Study on the effect of maternal anemia on birth weight of term neonates among rural population India

Background: Maternal anemia in pregnancy is common and has several deleterious effects on the health of the mother and the fetus. Maternal anemia is an important risk factor for LBW babies and preterm babies. There exists an insufficient information regarding the adverse effect of anemia during pregnancy especially among rural population. The aim of the study was to determine whether maternal anemia would affect the birth weight of the baby.Methods: The study was conducted in post-natal ward in Sri Venkateshwara Medical College Hospital and Research centre, Ariyur, Puducherry, India a tertiary care hospital in a rural area.Results: About 85% of low birth weight babies were born to mothers with severe maternal anemia with a p value of <0.001 which is statistically significant. None of the mothers who didn't have maternal anemia had low birth weight babies.Conclusions: Maternal anemia is directly proportional to fetal growth. Maternal anemia being an important risk factor for low birth weight should be prevented as early as possible thus helpful in de-creasing the incidence, mortality and morbidity of LBW babies.

Estudio Transversal: Anemia Materna del Tercer Trimestre y su Relación con Prematuridad y Antropometría Neonatal en el Hospital Vicente Corral Moscoso, Cuenca ­ Ecuador, 2016 - 2017 / Cross Sectional Research: Maternal Anemia During the Third Trimester and its Relationship with Prematurity and Neonatal Anthropometry at Vicente Corral Moscoso Hospital, Cuenca ­ Ecuador, 2016 - 2017

INTRODUCCIÓN: La anemia del tercer trimestre del embarazo (hemoglobina <11 g/dL) es una patología frecuente con importantes repercusiones en la madre y en el feto. El objetivo del presente estudio fue establecer la prevalencia de anemia materna en el tercer trimestre del embarazo y su asociación con prematuridad y antropometría neonatal. METODOLOGÍA: Se realizó un estudio transversal observacional, se incluyeron a 428 pacientes que acudieron al Hospital Vicente Corral Moscoso de la ciudad de Cuenca, para la atención de parto o cesárea durante el período septiembre 2016 ­ febrero 2017. Se excluyeron a pacientes con una edad gestacional menor a 27 semanas, embarazos gemelares, neonatos con malformaciones congénitas mayores y madres con enfermedades crónicas. Para el análisis se utilizó estadística descriptiva y se estableció asociación para una significancia estadística de p= <0.05. RESULTADOS: La edad promedio fue de 25 ± 6.9 años, las medias de hemoglobina, hematocrito y volumen corpuscular medio fueron de 11.5 ± 1.3 g/dL, 34.2 ± 3.3% y 84.3 fL respectivamente. La prevalencia de anemia gestacional del tercer trimestre fue del 31.8% (n=136); esta patología estuvo asociada con prematuridad (p= 0.049). No se encontró asociación estadística entre anemia del tercer trimestre y bajo peso al nacer (p= 0.651), peso pequeño para la edad gestacional (p= 0.061), talla pequeña para la edad gestacional (p= 0.497), ni perímetro cefálico pequeño para la edad gestacional (p= 0.446). CONCLUSIÓN: La prevalencia de anemia del tercer trimestre del embarazo fue elevada, constituyendo así un problema moderado para la salud pública según la clasificación de la Organización Mundial de la Salud; esta patología estuvo asociada con prematuridad; sin embargo, no se encontró asociación con las distintas variables relacionadas con antropometría fetal.(AU)

BACKGROUND: Anemia in the third trimester of pregnancy (hemoglobin <11 g/dL) is a frequent pathology with important repercussions in the mother and fetus. The aim of this study was to determine the prevalence of maternal anemia in the third trimester of pregnancy and its association with prematurity and neonatal anthropometry. METHODS: An observational cross-sectional research was performed; 428 patients were included, who attended to Vicente Corral Moscoso Hospital for delivery or C-section, during September 2016 ­ February 2017. Patients with a gestational age lower than 27 weeks, twin pregnancies, neonates with major congenital malformation and mothers with chronic diseases were excluded. For the analysis of information, descriptive statistics were used and an association was established for a statistical significance of p= <0.05. RESULTS: An observational cross-sectional research was performed; 428 patients were included, who attended to Vicente Corral Moscoso Hospital for delivery or C-section, during September 2016 ­ February 2017.Patients with a gestational age lower than 27 weeks, twin pregnancies, neonates with major congenital malformation and mothers with chronic diseases were excluded. For the analysis of information, descriptive statistics were used and an association was established for a statistical significance of p= <0.05. CONCLUSION: The prevalence of anemia in the third trimester of pregnancy was high, constituting a moderate problem for public health according to the classification of the World Health Organization; this pathology was associated with prematurity; however, no association was found with the different variables related to fetal anthropometry.(AU)

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.

Hierro, anemia y eritrocitosis en gestantes de la altura: riesgo en la madre y el recién nacido

El hierro es un micronutriente necesario para la salud, pero su exceso es dañino. El organismo tiene una alta capacidad de almacenar y reutilizar el hierro corporal, de tal manera que su requerimiento es mínimo (1 a 2 mg absorbido/día). La hepcidina, una hormona producida en el hígado, cumple un rol importante en la homeostasis del hierro inhibiendo a la proteína transportadora de hierro y disminuyendo la absorción de hierro. La anemia materna por deficiencia de hierro se constituye en un problema de salud pública cuando es de magnitud moderada (7 a <9 g/dL) y severa (Hb <7 g/dL), incrementando el riesgo de morbi-mortalidad materna y del neonato. Igualmente, se ha demostrado que niveles altos de hemoglobina en la gestante afecta a la madre y al neonato. En el Perú existe el Programa Nacional de Suplemento con hierro a todas las gestantes, sean o no anémicas. Las evidencias científicas muestran que valores de hemoglobina entre 9 y 10,5 g/dL son óptimas para el mejor crecimiento del feto y que el tratamiento con suplemento de hierro de gestantes no anémicas aumenta los niveles de hemoglobina, el estrés oxidativo y tiene efectos adversos en el recién nacido. Dado que en muchas poblaciones en la altura aumentan los niveles de hemoglobina, se ha sugerido corregir el punto de corte de la Hb para definir anemia. Diversos estudios han mostrado que no sería necesario corregir el punto de corte usado a nivel del mar. En conclusión, los resultados de los estudios no apoyan la necesidad de un suplemento de hierro de forma generalizada a toda gestante. La suplementación con hierro a las gestantes en la altura debería ser evitada si es que la anemia no está claramente demostrada. Se recomienda en cada población de altitud establecer el nivel de anemia y el estatus del hierro corporal, antes de decidir dar un tratamiento con suplemento de hierro.

Iron is essential for health but in excess may be harmful. The living organism has ability to store and re-use the iron body and as such its requirement is small (1-2 mg absorbed/day). Hepcidin, a hormone produced in the liver, has an important role in iron homeostasis by blocking the iron transport protein and inhibiting iron absorption. Maternal anemia due to iron deficiency is a public health problem when it is moderate (7- <9 g/dL) and severe (Hb<7 g/dL) since it increases the risk of maternal and neonatal morbi-mortality. Similarly, high levels of hemoglobin during pregnancy affect the mother and newborn. In Peru, there is a National Program to supplement with iron to all pregnant women anemic or not. Scientific evidence shows that hemoglobin values between 9-10.5 g/dL are optimal for best fetal growth and that treatment with iron supplementation to non anemic women increases levels of hemoglobin, oxidative stress, and has adverse effects on the newborn. Since many populations at highlands have increased hemoglobin levels, it has been suggested to correct hemoglobin cutoff to define anemia. Several studies have demonstrated that it would not be necessary to change this cut-off as defined for population at sea level. In conclusion, studies results do not support the need for generalized iron supplementation to all pregnant women. Iron supplementation to pregnant women at high altitude should be avoided if diagnosis of anemia is not clearly demonstrated. It is recommended for each altitudinal population determining the level of anemia and body iron status before deciding to treat with iron supplements.

Iron Parameters and Soluble Transferrin Receptor in Neonates

PURPOSE: Serum soluble transferrin receptor (sTfR) is a marker of iron deficiency and erythropoiesis. The purpose of this study is to evaluate the changes of iron parameters and sTfR in neonates by gestation; and to determine whether cord blood parameters for iron status and erythropoiesis are influenced by maternal iron deficiency or anemia. METHODS: Cord sTfR, iron and ferritin concentrations, hemoglobin (Hb), reticulocyte counts and total iron binding capacity were analyzed in 20 preterm and 60 term newborns. In term neonates, maternal iron status was classified by Hb and serum ferritin as anemic group (n=18; Hb or = 11 g/dl and ferritin < 12 microgram/l) and control (n=21, non anemic and non iron deficient). RESULTS: 1) Cord serum iron of preterm neonates was significantly lower than that of fullterm and the reticulocytes were significantly higher in preterm neonates. 2) The concentrations of cord serum iron were correlated positively with the gestational age, but other iron parameters and sTfR concentrations were not related to gestational age. The sTfR concentrations were correlated positively with cord blood hemoglobin. 3) Cord sTfR concentrations were significantly lower in newborns of anemic group compared with those of non-anemic group (P=0.03), or control (P=0.02). CONCLUSION: Cord sTfR was influenced by maternal iron deficiency aenmia, but not by maternal iron deficiency alone. Since sTfR reflects fetal erythropoietic activity, we speculate that low sTfR in newborns of iron deficiency anemic mother could suggest decreased fetal erythropoiesis by maternal anemia caused by iron depletion.

Effects of Maternal Anemia on the Iron Status of the Cord Blood and Pregnancy Outcomes / 대한지역사회영양학회지

Iron deficiency anemia in pregnant women has been of great concern because of its negative effects on the outcomes of pregnancy. Much of evidence has shown that there are associations between pregnancy outcomes and maternal iron status. Maternal iron status might affect pregnancy outcomes through the iron status of the cord blood. In this study, we divided 91 subjects into two groups : the anemic and the normal groups. The groups were classified according to their hemoglobin(Hb) and hematocrit(Hct) values of the maternal blood in the third trimester of the pregnancies. We determined the parameters for the iron status of the cord blood and then analyzed the correlations between these parameters and the pregnancy outcomes. Mothers in the anemic group had a significantly higher parity number and a lower dietary score as well as a shorter duration of iron supplements consumed compared to those in the normal group. Maternal Hb values in the third trimester had positive correlations with the infant's head and chest circumferences, and the Hct values related positively to the infant's chest circumferences. On the other hand, Hb concentrations of the cord blood had positive correlations with the infant's height and head and chest circumferences. The Hct values of the cord blood had positive correlations with gestational periods and the cord lengths. These results suggest that the maternal iron status might influence fetal development through the iron status of the cord blood.

A Hospital Based Case-Control Study for the Effects of Maternal Anemia on the Preterm Birth andAdverse Pregnancy Outcomes / 대한산부인과학회잡지

OBJECTIVE: Maternal anemia is one of the most common hematologic disorders of the child-bearingmothers. However the role of maternal anemia in the etiology of preterm delivery and adverse pregnancyoutcomes remains a source of controversy. The aim of this study was to determine the effects of maternalanemia on the preterm birth and the adverse pregnancy outcomes. STUDY DESIGN: A total of 1,010 women aged 19~44 years, who admitted to our hospitalfor the delivery between December 1994 and October 1995, were recruited into a hospitalbaed case-control study design. 259 women complicated by maternal anemia(cases) werecompared with 751 women without maternal anemia(controls). Multiple logistic regressionanalyses were performed to control for the effects of other potentially confounding factors,including maternal age, body mass index, previous term delivery, previous preterm deliveryand previous abortion. In all logistic regression analyses odds ratio and 95% confidenceintervals were calculated. RESULTS: The prevalence of maternal anemia(hemoglobin<10g/dl) was 25.6%. Therewas a positive linear relationship between the prepartum hemoglobin concentration and thepostpartum concentration. There was no significant differences of the incidence of pretermbirth and the neonatal morbidity, such as poor Apgar scores, fetal distress, congenitalanomaly, birth trauma, admission to neonatal intensive care unit, resuscitation and sepsisbetween case and control groups. Small for gestational age and low birth weight were associatedwith an somewhat decreased risk of maternal anemia and large for gestational age, notmacrosomia, was associated with an 70% increased risk of maternal anemia at the time ofdelivery. Maternal anemia was associated with 6.5 fold increases in the risks of postpartumbleeding, 8.5 fold increases in the postpartum transfusion and 80% increases in the puerperalfever respectively. CONCLUSIONS: Maternal anemia was not associated with increased risks of preterm birthand the neonatal morbidty. However there was a significant relationship between maternalanemia and postpartum maternal morbidity, such as postpartum bleeding, postpartum transfusionand puerperal fever.