Research Article
Maternal and neonatal outcomes related to iron deficiency anemia and serum ferritin status: A multicenter prospective study from Eastern Marmara, Turkey
Abstract
Background:
Iron
deficiency is the most common nutritional deficit in the world. More than 50%
of anemia in pregnancy results from iron deficiency and it is suggested that it
may be associated with negative pregnancy outcomes.
Aim:
The
aim of this study was to evaluate the incidence of irony deficiency anemia in
pregnancy in the East Marmara region of Turkey in order to determine its
prevalence in the country along with the effects and associations of iron
supplementation or iron status on maternal and neonatal outcomes.
Study Design: The study was designed as a prospective, longitudinal qualitative study.
Method:
This study was conducted in six centers in three provinces of the East Marmara
region(Turkey) and included a total of 1102 pregnant women. Blood samples were
collected for hematological status and serum ferritin levels during pregnancy,
and the adverse maternal and perinatal outcomes were determined.
Results:
The rate of anemia among the women included in the study was 19.8%, with 44% of
them receiving iron supplementation. The maternal age was lower in the anemic
group(26.5 vs. 27.7, p = 0.01). Selective iron use was more frequent in the
anemic group, while routine iron use was more frequent in the non-anemic
group(47.1% vs. 29.3%; p = 0.01).
Conclusions:
Iron deficiency anemia is a frequent problem in pregnancy. However, many anemic
pregnant women do not receive iron therapy. Iron supplementation may have
positive effects on some maternal and perinatal outcomes. In order to combat
iron deficiency anemia in pregnancy, widespread use of iron supplements should
be established.
References
- Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Glob Health 2013; 1: 16–25. doi:10.1016/S2214-109X(13)70001-9.
- United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control: A guide for programme managers. Geneva: World Health Organization; 2001.
- Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004: 163–210.
- Clark SF. Iron deficiency anemia. Nutr Clin Pract 2008; 23: 128–41.
- Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev 2011; 69: 23–9.
- Balarajan Y, Ramakrishnan U, Ozaltin E, et al. Anaemia in low income and middle-income countries. Lancet 2011; 378: 2123–35.
- de Sa SA, Willner E, Duraes Pereira TA, et al. Anemia in pregnancy: Impact on weight and in the development of anemia in newborn. Nutr Hosp 2015; 32: 2071–9.
- Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, Roger SD, Savoia HF, Tampi R, Thomson AR, et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust 2010; 193: 525–32.
- Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr 2017; 106: 1606–14.
- Mei Z, Cogswell ME, Parvanta I, Lynch S, Beard JL, Stoltzfus RJ, Grummer-Strawn LM. Hemoglobin and ferritin are currently the most efficient indicators of population response to iron interventions: An analysis of nine randomized controlled trials. J Nutr 2005; 135: 1974–80.
- WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and mineral nutrition information system. Geneva, Switzerland: World Health Organization; 2011.
- ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol 2002; 99(1): 171–173.
- World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus, 2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).
- Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable Fetal Weight Standard. Ultrasound Obstet Gynecol 1995; 6: 168–74.
- WHO. The Global Prevalence of Anaemia in 2011. Geneva: World Health Organization; 2015.
- Pinho-Pompeu M, Surita FG, Pastore DA, Paulino DSM, Pinto E, Silva JL. Anemia in pregnant adolescents: Impact of treatment on perinatal outcomes. J Matern Fetal Neonatal Med 2017; 30(10): 1158-62.
- Bencaiova G, Breymann C. Mild Anemia and Pregnancy Outcome in a Swiss Collective. Journal of Pregnancy 2014; 2014: 307535.
- Gambling L, Kennedy C, McArdle HJ. Iron and copper in fetal development. Seminars in Cell and Developmental Biology 2011; 22: 637–44.
- Kemper AR, Fan T, Grossman DC, Phipps MG. Gaps in evidence regarding iron deficiency anemia in pregnant women and young children: Summary of US Preventive Services Task Force recommendations. Am J Clin Nutr 2017; 106: 1555-58.
- WHO. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva, Switzerland: WHO; 2012.
- Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12: CD004736.
- Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E. A randomised placebo controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin or = 13.2 g/dl. BJOG 2007; 114: 684–8.
- Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, McDonald CM, Thomas A, Kurpad AV. Association of oral iron supplementation with birth outcomes in non-anaemic South Indian pregnant women. Eur J Clin Nutr 2015; 69: 609–13.
- Frenkel EP, Yardley DA. Clinical and laboratory features and sequelae of deficiency of folic acid (folate) and vitamin B12 (cobalamin) in pregnancy and gynecology. Hematol Oncol Clin North Am 2000; 14(5):1079-1100.
- Ramakrishnan U, Grant FK, Goldenberg T, Bui V, Imdad A, Bhutta ZA. Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: A systematic review. Paediatric and Perinatal Epidemiology 2012; 261: 153–67.
- Weekly iron and folic acid supplementation programmes for women of reproductive age: An analysis of best programme practices. Manila, World Health Organization Regional Office for the Western Pacific, 2011.
- lanco-Rojo R, Perez-Granados AM, Toxqui L, Zazo P, de la Piedra C, Vaquero MP. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming iron-fortified food. Eur J Nutr 2013;52:695–703
- Sim JJ, Lac PT, Liu IL, Meguerditchian SO, Kumar VA, Kujubu DA, Rasgon SA. Vitamin D deficiency and anemia: A cross-sectional study. Ann Hematol 2010; 89: 447–52.
- Alon DB, Chaimovitz C, Dvilansky A, Lugassy G, Douvdevani A, Shany S, Nathan I. Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol 2002; 30: 403–9.
- Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K, Nayak A, Wesseling-Perry K, Westerman M, Hollis BW, et al. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol 2014;25:564–72.
Demir Eksikliği Anemisi ve Serum Ferritin Düzeyi ile İlgili Maternal ve Neonatal Sonuçlar: Doğu Marmara Bölgesine Ait Çok Merkezli Bir Prospektif Çalışma, Türkiye
Abstract
Amaç:
Bu
çalışmanın amacı, demir takviyesi ve demir durumunun maternal ve neonatal
etkileri ile birlikte Türkiye'nin Doğu Marmara bölgesinde gebelikte görülen
demir eksikliği anemisi insidansını değerlendirmektir.
Yöntem:
Bu çalışma Doğu Marmara Bölgesi'nin (Türkiye) üç ilinde altı merkezde
gerçekleştirilmiş ve toplam 1102 gebeyi kapsamıştır. Gebelik sırasında
hematolojik durum ve serum ferritin düzeyleri için kan örnekleri toplandı ve
olumsuz maternal ve perinatal sonuçlar belirlendi.
Bulgular:
Çalışmaya dahil edilen kadınlarda anemi oranı % 19.8 idi ve bunların % 44'ü
demir desteği alıyordu. Maternal yaş anemik grupta daha düşüktü (26.5'e karşı
27.7, p = 0.01). Anemik grupta selektif demir kullanımı daha sık görülürken,
anemik olmayan grupta rutin demir kullanımı daha sık görüldü (% 47.1'e
karşılık% 29.3; p = 0.01).
Sonuçlar: Demir eksikliği anemisi gebelikte sık görülen
bir problemdir. Bununla birlikte, birçok anemik gebeye demir tedavisi verilmez.
Demir takviyesi, bazı maternal ve perinatal sonuçlar üzerinde olumlu etkileri olabilir.
Gebelikte demir eksikliği anemisiyle mücadele etmek için demir takviyelerinin
yaygın kullanımı sağlanmalıdır.
Keywords
References
- Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Glob Health 2013; 1: 16–25. doi:10.1016/S2214-109X(13)70001-9.
- United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control: A guide for programme managers. Geneva: World Health Organization; 2001.
- Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004: 163–210.
- Clark SF. Iron deficiency anemia. Nutr Clin Pract 2008; 23: 128–41.
- Scholl TO. Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev 2011; 69: 23–9.
- Balarajan Y, Ramakrishnan U, Ozaltin E, et al. Anaemia in low income and middle-income countries. Lancet 2011; 378: 2123–35.
- de Sa SA, Willner E, Duraes Pereira TA, et al. Anemia in pregnancy: Impact on weight and in the development of anemia in newborn. Nutr Hosp 2015; 32: 2071–9.
- Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK, Roger SD, Savoia HF, Tampi R, Thomson AR, et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust 2010; 193: 525–32.
- Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr 2017; 106: 1606–14.
- Mei Z, Cogswell ME, Parvanta I, Lynch S, Beard JL, Stoltzfus RJ, Grummer-Strawn LM. Hemoglobin and ferritin are currently the most efficient indicators of population response to iron interventions: An analysis of nine randomized controlled trials. J Nutr 2005; 135: 1974–80.
- WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and mineral nutrition information system. Geneva, Switzerland: World Health Organization; 2011.
- ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol 2002; 99(1): 171–173.
- World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus, 2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).
- Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable Fetal Weight Standard. Ultrasound Obstet Gynecol 1995; 6: 168–74.
- WHO. The Global Prevalence of Anaemia in 2011. Geneva: World Health Organization; 2015.
- Pinho-Pompeu M, Surita FG, Pastore DA, Paulino DSM, Pinto E, Silva JL. Anemia in pregnant adolescents: Impact of treatment on perinatal outcomes. J Matern Fetal Neonatal Med 2017; 30(10): 1158-62.
- Bencaiova G, Breymann C. Mild Anemia and Pregnancy Outcome in a Swiss Collective. Journal of Pregnancy 2014; 2014: 307535.
- Gambling L, Kennedy C, McArdle HJ. Iron and copper in fetal development. Seminars in Cell and Developmental Biology 2011; 22: 637–44.
- Kemper AR, Fan T, Grossman DC, Phipps MG. Gaps in evidence regarding iron deficiency anemia in pregnant women and young children: Summary of US Preventive Services Task Force recommendations. Am J Clin Nutr 2017; 106: 1555-58.
- WHO. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva, Switzerland: WHO; 2012.
- Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12: CD004736.
- Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E. A randomised placebo controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin or = 13.2 g/dl. BJOG 2007; 114: 684–8.
- Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, McDonald CM, Thomas A, Kurpad AV. Association of oral iron supplementation with birth outcomes in non-anaemic South Indian pregnant women. Eur J Clin Nutr 2015; 69: 609–13.
- Frenkel EP, Yardley DA. Clinical and laboratory features and sequelae of deficiency of folic acid (folate) and vitamin B12 (cobalamin) in pregnancy and gynecology. Hematol Oncol Clin North Am 2000; 14(5):1079-1100.
- Ramakrishnan U, Grant FK, Goldenberg T, Bui V, Imdad A, Bhutta ZA. Effect of multiple micronutrient supplementation on pregnancy and infant outcomes: A systematic review. Paediatric and Perinatal Epidemiology 2012; 261: 153–67.
- Weekly iron and folic acid supplementation programmes for women of reproductive age: An analysis of best programme practices. Manila, World Health Organization Regional Office for the Western Pacific, 2011.
- lanco-Rojo R, Perez-Granados AM, Toxqui L, Zazo P, de la Piedra C, Vaquero MP. Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming iron-fortified food. Eur J Nutr 2013;52:695–703
- Sim JJ, Lac PT, Liu IL, Meguerditchian SO, Kumar VA, Kujubu DA, Rasgon SA. Vitamin D deficiency and anemia: A cross-sectional study. Ann Hematol 2010; 89: 447–52.
- Alon DB, Chaimovitz C, Dvilansky A, Lugassy G, Douvdevani A, Shany S, Nathan I. Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol 2002; 30: 403–9.
- Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K, Nayak A, Wesseling-Perry K, Westerman M, Hollis BW, et al. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol 2014;25:564–72.
There are 30 citations in total.
Details
| Primary Language | English |
|---|---|
| Journal Section | Orginal Article |
| Authors | |
| Publication Date | December 18, 2019 |
| Published in Issue | Year 2019 Volume: 7 Issue: 3 |
