Factores sociales y demográficos asociados a la anemia en mujeres embarazada en Perú / Social and demographic factors associated with anemia in pregnant women in Peru

INTRODUCCIÓN Y OBJETIVOS: La anemia en el embarazo persiste como un problema de salud pública y varía según características propias en cada población. El objetivo del estudio fue determinar los factores sociales y demográficos asociados a la anemia en mujeres embarazadas en Perú. MÉTODO: Estudio analítico transversal de la Encuesta Demográfica y de Salud Familiar (ENDES) de 2019. Se incluyeron las mujeres embarazadas que participaron en la encuesta poblacional. Se analizaron las características sociales y demográficas asociados a la anemia, mediante análisis bivariado y análisis de regresión logística múltiple, procesados en el software estadístico R. RESULTADOS: Se incluyeron datos de 1090 mujeres embarazadas, 28,3% presento anemia. En el análisis bivariado, se evidencio asociación entre anemia y región geográfica, nivel educativo, edad y tener seguro de salud (p<0,05). En el análisis multivariado, se evidencio que la anemia se encuentra asociada al nivel educativo de primaria (OR=1,96; IC: 1,18-3,28), secundaria (OR=2,0; IC95%: 1,42-2,82), edad de 15 a 18 años (OR=2,35; IC95%: 1,33-4,14), edad mayor a 35 años (OR=1,51; IC95%: 1,06-2,16), no tener seguro de salud (OR=1,82; IC95%: 1,19-2,79). CONCLUSIÓN: La prevalencia de anemia en mujeres embarazadas fue del 28,3%. Los factores sociales y demográficos asociados a la anemia en mujeres embarazadas fueron la edad de 15 a 18 años, edad tardía de 35 años a más, tener un bajo nivel educativo y no contar con un seguro de salud. Estos factores evidenciaron asociación con anemia en mujeres embarazadas, estando ajustados por otras características como región geográfica, quintil de riqueza y lugar de residencia. Se requieren de más estudios que permiten analizar los resultados según temporalidad en la población con independencia de otros factores asociados.

INTRODUCTION AND OBJECTIVES: Anemia in pregnancy persists as a public health problem and varies according to specific characteristics in each population. The purpose was to determine the social and demographic factors associated with anemia in pregnant women in Peru. METHOD: Analytical cross-sectional study of the 2019 Demographic and Family Health Survey (ENDES). The study included data on pregnant women. The social and demographic characteristics associated with anemia were analyzed using bivariate analysis and multiple logistic regression analysis, processed in the R statistical software. RESULT: Data from 1 090 women were analyzed; 28.3% had anemia. Bivariate analysis showed an association between anemia and geographical region, educational level, age and health insurance (p<0.05). In the multivariate analysis, anemia was associated with the educational level of primary (OR=1,96; IC: 1,18-3,28), secondary (OR=2,0; IC95%: 1,42-2,82), age from 15 to 18 years (OR=2,35; IC95%: 1,33-4,14), age over 35 years (OR=1,51; IC95%: 1,06-2,16), not having health insurance (OR=1,82; IC95%: 1,19-2,79). CONCLUSION: The prevalence of anemia in pregnant women was 28.3%. The social and demographic factors associated with anemia in pregnant women were age 15-18, late age to 35, low educational level and lack of health insurance; regardless of geographical region, wealth quintile and place of residence. More studies are needed to analyze the results according to temporality in the population, independently of other associated factors.

Forced international migration for refugee food: a scoping review / Migração internacional forçada e alimentação de refugiados: uma scoping review

Abstract Recent crisis and conflicts in African countries, the Middle East and the Americas have led to forced population migration and rekindled concern about food security. This article aims to map in the scientific literature the implications of forced migration on food and nutrition of refugees. Scoping Review, and database search: databases: PubMed Central, LILACS, SciElo, Science Direct and MEDLINE. Languages used in the survey were: English, Portuguese and Spanish, with publication year from 2013 to 2018. 173 articles were obtained and after removing of duplicates and full reading, 26 articles were selected and submitted to critical reading by two reviewers, resulting in 18 articles selected. From the analysis of the resulting articles, the following categories emerged: Food Inequity; Cultural Adaptation and Nutrition; Emerging Diseases and Strategies for the Promotion of Nutritional Health. Food insecurity is a marked consequence of forced international migration, and constitutes an emerging global public health problem, since concomitant with increasing population displacements also widens the range of chronic and nutritional diseases.

Resumo As recentes crises e conflitos em países Africanos, no Oriente Médio e Américas têm originado migração forçada de populações e reacende a preocupação com os cuidados com a alimentação. O objetivo deste artigo é mapear na literatura científica as implicações da migração forçada sobre a alimentação e nutrição de refugiados. Scoping Review, com buscas nas bases de dados: bases de dados: PubMed Central, LILACS, SciElo, Science Direct e MEDLINE. Os idiomas de pesquisa foram: Inglês, Português e Espanhol, e ano de publicação compreendido entre 2013 e 2018. Obteve-se 173 artigos e após remoção dos duplicados e leitura integral, 26 artigos foram selecionados e submetidos à leitura crítica por dois revisores independentes, resultando em 18 artigos selecionados. Da análise dos resultados dos artigos, emergiram as categorias: Iniquidade Alimentar; Adaptação Cultural e Nutrição; Doenças Emergentes e Estratégias de Promoção da Saúde Nutricional. A insegurança alimentar é consequência marcante da imigração internacional forçada, e se constitui um emergente problema de saúde pública global, pois concomitante aos crescentes deslocamentos populacionais também se ampliam a gama de doenças crônicas e nutricionais.

Food Insecurity, Prenatal Care and Other Anemia Determinants in Pregnant Women from the NISAMI Cohort, Brazil: Hierarchical Model Concept / Insegurança alimentar, cuidado pré-natal e outros determinantes da anemia em mulheres grávidas da coorte Nisami, Brasil: modelo conceitual hierárquico

Abstract Objective To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women. Methods A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb < 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels. Results The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15;95%CI: 1.43-18.50); multiparity (OR = 2.27;95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care. Conclusions In the present study, the chance of occurrence of anemia in pregnant women was significantly higher,mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.

Resumo Objetivo Identificar a prevalência de anemia e sua relação com a insegurança alimentar (IA) e outros determinantes em mulheres grávidas. Métodos Trata-se de estudo transversal aninhado a uma coorte, do qual participaram 245 gestantes atendidas em Unidades de Saúde da Família do município de Santo Antônio de Jesus-BA. As participantes foram submetidas a exame de sangue para dosagem de hemoglobina, exame antropométrico, e responderam a um questionário estruturado. Utilizou-se o parâmetro hemoglobina (Hb < 11 g/dL) para a classificação do diagnóstico de anemia. A IA foi avaliada por meio da escala curta norte-americana de avaliação da segurança alimentar. Para as análises estatísticas, adotou-se a regressão logística, tomando-se como base um modelo conceitual hierarquizado definido a priori, que possibilitou a mensuração da decomposição do efeito total em seus componentes não mediados e mediados nos níveis hierárquicos propostos. Resultados A prevalência de anemia na população estudada foi de 21,8%, e amédia de hemoglobina foi de 12,06 g/dL (desvio padrão [DP]: 1,27). A IA foi identificada em 28,16% das gestantes. A média de idade materna foi de 25,82 anos (DP: 5,94). Após a hierarquização, permaneceram significativas as variáveis associadas positivamente à anemia: IA (razão de possibilidades [OR] = 3,63; intervalo de confiança de 95% [IC95%]: 1,77-7,45); não realização de pré-natal (OR = 5,15; IC95%: 1,43-18,50); multiparidade (OR = 2,27; IC95%: 1,02-5,05); e a não suplementaçãomedicamentosa de ferro (OR = 2,45; IC95%: 1,04-5,76). Os resultados indicaram ainda que os fatores socioeconômicos e ambientais forammediados emgrande parte pela IA e pelos fatores de cuidado pré-natal. Conclusões Nesse estudo, a chance de ocorrência de anemia em gestantes foi significantemente maior, principalmente, entre aquelas que estavam em situação de IA, não realizaram o pré-natal, eram multíparas, e não fizeram a suplementação de ferro.

Análisis espacial de la anemia gestacional en el Perú, 2015 / Spatial analysis of gestational anemia in Peru, 2015

RESUMEN Objetivos Establecer las prevalencias regionales e identificar conglomerados distritales con altas prevalencias deanemia en gestantes atendidas en los establecimientos de salud públicos del Perú en el 2015. Materiales y métodos Se realizó un estudio ecológico de datos de gestantes con anemia, registrados en el Sistema de Información del Estado Nutricional (SIEN), que fueron atendidas en 7703 establecimientos públicos de salud durante el 2015. Se calcularon prevalencias de anemia gestacional regionales y distritales. Mediante el índice de Moran se identificaron conglomerados distritales con alta prevalencia de anemia gestacional. Resultados Se recolectó información de 311 521 gestantes, distribuidas en 1638 distritos del Perú. La prevalencia nacional de anemia fue de 24,2% (IC 95%: 24,0-24,3) y 30,5% en el área rural vs. 22,0% en el área urbana. Las regiones de Huancavelica (45,5%; IC 95%: 44,2-46,7), Puno (42,8%; IC 95%: 41,9-43,7), Pasco (38,5%; IC 95%: 36,9-40,0), Cusco (36,0%; IC 95%: 35,3-36,8) y Apurímac (32,0%; IC 95%: 30,8-33,1) tuvieron las mayores prevalencias de anemia. El índice local de Moran identificó 202 distritos (12,3%) (44 urbanos y 158 rurales) de alta prioridad (alto-alto o hot spots) situados en Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco y Puno, que muestran conglomerados distritales con altas prevalencias. Conclusiones La anemia gestacional en Perú concentra sus mayores prevalencias en las áreas rural y sur de la sierra. Los conglomerados distritales con altas prevalencias de anemia gestacional coinciden con las zonas de alta prevalencia regional.

ABSTRACT Objectives To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates. Materials and Methods An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index. Results Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates. Conclusions Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.

Nutrition situation in Latin America and the Caribbean: current scenario, past trends, and data gaps / Situación nutricional en América Latina y el Caribe: panorama actual, tendencias y brechas en la información

ABSTRACT Objective To determine the current nutritional status in Latin America and the Caribbean (LAC) and identify data gaps and trends in nutrition surveillance. Methods A systematic Internet search was conducted to identify official sources that allowed for monitoring of LAC countries’ nutritional status, including progress toward World Health Organization Global Nutrition Targets 2025. Reports from national nutrition surveillance systems and reports on nationally representative surveys were collected and collated to 1) analyze nutritional status, based on life-course anthropometric indicators and biomarkers, and 2) identify gaps in data availability and trends in nutritional deficiencies. Information on iron, vitamin A, iodine, folate, and vitamin B12 deficiency was also collected and collated. Results Twenty-two of the 46 LAC countries/territories (48%) had information on undernutrition (stunting, underweight, and wasting) in children under 5 years old and women of reproductive age (WRA). Seventeen countries (38%) had information on anemia in children under 5 years old and WRA, and 12 (27%) had information on anemia in pregnant women. Although overall nutritional status has improved in the past few decades in all countries in the region, some LAC countries still had a high prevalence of stunting and anemia in children and WRA. Overweight affected at least 50% of WRA in nine countries with available data, and was increasing in children. Data for school-age children, adolescents, adult males, and older adults were scarce in the region. Conclusions Overall nutritional status has improved in the LAC countries with available information, but more efforts are needed to scale up nutrition-sensitive and nutrition-specific interventions to tackle malnutrition in all its forms, as stunting, anemia, and vitamin A deficiency are still a public health problem in many countries, and overweight is an epidemic. Nutrition information systems are weak in the region, and countries need to strengthen their capacity to monitor nutritional status indicators.

RESUMEN Objetivo Determinar la situación actual de las carencias nutricionales en América Latina y el Caribe (ALC) e identificar las deficiencias en los datos y el curso actual de la vigilancia en materia de nutrición. Métodos Se realizó una búsqueda sistemática de la internet para encontrar fuentes oficiales dedicadas a observar la evolución de la situación nutricional de los países de América Latina y el Caribe, incluidos los avances en relación con las metas mundiales de nutrición fijadas por la Asamblea Mundial de la Salud para el 2025. Se recopilaron y compaginaron los informes de diferentes sistemas de vigilancia nutricional nacionales y de encuestas representativas de alcance nacional con el fin de: (1) analizar la situación nutricional con respecto a indicadores antropométricos y marcadores biológicos para todas las etapas de la vida y (2) detectar brechas en la disponibilidad de datos y observar la evolución de las carencias nutricionales. También se recopiló y compaginó información relativa a la carencia de hierro, vitamina A, yodo, folato y vitamina B12. Resultados Veintidós países de América Latina y el Caribe (48%) contaban con información acerca de la desnutrición (retraso del crecimiento, peso inferior al normal y emaciación) en niños menores de 5 años de edad, niños en edad escolar, adolescentes y mujeres en edad fecunda (MEF). Diecisiete países (38%) tenían información sobre la anemia en niños menores de 5 años; 12 (27%) la tenían sobre la anemia en MEF. Aunque la situación nutricional en general ha mejorado en los últimos decenios en todos los países de la Región, algunos países de América Latina y el Caribe siguen teniendo una alta prevalencia de retraso del crecimiento y anemia en niños y MEF. El sobrepeso afectaba a por lo menos 50% de las MEF en nueve de los países que poseían datos y estaba aumentando en los niños. En la Región hay pocos datos relativos a los niños en edad escolar, los adolescentes, los hombres adultos y las personas de edad. Conclusiones La situación nutricional en general ha mejorado en los países de América Latina y el Caribe para los cuales se cuenta con información, pero hay que tomar más medidas para incrementar las intervenciones relacionadas de manera tangencial o directa con la nutrición a fin de combatir la desnutrición en todas sus manifestaciones, habida cuenta de que el retraso del crecimiento, la anemia y la carencia de vitamina A siguen siendo problemas de salud pública en muchos países y que el sobrepeso constituye una epidemia. Los sistemas de información nutricional de la Región son pobres y los países tienen que fortalecer su capacidad para vigilar los indicadores de la situación nutricional.

Enfermedad de células falciformes en el embarazo / Sickle Cell Disease in Pregnancy

La anemia de células falciformes o drepanocitosis, es una de las hemoglobinopatías estructurales más comunes en el mundo. La clínica se resume en oclusión vascular e isquemia tisular, anemia hemolítica y la susceptibilidad a infecciones. La procreación en mujeres con hemoglobinopatías deviene un grave problema de salud, que exige una atención diferenciada y multidisciplinaria. Para esta afección no existe tratamiento especifico definitivo, el arsenal medico existente solo puede manejar los efectos y no la causa. La siguiente revisión tiene como objetivo ofrecer a los profesionales algunos aspectos relacionados con la fisiopatología, una discusión del problema clínico, diagnóstico y opciones terapéuticas de la enfermedad, lo que permite contribuir en la reducción de la morbilidad y mortalidad materna y perinatal. Se concluye que un alto índice de perspicacia y buen diagnóstico es menester para obtener resultados óptimos en las embarazadas afectadas por enfermedad de células falciformes(AU)

Sickle cell anemia or sickle cell disease is one of the most common structural hemoglobinopathies in the world. The clinic is summarized in vascular occlusion and tissue ischemia, hemolytic anemia and vulnerability to infections. Procreation in women with hemoglobinopathies becomes a serious health problem that requires a differentiated and multidisciplinary care. There is no definitive specific treatment for this condition, the existing medical resources can only address the effects and not the cause. The following review aims to offer professionals some aspects related to the pathophysiology, a discussion of the clinical problem, diagnosis and treatment options, which can contribute in reducing morbidity and maternal and perinatal mortality. It is concluded that high level of insight and good diagnosis are necessary for optimum results in pregnant women affected by sickle cell disease(AU)

Fatores de associados à anemia em gestantes da rede pública de saúde de uma capital do Nordeste do Brasil / Risk factors associated among anemia in pregnancy women of network public health of a capital of Brazil Northeastern

OBJETIVO: Avaliar os fatores associados à anemia em gestantes atendidas pela rede pública de saúde de uma capital do Nordeste do Brasil.MÉTODOS: Estudo de caráter transversal, envolvendo amostra (n=428) obtida, considerando a prevalência de anemia em gestantes (50%), um intervalo de confiança (IC) de 95%, um erro de 5% e uma perda amostral de 20%, sendo elegíveis gestantes que residiam no município e que eram atendidas pela rede pública de saúde municipal, das quais foram coletados dados socioeconômicos, de estilo de vida, clínicos, de consumo de ferro dietético, antropométricos e medida de hemoglobina capilar. A anemia foi identificada por um nível de hemoglobina <11 g/dL e sua associação com os fatores de risco foi testada por meio de análise de regressão múltipla de Poisson, com os resultados expressos pela Razão de Prevalência (RP) e IC95%.RESULTADOS: A prevalência de anemia foi de 28,3%, sendo maior naquelas gestantes com mais membros no domicílio (RP=1,49; IC95% 1,01-2,22; p=0,046) e naquelas que viviam com insegurança alimentar (RP=1,43; IC95% 1,00-2,04; p=0,047).CONCLUSÃO: A prevalência de anemia nas gestantes atendidas pela rede pública de saúde do município é um problema moderado de saúde pública, tornando necessário o planejamento de medidas efetivas para o seu controle.

PURPOSE: To evaluate the factors associated with anemia among pregnant women receiving public health care in a capital city in Northeastern Brazil.METHODS: This was a cross-sectional study conducted on a sample of 428 patients obtained on the basis of the estimated prevalence of anemia during pregnancy (50%), a 95% confidence interval (95%CI), an error of 5% and a sample loss of 20%. Pregnant women who lived in the city and were served by the municipal public health network were considered to be eligible for the study. Socioeconomic, lifestyle, clinical and anthropometric data and dietary iron intake were obtained, and capillary hemoglobin was determined. Anemia was identified as a hemoglobin level <11 g/dL, and its association with risk factors was tested using multivariate Poisson regression analysis, with the results expressed as the Prevalence Ratio (PR) and 95%CI.RESULTS: The prevalence of anemia was 28.3% and was higher among women with more members in the household (PR=1.49; 95%CI 1.01-2.22; p=0.046) and those living with food insecurity (PR=1.43; 95%CI 1.00-2.04; p=0.047).CONCLUSION: The prevalence of anemia among pregnant women receiving care from the public health system of the city is a moderate public health problem, requiring the planning of effective measures for its control.

Evolução temporal da prevalência de anemia em adolescentes grávidas de uma maternidade pública do Rio de Janeiro / Temporal evolution of anemia prevalence in pregnant adolescents of a public maternity of Rio de Janeiro

OBJETIVO: Descrever a evolução temporal da prevalência de anemia em adolescentes grávidas atendidas em uma maternidade pública do município do Rio de Janeiro no período de 2004 a 2013. MÉTODOS: Trata-se de um estudo analítico transversal retrospectivo com 628 gestantes/puérperas adolescentes, distribuídas em 3 grupos distintos: Grupo A (2004 a 2006), Grupo B (2007 a 2010) e Grupo C (2013). Informações relativas às características antropométricas, clínicas, sociodemográficas, obstétricas e da assistência pré-natal das adolescentes foram obtidas dos prontuários das gestantes. A concentração de hemoglobina (Hb) <11 g/dL foi considerada como anemia. A análise dos dados foi realizada por meio dos testes do χ2, t de Student e ANOVA, e o post hoc adotado foi o Tukey. RESULTADOS: A prevalência de anemia gestacional ao longo dos anos foi de 43% (GA=138), 36% (GB=80) e 47,1% (GC=40), e no período de 2004 a 2013 foi de 41,1% (n=258). A ocorrência de gestantes anêmicas aumentou com a evolução da gravidez; contudo, no 3º trimestre foi observada uma redução da prevalência de anemia no GB (29,3%) em relação ao GA (38,7%; p=0,04). Os fatores associados à anemia foram número de consultas de pré-natal e da assistência nutricional pré-natal, local de moradia, estado nutricional nos períodos pré-gestacional e gestacional. CONCLUSÃO: Os resultados sugerem que a prevalência de anemia em adolescentes grávidas atendidas na referida maternidade foi alta. Não foi verificada redução da anemia ao longo do período estudado, e na gênese da anemia nessa população outros fatores estão associados, além da própria deficiência de ferro. .

PURPOSE: To describe the evolution of the prevalence of anemia in pregnant adolescents attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013. METHODS: A retrospective cross-sectional study with 628 pregnant/postpartum women divided into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013). Information about anthropometric, clinical, sociodemographic data and obstetric and prenatal care of adolescents was obtained from medical records of the pregnant women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data were analyzed statistically by the chi-square test, Student's t-test and ANOVA, and the post hoc Tukey test. RESULTS: The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80) and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1% (n=258). The occurrence of anemic pregnant women increased with the progression of pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with anemia were number of prenatal visits and prenatal nutritional assistance, place of residence, pre-pregnancy BMI, and gestational weight gain. CONCLUSION: The results showed that the prevalence of anemia among pregnant adolescents seen at a public maternity is high. There was no reduction of anemia during the study period and other factors in addition to iron deficiency were involved in the genesis of anemia in this population. .

Resultados gestacionais e trombofilias em mulheres com historia de obito fetal de repeticao / Pregnancy outcome and thrombophilia of women with recurrent fetal death

OBJETIVO: Descrever desfechos obstétricos e frequência de trombofilias em gestantes com óbito fetal de repetição após a 20a semana de gravidez. MÉTODOS: Avaliação de desfechos obstétricos em uma série de casos de gestantes com óbito fetal de repetição após a 20a semana de gestação, acompanhadas de 2001 a 2013. A atividade de antitrombina, atividade da proteína C e S, presença de fator V de Leiden, presença da mutação do gene de protrombina e presença de síndrome antifosfolípide foram avaliadas nessas pacientes. RESULTADOS: Foram incluídas 20 pacientes que tinham óbito fetal de repetição. Trombofilias foram encontradas em 11 delas, sendo 7 diagnosticadas como síndrome antifosfolípide, 3 como deficiência de proteína S e 1 como mutação do gene da protrombina. Todas foram tratadas com heparina subcutânea (heparina não fracionada ou enoxaparina) e 14 delas com ácido acetilsalicílico (AAS) durante toda a gestação. Complicações obstétricas ocorreram em 15 pacientes e incluíram: restrição de crescimento fetal intrauterino (25%), placenta prévia (15%), índice de líquido amniótico diminuído (25%), pré-eclâmpsia grave (10%), sofrimento fetal (5%) e óbito fetal (5%). A idade gestacional média do parto foi de 35,8±3,7 semanas e o peso dos recém-nascidos foi, em média, de 2.417,3±666,2 g. CONCLUSÃO: A pesquisa de trombofilias deve ser realizada em todas as gestantes com óbitos fetais de repetição após a 20a semana de gestação, como forma de identificar possíveis fatores causas passíveis de tratamento. .

PURPOSE: To evaluate pregnancy outcome and thrombophilia frequency in women with recurrent fetal death. METHODS: Evaluation of obstetric outcomes in a retrospective cohort of pregnant women with recurrent stillbirth after the 20th week, from 2001 to 2013. Antithrombin activity, protein C and S activity, factor V Leiden, prothrombin gene mutation and antiphospholipid syndrome were analyzed. RESULTS: We included 20 patients who had recurrent fetal death. Thrombophilia were found in 11 of them, 7 diagnosed with antiphospholipid syndrome, 3 with protein S deficiency and 1 with prothrombin gene mutation. All of them were treated with subcutaneous heparin (unfractionated heparin or enoxaparina) and 14 of them with acetylsalicylic acid (AAS) during pregnancy. Obstetric complications occurred in 15 patients and included: intrauterine fetal growth restriction (25%), placenta previa (15%), reduced amniotic fluid index (25%), severe preeclampsia (10%), fetal distress (5%), and stillbirth (5%). The mean gestational age at delivery was 35.8±3.7 weeks and newborn weight averaged 2,417.3±666.2 g. CONCLUSION: Thrombophilia screening should be performed in all pregnant women with recurrent fetal death after the 20th week as a way to identify possible causal factors suitable for treatment. .

Níveis de hemoglobina e prevalência de anemia em gestantes atendidas em unidades básicas de saúde, antes e após a fortificação das farinhas com ferro / Hemoglobin levels and prevalence of anemia in pregnant women assisted in primary health care services, before and after fortification of flour / Hemoglobin levels and prevalence of anemia in pregnant women assisted in primary health care services, before and after fortification of flour*

Avaliaram-se níveis de hemoglobina-Hb e prevalência de anemia em gestantes, antes e após a fortificação das farinhas. Estudo de avaliação do tipo antes e depois, com amostras populacionais independentes, realizado em unidades básicas de saúde de Maringá, PR. Foram avaliados 366 prontuários de gestantes Antes da fortificação obrigatória das farinhas, e 419 Após a fortificação. Gestantes com Hb < 11g/dL foram consideradas anêmicas. Realizou-se análise de regressão linear múltipla. Verificou-se baixa prevalência de anemia que afetava 12,3% e 9,4% das gestantes, Antes e Após a fortificação (p > 0,05), porém o Grupo Após a fortificação obrigatória apresentou média de Hb mais elevada (p < 0,05). Evidenciou-se associação entre Hb e Grupo, idade gestacional, gestação anterior, ocupação e situação conjugal (p < 0,05). Embora a fortificação de farinhas possa ter um papel no aumento da média de hemoglobina, é preciso considerar a contribuição de outras variáveis não investigadas.

We evaluated hemoglobin-Hb levels and prevalence of anemia in pregnant women before and after fortification of flour. It was developed a study to evaluate intervention, of the type before and after, with independent population samples. Study was conducted in primary health care services in Maringá, PR. We assessed 366 and 419 medical records, Before and After implementation of fortification. Pregnant women with Hb < 11g/dL were considered anemic. Data were submitted to multiple linear regression analysis. There was low prevalence of anemia affecting 12.3% and 9.4% pregnant women Before and After fortification (p > 0.05), but the Group After the fortification had higher Hb levels (p < 0.05). Hb levels associated with Group, gestational age, previous pregnancy number, employment and marital status (p < 0.05). Although the fortification of flour may have had role in increasing the mean hemoglobin, we need consider the contribution of other variables not investigated.

Maternal Anemia and its Effect on Cord Hemoglobin.

Background: Maternal anemia is a common problem during pregnancy and it can lead to adverse consequences in both the mother and the fetus. Aim of study: To determine the effect of maternal anemia on fetal cord blood hemoglobin. Materials and Methods : The study was conducted over a period of one year in Gian Sagar Medical College and Hospital, a rural medical college near Chandigarh. A total of 248 pregnant women in labour were included in the study. 108 of the women were anemic with hemoglobin of less than 11g/dl. 138 women had hemoglobin more than 11gm/dl and they formed the control group. After delivery of the baby, the cord was clamped and divided. Blood for hemoglobin assessment was taken from the cord and sent for analysis. The results of cord hemoglobin were compared between the two groups. Results: Cord blood hemoglobin was lower in neonates born to anemic mothers as compared to non anemic mothers.

Niveles de hemoglobina en gestantes atendidas en establecimientos del Ministerio de Salud del Perú, 2011 / Hemoglobin levels in pregnant women seen in health care centers of the peruvian ministry of health, 2011

Objetivos. Determinar los niveles de hemoglobina y la prevalencia de anemia en gestantes atendidas en los establecimientos del Ministerio de Salud a nivel nacional. Materiales y métodos. Estudio transversal donde se analizó la base de datos del Sistema de Información del Estado Nutricional del Niño menor de 5 años y de la Gestante (SIEN). Se incluyó 287 691 registros de gestantes evaluadas en establecimientos del Ministerio de Salud del Perú en 2011, se analizaron los niveles de hemoglobina corregida a la altura, edad, edad gestacional, altitud a nivel del mar y prevalencia de anemia (leve, moderada y grave). Se aplicaron estadísticas descriptivas y chi cuadrado. Resultados. La prevalencia a nivel nacional de anemia en la gestante fue de 28,0% siendo anemia leve de 25,1%, moderada de 2,6% y grave de 0,2%. Los niveles de hemoglobina son mayores en mujeres con mayor edad y menores durante los primeros meses de gestación, la frecuencia de anemia decrece con la altitud. Asimismo, la prevalencia es mayor en departamentos de la sierra. Huancavelica fue el departamento con mayor prevalencia de anemia (53,6%), seguido de Puno con 51,0%. Conclusiones. Los niveles de hemoglobina son mayores conforme la edad materna es mayor, y menores conforme el trimestre de gestación y altitud. Huancavelica tiene la mayor prevalencia de anemia en gestantes.

Objectives. Determine hemoglobin levels and prevalence of anemia in pregnant women seen in health care centers of the Ministry of Health at national level. Materials and methods. Cross-cut study where the database of the Information System on the Nutritional Health of Children under 5 and Pregnant Women (SIEN) were analyzed. 287 691 records of pregnant women examined at the health care centers of the Peruvian Ministry of Health in 2011 were included, hemoglobin levels corrected by height, age, gestational age, altitude and prevalence of anemia (light, moderate and serious) were analyzed. Descriptive statistics and the chi-square method were used. Results. Nationwide prevalence of anemia in pregnant women was 28.0%, with mild anemia being at 25.1%, moderate anemia at 2.6% and severe anemia at 0.2%. Hemoglobin levels are higher in older and younger women during the first months of pregnancy, prevalence of anemia decreases with altitude. Furthermore, prevalence is higher in the Highland regions. Huancavelica was the region with higher prevalence of anemia (53.6%), followed by Puno with 51.0%. Conclusions. Hemoglobin levels get higher as the mother gets older, and they go down in keeping with the gestation trimester and altitude. Huancavelica has the highest prevalence of anemia in pregnant women.

Comparison of Oral and Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy.

Oral iron supplementation is standard obstetrical practice. But programmes of anaemia prophylaxis based on oral iron supplementation still remain a failure. Whether or not there is need for parenteral iron may be debated. Parenteral iron is indicated when oral iron supplementation is not possible or fails. Intravenous iron could be a good alternative in pregnant women to ensure compliance. Many workers have shown that parenteral iron therapy supplies enough iron for erythropoiesis. Therefore, In the present review, we assessed oral iron supplementation with intravenous (IV) iron sucrose in the management of iron deficiency anaemia in pregnancy. Intravenous iron sucrose appears a good alternative to oral iron in patients who are either intolerant to oral iron or are non compliant and may also reduce the incidence of blood transfusion and its associated risks.

Uso de hierro en forma de medicamento en gestantes colombianas / Pregnant Colombian females' iron in take in drug form

Objetivo Caracterizar el consumo de hierro en forma de medicamento en un grupo de embarazadas colombianas. Metodología Estudio observacional descriptivo, se obtuvo información de mujeres en control prenatal y/o atención del parto en 4 ciudades de Colombia. Las fuentes de información fueron entrevistas a gestantes y registros de historia clínica. Resultados La muestra fue de 1 637 mujeres en 15 instituciones. A 1 396 mujeres (85,3 %) les recomendaron consumir hierro, recomendación realizada por médico al 85,3 % de ellas, el 86,8 % tuvo adherencia al tratamiento. Al 84,7 % el hierro fue suministrado por la empresa aseguradora de salud, el 11,9 % lo compró a sus expensas. El 90,0 % de gestantes anémicas y el 82,8 % de las no anémicas consumieron hierro en forma de medicamento, en conjunto, en el 37,2 % de las gestantes el consumo de suplencia de hierro fue pertinente (es decir, lo necesitaban, se les recomendó y lo consumieron o no le necesitaban, no se recomendó y/o no lo consumieron). Discusión Se recomienda y se consume hierro independientemente de presentar anemia. Se invita a reflexionar sobre la utilidad de los programas que promueven el consumo masivo de esta sustancia en forma de medicamento durante el embarazo, programas que parecen desconocer las causas fundamentales de los problemas nutricionales que aquejan a la población.

Objective Describing a group of pregnant Colombian females' iron intake, in drug form. Methodology This was an observational descriptive study; information was collected in 4 Colombian cities regarding pregnant females during antenatal control or when giving birth. Information sources consisted of interviews with pregnant women and their clinical records. Results The sample consisted of 1,637 female sat tending 15 institutions. An iron intake was recommended for1, 396 women (85.3 %); a doctor made such recommendation in 85.3 % of cases and adherence was 86.8 %. Health insurance was used by 84.7 % of the females for supplying iron; 11.9 % of them bought it themselves. Iron intake as medication for anemic pregnant females was 90.0 % and 82.8 % in non-anemic ones. Iron intake supply was appropriate in 37.2 % of the pregnant females (i.e. they needed it, someone recommended it for them and they consumed it, or they didn't need it, someone didn't recommend it to them and/or they did not take it). Discussion Iron intake was recommended and consumed regardless of anemia status. The results invite to think on the usefulness of programs promoting the mass intake of iron as a medication during pregnancy. Such programs seem to be unaware of the fundamental causes of people's nutritional problems.

Anemia em gestantes brasileiras antes e após a fortificação das farinhas com ferro / Anemia in Brazilian pregnant women before and after flour fortification with iron / Anemia en gestantes brasileñas antes y después de la fortificación de harinas con hierro

OBJETIVO: Comparar prevalência de anemia e valores de hemoglobina (Hb) em gestantes brasileiras, antes e após a fortificação das farinhas com ferro. MÉTODOS: Estudo de avaliação de painéis repetidos, desenvolvido em serviços públicos de saúde de municípios das cinco regiões brasileiras. Dados retrospectivos foram obtidos de 12.119 prontuários de gestantes distribuídas em dois grupos: antes da fortificação, com parto anterior a junho de 2004, e após a fortificação, com última menstruação após junho de 2005. Anemia foi definida como Hb < 11,0 g/dL. Valores de Hb/idade gestacional foram avaliados segundo dois referenciais da literatura. Foram utilizados teste qui-quadrado, t de Student e regressão logística, com nível de 5 por cento de significância. RESULTADOS: Na amostra total, anemia caiu de 25 por cento para 20 por cento após fortificação (p < 0,001), com médias de Hb significativamente maiores no grupo "após" (p < 0,001). Observaram-se, entretanto, diferenças regionais importantes: reduções significativas nas regiões Nordeste (37 por cento para 29 por cento) e Norte (32 por cento para 25 por cento), onde as prevalências de anemia eram elevadas antes da fortificação, e reduções menores nas regiões Sudeste (18 por cento para 15 por cento) e Sul (7 por cento para 6 por cento), onde as prevalências eram baixas. Os níveis de Hb/idade gestacional de ambos os grupos se mostraram discretamente mais elevados nos primeiros meses, porém bem mais baixos após o terceiro ou quarto mês, dependendo da referência utilizada para comparação. Análise de regressão logística mostrou que grupo, região geográfica, situação conjugal, trimestre gestacional, estado nutricional inicial e gestação anterior associaram-se com anemia (p < 0,05). CONCLUSÕES: A prevalência de anemia diminuiu após a fortificação, porém continua elevada nas regiões Nordeste e Norte. Embora a fortificação possa ter tido papel nesse resultado favorável, há que se considerar a contribuição de outras políticas públicas implementadas no período estudado.

OBJECTIVE: To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS: A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Student's t tests, and logistic regression, with a significance level of 5 percent. RESULTS: In the total sample, prevalence of anemia fell from 25 percent to 20 percent after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37 percent to 29 percent) and North (32 percent to 25 percent) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18 percent to 15 percent) and South (7 percent to 6 percent) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS: Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

OBJETIVO: Comparar prevalencia de anemia y valores de hemoglobina (Hb) en gestantes brasileñas, antes y después de la fortificación de las harinas con hierro. MÉTODOS: Estudio de evaluación de paneles repetidos, desarrollado en servicios públicos de salud de municipios de las cinco regiones brasileñas. Datos retrospectivos se obtuvieron de 12.119 prontuarios de gestantes distribuidas en dos grupos: antes de la fortificación, con parto anterior a junio de 2004, y posterior a la fortificación, con última menstruación después de junio 2005. Anemia fue definida como Hb<11,0 g/dL. Valores de Hb/edad gestacional fueron evaluados según dos referenciales de la literatura. Se utilizaron prueba de chi-cuadrado, t de Student y regresión logística, con nivel de 5 por ciento de significancia. RESULTADOS: En la muestra total, anemia disminuyó de 25 por ciento a 20 por ciento después de la fortificación (p<0,001), con promedios de Hb significativamente mayores en el grupo "posterior" (p<0,001). Se observaron, sin embargo, diferencias regionales importantes: reducciones significativas en las regiones Noreste (de 37 por ciento a 29 por ciento) y Norte (de 32 por ciento a 25 por ciento), donde las prevalencias de anemia eran elevadas antes de la fortificación; y reducciones menores en las regiones Sureste (de 18 por ciento a 15 por ciento) y Sur (de 7 por ciento a 6 por ciento), donde las prevalencias eran bajas. Los niveles de Hb/edad gestacional de ambos grupos se mostraron discretamente mas elevados en los primeros meses, aunque mucho mas bajos posterior al tercero o cuarto mes, dependiendo de la referencia utilizada para comparación. Análisis de regresión logística mostró cual grupo, región geográfica, situación conyugal, trimestre gestacional, estado nutricional inicial y gestación anterior se asociaron con anemia (p<0,05). CONCLUSIONES: La prevalencia de anemia disminuyó posterior a la fortificación, aunque continua elevada en las regiones Noreste y Norte. A pesar de que la fortificación pueda haber tenido papel en este resultado favorable, hay que considerar la contribución de otras políticas públicas implementadas en el periodo estudiado.

Pattern of pregnancy weight gain in homozygous sickle cell disease and effect on birth size / Patrones de ganancia de peso gestacional y tamaño al nacer en los casos de anemia de células falciformes

OBJECTIVES: To assess pregnancy weight gain and newborn anthropometry in mothers with homozygous sickle cell (SS) disease and normal controls. METHODS: An eleven-year retrospective review at the University Hospital of the West Indies, Kingston, Jamaica, revealed 128 singleton deliveries in women with SS disease who were matched by maternal age and birth date with 128 controls with a normal AA phenotype. Restriction to those commencing antenatal care before 16 weeks gestation resulted in the final study group of 80 SS patients and 115 AA controls. Weight and height were measured at first antenatal visit and weight at 20, 25, 30, 35 and 38 weeks gestation. Longitudinal regression used mothers'weight as the outcome, genotype as a predictor and gestational age as a random effect. Regression analyses ofmaternal weight on childhood anthropometry were repeated in separate maternal genotypes. Neonatal indices included gestational age, birthweight, head circumference and crown-heel length. RESULTS: Mothers with SS disease had lower weight and body mass index at first antenatal clinic visit (p < 0.001). Total weight gain was 6.9 kg for SS women and 10.4 kg for AA controls (p < 0.001) and weekly weight gain 0.263 kg (95% CI 0.224, 0.301) and 0.396 kg (95% CI 0.364, 0.427) respectively. A significant relationship occurred between birthweight and maternal weight gain at 25-30 weeks gestation in AA controls but this relationship appears delayed in SS disease. CONCLUSION: Different patterns of maternal weight gain in SS mothers and normal controls may have significance for the lower birthweight in SS mothers.

OBJETIVO: Evaluar la ganancia de peso gestacional y la antropometría neonatal en madres con anemia de células falciformes (CF) homocigóticas y en controles normales. MÉTODO: Un examen retrospectivo de once años en el Hospital Universitario de West Indies West Indies, Kingston, Jamaica, reveló la ocurrencia de 128 partos únicos (e.d. de un solo bebé) en mujeres con la enfermedad de CF, que fueron comparadas sobre la base de la edad materna y la fecha de nacimiento, con 128 controles de fenotipo AA normal. A partir de restricciones a las gestantes que comenzaron el cuidado prenatal antes de las 16 semanas de gestación, se llegó finalmente al grupo de estudio de 80 pacientes con CF y 115 controles con AA. El peso y la altura se midieron en la primera visita prenatal, y el peso a las 20, 25, 30, 35 y 38 semanas de gestación. La regresión longitudinal usó el peso de las madres como resultado, el genotipo como predictor, y la edad gestacional como efecto aleatorio. Los análisis de la regresión de peso materno sobre la antropometría fueron repetidos en genotipos maternos separados. Los índices neonatales incluyeron la edad gestacional, el peso al nacer y la circunferencia cefálica. RESULTADOS: Las madres con la enfermedad de CF tenían más bajo peso e índice de masa corporal en la primera visita clínica prenatal (p < 0.001). La ganancia de peso total fue 6.9 kg para las mujeres con CF y 10.4 kg para los controles AA (p < 0.001) y la ganancia de peso semanal 0.263 kg (95% CI 0.224-0.301) y 0.396 kg (95% CI 0.364-0.427) respectivamente. Una relación significativa tuvo lugar entre el peso al nacer y la ganancia de peso materna en las semanas 25-30 de gestación en los controles AA, pero esta relación parece demorada en la enfermedad de CF. CONCLUSION: Los patrones diferentes de ganancia de peso materno en las madres con CF y los controles normales, pueden tener importancia significativa para las madres con CF.