population 278 pregnant women with iron deficiency. Methods Participants received either 500 mg (n=152) or 1000mg (n=126) of intravenous ferric carboxymaltose in the second or third trimester. Main outcome measures The proportion of participants requiring additional intravenous iron (500mg) to achieve and maintain ferritin >30ug/L (diagnostic threshold for iron deficiency) at 4 weeks post-infusion, and at 6 weeks, and 3-, 6- and 12-months postpartum. Secondary endpoints included repeat infusion rate, iron status, birth, and safety outcomes. Results The two doses were not equivalent within a 5% margin at any timepoint. At 4 weeks post infusion, 26/73 (36%) participants required a repeat infusion in the 500 mg group compared with 5/67 (8%) in the 1000 mg group (difference in proportions, 0.283 95% confidence interval (0.177, 0.389)). Overall, participants in the 500 mg arm received twice the repeat infusion rate (0.81 (SD= 0.824 vs 0.40 (SD= 0.69), rate ratio 2.05, 95% CI (1.45, 2.91)). Conclusions Administration of 1000mg ferric carboxymaltose in pregnancy maintains iron stores and reduces the need for repeat infusions. A 500 mg dose requires ongoing monitoring to ensure adequate iron stores are reached and sustained.

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The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

Cited by 21 publications

References 30 publications

Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting

Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting

The Influence of Nutritional Supplementation for Iron Deficiency Anemia on Pregnancies Associated with SARS-CoV-2 Infection

Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial

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