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In evaluating pregnant women with anemia, it is essential to do a complete history and physical examination, as well as a complete blood count with indices and a blood smear examination. Based on these findings, other tests such as ferritin and serum or red cell folate may be ordered. Because of the normal physiologic changes in pregnancy that affect the hematocrit, indices, and some other parameters, diagnosing true anemia, as well as the etiology of anemia, is challenging. Because of the increased nutritional requirements of the mother and fetus, the most common anemias are iron deficiency anemia and folate deficiency megaloblastic anemia. These anemias are more common in women who have inadequate diets and who are not receiving prenatal iron and folate supplements. Other less common causes of acquired anemia in pregnancy are aplastic anemia and hemolytic anemia associated with preeclampsia. In addition, congenital anemias such as sickle cell disease can impact on the health of the mother and fetus. Obviously, severe anemia has adverse effects on the mother and the fetus. There is also evidence that less severe anemia is associated with poor pregnancy outcome. The cause of this association has yet to be elucidated. It is important, however, to diagnose and treat anemia in pregnancy to provide for optimal health of the mother and infant.
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PMID:Anemia in pregnancy. 157 61

The diagnostic value of ferritin, transferrin saturation, and red blood cell zinc protoporphyrin for detecting iron depletion and predicting third-trimester anemia was studied in 87 women attending a private obstetrics clinic. A decline in ferritin and transferrin saturation and an increase in red blood cell zinc protoporphyrin levels were observed in third-trimester measurements when compared with those of the first trimester. Third-trimester anemia (hemoglobin less than 11.5 gm/dl or 115 gm/L) was detected in 13 (15%) women. Red blood cell zinc protoporphyrin was the only test that consistently demonstrated significantly different mean values between anemic and normal subgroups. The diagnostic sensitivity and predictive value of red blood cell zinc protoporphyrin for evaluating iron depletion and risk of anemia in pregnancy compared favorably to those of ferritin and transferrin saturation measurements. The operational simplicity and low cost of red blood cell zinc protoporphyrin measurements are additional characteristics that favor this procedure for office testing.
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PMID:Red blood cell zinc protoporphyrin testing for iron-deficiency anemia in pregnancy. 275 Aug 16

Serum ferritin, folate, cobalamin and hemoglobin concentrations were determined by radioimmunoassay, radioisotopic assay, radioassay and an automated hematology analyser respectively, and then analysed in 221 normal full-term pregnant women in order to evaluate the incidence and the prevalence of nutritional anemia in pregnancy. None of them had received any hematonic during their pregnancy. Their mean age was 27.68 years and the mean duration of pregnancy was 39.51 weeks. Twenty-three (10.41%) of these previously non-anemic pregnant women had clinical anemia after full-term pregnancy. Of the 23 women, 11 (47.83%) had iron-deficiency anemia, with serum ferritin less than 12 micrograms/l; another 11 women had some degree of iron depletion, with serum ferritin less than 20 micrograms/l. So in 22 of the 23 anemic women (95.65%) the cause of anemia may correlate to iron depletion. The remaining one had folate-deficiency anemia. No pure cobalamin deficiency anemia was found in this study. Among the 198 non-anemic normal full-term pregnant women, 92 (46.46%) had iron depletion (serum ferritin less than 20 micrograms/l), of whom 35 (17.68%) had severe iron deficiency, with serum ferritin less than 12 micrograms/l. Another 3 had folate deficiency and 3 had cobalamin deficiency. By including all the anemic and non-anemic pregnant women, 114 (51.58%) of them had some degree of iron depletion. In other words, pregnancy can produce a considerable degree of iron depletion in more than half of the previously non-anemic women.
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PMID:Serum ferritin, folate and cobalamin levels and their correlation with anemia in normal full-term pregnant women. 366 65

The known increased need for iron during pregnancy appears to be met only in part by increased iron absorption and amenorrhea. Considerable demands are made on maternal iron stores and, since many women lack sufficient storage iron, pregnancy may be expected to cause iron deficiency. This may lead to anemia in pregnancy and post partum and could also have a bearing on the iron status of the fetus and the neonate. Based on these considerations, prophylactic supplementation of dietary iron is advocated but remains a disputed issue. In the present controlled, prospective and longitudinal study changes in hematologic status, and in particular in iron stores, during pregnancy were investigated in 44 healthy Caucasian women with uncomplicated pregnancies and deliveries. They were randomly assigned to a study group (n = 21) receiving oral iron supplements from the 16th week of amenorrhea until 6 weeks post partum, and a control group (n = 23) without iron supplementation. Maternal concentrations of hemoglobin, serum iron, serum transferrin and serum ferritin were determined at 16, 28 and 36 weeks of amenorrhea, at delivery, and 6 and 12 weeks post partum. The same variables were determined in cord blood. Iron supplementation appeared to prevent the physiologic fall in hemoglobin and serum iron concentrations which occurred in the control group, but had little influence on the observed rise in transferrin concentrations. Ferritin levels in serum, which are known to reflect mobilisable iron stores, fell to 30% of the initial values in the control group and to 70% in the study group. Six and 12 weeks post partum ferritin levels were still low in the nonsupplemented group (Tab. I).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of oral iron supplementation during pregnancy on maternal and fetal iron status. 672 96

The prevalence, causes and role of iron prophylaxis in pregnant women was studied. All women delivered at the National University Hospital, Singapore in 1993 had their haemoglobin estimated. If it was less than 11 g/dl, blood was taken for serum iron, ferritin, transferrin, red cell zinc protoporphyrin, serum folate, vitamin B12 and thalassemia screen to establish cause of anaemia. Data was also collected with regards to their antenatal progress and iron prophylaxis. Logistic regression, Chi-square test, Fischer's exact test and Mantel-Haenszel tests were also used to assess the relationships between categorical variables. The prevalence of anaemia at first antenatal visit was 20.6% while the prevalence of anaemia at delivery was 15.3%. The commonest cause of the anaemia in pregnancy was due to iron deficiency (81.3%). In the non-anaemic group, 90.7% were on prophylactic iron supplements compared to 50.6% in the anaemic group (P < 0.001). Of the 752 women found to be anaemic at booking, 591 received prophylactic iron supplements while 161 women did not. A total of 166 (28.1%) of those with iron supplements were anaemic at delivery, whereas 140 (87.0%) of those who did not receive prophylactic iron remained anaemic at delivery (P < 0.001). Of the 2516 non-anaemic women who received prophylactic iron, 118 (4.7%) developed anaemia at delivery while 133 (34.1%) out of the 390 women who did not receive prophylactic iron were anaemic at delivery (P < 0.001). Multivariate logistic regression analysis revealed the odds of anaemia for a woman not on iron therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76 to 14.13). A 55% reduction in odds of anaemia was estimated per 1 gm% increase in haemoglobin at booking. Prophylactic antenatal iron supplements not only prevent a fall but also improved haemoglobin levels during pregnancy. Those who were not on any iron supplements were 11 times more likely to develop anaemia in the present pregnancy.
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PMID:The role of prophylactic iron supplementation in pregnancy. 1036 8

A high prevalence of iron-deficiency anaemia has been reported in Jordanian infants. A prospective study of infants in downtown Amman examined the relationship between anaemia in pregnancy and iron deficiency in infancy. The iron status of infants born to 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was reviewed at 3, 6, 9 and 12 months. Indicators to define iron-deficiency anaemia were Hb < 11 g/dl and either plasma ferritin < 12 microg/l or zinc protoporphyrin (ZPP) > 35 microg/dl whole blood. Haemoglobin electrophoresis excluded haemoglobinopathy. There was 72% iron-deficiency anaemia throughout the year, significantly higher in infants born to anaemic mothers (81%; n = 91) compared with controls (65%; n = 112). At 12 months, 72% of the infants tested (n = 195) were anaemic. While 57% were identified as iron-deficient by research criteria of either ferritin or ZPP, only 37% were identified by ferritin alone, 40% by ZPP alone and 29% if both ferritin and ZPP were required to meet criteria. Most infant anaemia was identified as due to iron deficiency, supporting contextual setting as assisting diagnosis: infants in developing countries are recognised as vulnerable to iron deficiency. Using multiple criteria, more cases were identified when either ferritin or ZPP were abnormal than when one alone, or both parameters were required to meet research criteria.
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PMID:Incidence of iron-deficiency anaemia in infants in a prospective study in Jordan. 1077 94

In sub-Saharan Africa, anaemia in pregnancy results from multiple causes including malaria, iron deficiency and haemoglobinopathies. In a cross-sectional study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrations of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha-globin genotypes. Anaemia (haemoglobin [Hb] < 11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. Ferritin levels were considerably influenced by malaria and inflammatory processes (CRP > 0.6 mg/dL). Depending on the definition applied, the prevalence of iron deficiency ranged between 5% and 46%. The HbAS trait was observed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta-thalassaemia was present in 1% of the women and alpha(+)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS had higher malaria parasite densities than those with HbAA. In individuals with highly elevated HbF (> 10%), parasitaemia occurred in 27% only. Low gravidity, second trimester of pregnancy, malaria, raised CRP levels, and homozygous alpha(+)-thalassaemia were independent risk factors for anaemia in multivariate analysis. alpha(+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women. Iron deficiency appears not to be a major health problem in this population. Haemoglobinopathies are common but, except for homozygous alpha(+)-thalassaemia, do not substantially contribute to anaemia in pregnancy. alpha(+)-Thalassaemia ameliorates malarial anaemia in pregnant women.
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PMID:Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies. 1113 70

A cohort study was carried out in Purworejo District, Central Java, Indonesia to investigate prevalence of anemia and low iron stores during pregnancy in relation to intestinal helminth infection. 442 pregnant women were followed until 5-10 weeks postpartum, during the period of April 1996 - August 1998. Information on intestinal helminths, hemoglobin and serum ferritin was collected each trimester. Highest prevalence of anemia in pregnancy (37.1%) was found in the second trimester, while the highest prevalence of low iron stores (49.5%) was found in the third trimester. Most pregnant women (69.7%) were infected with at least one species of pathogenic intestinal helminths. The most common helminth detected was Trichuris trichiura followed by Necator americanus (hookworm) and Ascaris lumbricoides. A significant negative association was found between hookworm infection and serum ferritin at the first trimester (p = 0.010). It is concluded that hookworm infection can interfere iron stores. Other causes of anemia among pregnant women should be considered. Anthelminthic therapy could be given to infected women before conception as public health strategy to improve iron status.
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PMID:Impact of intestinal helminth infection on anemia and iron status during pregnancy: a community based study in Indonesia. 1148 75

Anaemia is one of the most common risk factors in the area of obstetrics and perinatal medicine. During pregnancy and in the puerperium it is associated with an increased incidence of both maternal and fetal morbidity and mortality, the extent of which is dependent upon the severity of anaemia and the resulting complications. In order to correctly diagnose the type and degree of anaemia, a prerequisite for selection of the proper therapy, one must first of all correctly differentiate between the relative, i.e., the physiological anaemia of pregnancy due to the normal plasma volume increase during pregnancy, and "real anaemias" with various different pathophysiological causes. When defining the Hb cutoff value for anaemia in pregnancy, the extent of the plasma volume changes with respect to the gestational age must be taken into consideration. It has been found that haemoglobin values < 11.0 g/dl in the first and third trimesters, and < 10.5 g/dl in the second trimester may point to an anaemic situation which should be further clarified. The first important steps for diagnosing anaemia in a pregnant patient include a thorough check of her medical history and a medical examination. This procedure often lays the basis for a correct diagnosis. The current gold standard to detect iron deficiency remains the serum ferritin value. To be reliable, this requires the ruling out of an infection (chronic or acute) as a cause of the anaemia. We recommend a complete laboratory test for the exact haematological status as well as the assessment of specific chemical laboratory parameters. These should include a palette of additional, promising new parameters such as hypochromic red cells and transferrin receptors which allow more accurate detection of iron deficiency and differential diagnosis of iron deficiency anaemia. After correct diagnosis, major emphasis should be put on safe and effective treatment of anaemia which again depends on severity of anaemia, time for restoration and patients characteristics. Today effective alternatives to oral iron only or blood transfusion such as parenteral iron sucrose complex and in selected cases also recombinant erythropoietin have been investigated and show promising results concerning effective treatment of anaemia during pregnancy and postpartum.
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PMID:[Current aspects of diagnosis and therapy of iron deficiency anemia in pregnancy]. 1151 93

Iron-deficiency anemia in pregnant women is a serious public health problem especially in tropical countries. The aim of this study was to assess the prevalence of iron-deficiency anemia in pregnant women in Bali and determine the risk factors for anemia. A cross-sectional study was conducted among 1,684 pregnant women in 42 villages in Bali that were selected by probabilistic/proportional-to-size sampling technique. Two ml of venous blood were collected for hemoglobin estimation using an automatic hematology analyzer (Technician H-I), and serum ferritin examination using immunolescent technique. The WHO criterion for anemia in pregnancy was applied and serum ferritin < 20 microg/l as cut-off point for iron deficiency. Data regarding risk factors were gathered using pre-designed questionnaires. The prevalence of iron-deficiency anemia in pregnant women was 46.2%; most of the cases of anemia were mild. The risk factors for anemia identified in this study were: length of gestation; level of education; antenatal intake of iron pills. Given the high prevalence of iron-deficiency anemia in pregnant women in Bali, preventive measures, eg iron supplementation, the iron fortification of food, and health education, should be encouraged.
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PMID:Iron-deficiency anemia in pregnant women in Bali, Indonesia: a profile of risk factors and epidemiology. 1269 98


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