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Query: UMLS:C0240066 (iron deficiency)
 7,156 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hematological status of pregnant women from low and middle economic classes before and after similar hematinic therapy were compared. Subjects were 88 economically indigent and 88 middle-class women. Both groups came from the same ethnic background. Before treatment mean values for hemoglobin and nutrients were significantly lower in the poor pregnant women, except for serum folate which was similar. The only parasitic infestations found were whipworm (Trichuris trichiura) in 10% of the poor group and 2% of the middle-class group. Treatment of 40 poor and 33 middle-class patients was with oral doses of 130 mg of ferrous fumarate. The other 48 poor and 55 middle-class patients also received 2.5 mg of folic acid orally daily. At term, after treatment, there was still a statistically but lesser difference between the 2 groups, with the exception of serum iron. Total iron binding capacity was similar in both groups. The frequency of preeclampsia was 4% in the middle-class and 5% in the poor patients. At term, despite the iron dosage, anemia frequency and iron deficiency remained the same in both groups. Those taking folic acid improved so that the 2 classes were equal. Low serum folate levels for those of the middle class not taking folic acid were 25%. It is concluded that all pregnant women in this population should receive both iron and folic acid supplementation throughout pregnancy. For women with an iron deficiency at the beginning of pregnancy, 120 mg/day was not enough. There was the possibility of impaired iron absorption in these patients.
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PMID:Nutritional anaemia during pregnancy. A comparative study of two socio-economic classes. 440 70

The incidence of megaloblastic anaemia in pregnancy and the puerperium in north Staffordshire has steadily declined as a result of prophylaxis with folic acid. In the presence of advanced folic acid deficiency and with a florid megaloblastic marrow, the anaemia is usually severe, but in many patients the disease is relatively mild and the degree of anaemia is determined more by blood loss or associated iron deficiency than by the megaloblastosis. Microscopic examination of marrow films is still the most reliable method of diagnosis, although estimation of the labile serum folate has produced a 95% correlation with the marrow findings. There are three main factors which operate in the pathogenesis of megaloblastic anaemia in pregnancy and the puerperium. First, the maternal stores of folic acid are used up by the growing foetus, and this process is accelerated in multiple pregnancies, after haemorrhage, or in women with haemolytic anaemia. Secondly, an insufficient intake of folic acid, due to poor diet in pregnancy, plays a part in many cases. The third, and possibly the most important, factor is an absorption defect. Folic acid absorption is usually impaired in established cases, and this can still be demonstrated years later in a majority of patients, when they are neither pregnant nor anaemic. More than 20% of all cases also show abnormal fat absorption. An inherited defect in folic acid absorption may also explain why certain women appear to be constitutionally predisposed to megaloblastic anaemia of pregnancy and the puerperium, as shown by the abnormal blood group distribution in these patients and by the tendency of megaloblastic anaemia to recur not only in subsequent pregnancies, but, as in six of our cases, following other kinds of stress. The significance of commonly associated conditions like pre-eclampsia and infection is still incompletely understood. Although the treatment of megaloblastic anaemia is simple and effective, the main emphasis should be placed on prophylaxis by administering folic acid to all pregnant women.
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PMID:An account of 335 cases of megaloblastic anaemia of pregnancy and the puerperium. 590 77

Significant changes in fetal iron status potentially occur in pregnancies in which reduced fetal nutrient delivery is severe enough to result in intrauterine growth retardation (IUGR), particularly if chronic fetal hypoxia is also present and increases fetal iron demand for hemoglobin synthesis. Neonates rarely die following IUGR secondary to maternal preeclampsia, but bilateral renal agenesis, which is also characterized by reduced maternal-fetal blood flow, late gestation placental failure, and IUGR, is uniformly fatal. We measured neonatal liver iron concentration, as an assessment of fetal storage iron status, and heart and brain iron concentrations, as assessments of nonheme tissue iron status, in 11 infants who died in the neonatal period of bilateral renal agenesis, and compared them with values for gestational age-matched control infants whose gestation was not complicated by fetal growth retardation or hypoxia. Stainable nonheme iron in the hepatocytes was significantly reduced in all and completely absent in 8 of the 11 cases of renal agenesis (P < .001 compared with control). The mean +/- SEM liver iron concentration of the bilateral renal agenesis group (999 +/- 218 micrograms/g dry tissue weight) was 26% of the control value (3894 +/- 548 micrograms/g dry tissue weight; P < .001). Brain iron concentration was also lower in the group with bilateral renal agenesis (109 +/- 17 vs. 161 +/- 19; P = .015) and was correlated with liver iron concentration (r = .47; P = .03). Heart iron concentrations were similar in the two groups. Nine of the subjects with bilateral renal agenesis had placental weights below the fifth percentile for gestational age. The bilateral renal agenesis group had a lower mean birth weight (P < .001) and had a higher prevalence of fetal growth retardation (55% vs. 0%; P < .001). We conclude that infants with bilateral renal agenesis are at risk for severe iron deficiency of storage and nonstorage tissues. Liveborn infants with nonfatal fetal conditions characterized by significant restriction of maternal-fetal blood flow may also be at significant risk for postnatal iron deficiency.
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PMID:Liver and brain iron deficiency in newborn infants with bilateral renal agenesis (Potter's syndrome). 902 49

Pregnancy requires additional maternal absorption of iron. Maternal iron status cannot be assessed simply from hemoglobin concentration because pregnancy produces increases in plasma volume and the hemoglobin concentration decreases accordingly. This decrease is greatest in women with large babies or multiple gestations. However, mean corpuscular volume does not change substantially during pregnancy and a hemoglobin concentration <95 g/L in association with a mean corpuscular volume <84 fL probably indicates iron deficiency. Severe anemia (hemoglobin <80 g/L) is associated with the birth of small babies (from both preterm labor and growth restriction), but so is failure of the plasma volume to expand. Hemoglobin concentrations >120 g/L at the end of the second trimester are associated with a </=3-fold increased risk of preeclampsia and intrauterine growth restriction. The minimum incidence of low birth weight (<2.5 kg) and of preterm labor (<37 completed weeks) occurs in association with a hemoglobin concentration of 95-105 g/L. This is widely regarded as indicating anemia in the pregnant woman but, if associated with a mean corpuscular volume >84 fL, should be considered optimal.
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PMID:Maternal hemoglobin concentration and birth weight. 1079 3

An association between moderate anemia and poor perinatal outcomes has been found through epidemiologic studies, although available evidence cannot establish this relation as causal. Anemia may not be a direct cause of poor pregnancy outcomes, except in the case of maternal mortality resulting directly from severe anemia due to hypoxia and heart failure. Preventing or treating anemia, whether moderate or severe, is desirable. Because iron deficiency is a common cause of maternal anemia, iron supplementation is a common practice to reduce the incidence of maternal anemia. Nevertheless, the effectiveness of large-scale supplementation programs needs to be improved operationally and, where multiple micronutrient deficiencies are common, supplementation beyond iron and folate can be considered. High hemoglobin concentrations are often mistaken as adequate iron status; however, high hemoglobin is independent of iron status and is often associated with poor health outcomes. Very high hemoglobin concentrations cause high blood viscosity, which results in both compromised oxygen delivery to tissues and cerebrovascular complications. Epidemiologic studies have also found an association between high maternal hemoglobin concentrations and an increased risk of poor pregnancy outcomes. Evidence does not suggest that this association is causal; it could be better attributed to hypertensive disorders of pregnancy and to preeclampsia. The pathophysiologic mechanism of these conditions during pregnancy can produce higher hemoglobin concentrations because of reduced normal plasma expansion and cause fetal stress because of reduced placental-fetal perfusion. Accordingly, higher than normal hemoglobin concentrations should be regarded as an indicator of possible pregnancy complications, not necessarily as a sign of adequate iron nutrition, because iron supplementation does not increase hemoglobin higher than the optimal concentration needed for oxygen delivery.
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PMID:Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. 1087 93

A balanced diet that provides an adequate supply of vitamins and minerals is essential for normal fetal development. Maternal morbidity is also lower, since such complications of pregnancy as preeclampsia and premature birth occur less frequently. Consideration should be given to folate deficiency--in particular during the periconceptive period--and iron deficiency during pregnancy. For the structural development of the fetus, long-chain polyunsaturated fatty acids also appear to have a major role to play. Daily iodine supplementation should be used to avoid goiter in mother and child. Calcium appears to have a protective effect against preeclampsia and hypertension, as also do vitamins E and C. The tocolytic action of magnesium can help reduce the incidence of premature birth. Such noxae as alcohol and nicotine should be avoided completely during the entire pregnancy.
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PMID:[Nutrition during pregnancy--current aspects]. 1515 64

Supplementation with iron is generally recommended during pregnancy to meet the iron needs of both mother and fetus. When detected early in pregnancy, iron deficiency anemia (IDA) is associated with a > 2-fold increase in the risk of preterm delivery. Maternal anemia when diagnosed before midpregnancy is also associated with an increased risk of preterm birth. Results of recent randomized clinical trials in the United States and in Nepal that involved early supplementation with iron showed some reduction in risk of low birth weight or preterm low birth weight, but not preterm delivery. During the 3rd trimester, maternal anemia usually is not associated with increased risk of adverse pregnancy outcomes and may be an indicator of an expanded maternal plasma volume. High levels of hemoglobin, hematocrit, and ferritin are associated with an increased risk of fetal growth restriction, preterm delivery, and preeclampsia. While iron supplementation increases maternal iron status and stores, factors that underlie adverse pregnancy outcome are considered to result in this association, not iron supplements. On the other hand, iron supplements and increased iron stores have recently been linked to maternal complications (eg, gestational diabetes) and increased oxidative stress during pregnancy. Consequently, while iron supplementation may improve pregnancy outcome when the mother is iron deficient it is also possible that prophylactic supplementation may increase risk when the mother does not have iron deficiency or IDA. Anemia and IDA are not synonymous, even among low-income minority women in their reproductive years.
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PMID:Iron status during pregnancy: setting the stage for mother and infant. 1588 55

Fortified beverages and supplementary foods, when given during pregnancy, have been shown to have positive effects on preventing maternal anaemia and iron deficiency. Studies show that use of micronutrient fortified supplementary foods, especially those containing milk and/or essential fatty acids during pregnancy, increase mean birthweight by around 60-73 g. A few studies have also shown that fortified supplementary foods have impacts on increasing birth length and reducing preterm delivery. Fortification levels have ranged generally from 50% to 100% of the recommended nutrient intake (RNI). Iron, zinc, copper, iodine, selenium, vitamins A, D, E, C, B1, B2, B6, and B12, folic acid, niacin and pantothenic acid are important nutrients that have been included in fortified beverages and supplemental foods for pregnant and lactating women. While calcium has been shown to reduce the risk of pre-eclampsia and maternal mortality, calcium, phosphorus, potassium, magnesium and manganese can have negative impacts on organoleptic properties, so many products tested have not included these nutrients or have done so in a limited way. Fortified food supplements containing milk and essential fatty acids offer benefits to improving maternal status and pregnancy outcome. Fortified beverages containing only multiple micronutrients have been shown to reduce micronutrient deficiencies such as anaemia and iron deficiency.
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PMID:Review of fortified food and beverage products for pregnant and lactating women and their impact on nutritional status. 2192 34

Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This review discusses specifically the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations; however, care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist, and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy, and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored.
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PMID:Hematologic complications of pregnancy. 2395 39

Pregnancy represents a challenge from a nutritional perspective, because micronutrient intake during the periconceptional period and in pregnancy affects fetal organ development and the mother's health. Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia. This article reviews the risks associated with nutrient deficiencies in pregnant women and presents an overview of recommendations for dietary supplementation in pregnancy, focusing on oral iron supplementation. Risk factor detection, including dietary patterns and comorbidities, is paramount in optimal pregnancy management. Dietary habits, which can lead to deficiencies (e.g., iron, folate, vitamin D, and calcium) and result in negative health consequences for the mother and fetus/newborn, need to be investigated. Prenatal care should be personalized, accounting for ethnicity, culture, education, information level about pregnancy, and dietary and physical habits. Clinicians should make a plan for appropriate supplementation and prophylaxis/treatment of nutritional and other needs, and consider adequate intake of calcium, iodine, vitamin D, folate, and iron. Among the available oral iron supplements, prolonged-released ferrous sulfate (ferrous sulfate-polymeric complex) presents the lowest incidence of overall and gastrointestinal adverse events, with positive implications for compliance.
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PMID:Supplementation during pregnancy: beliefs and science. 2695 54


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