Safety monitoring of oral iron supplements in pregnant women with anemia: a multi-center observational clinical study.

Aims: To investigate the safety of oral iron therapy in pregnant women with iron-deficiency anemia (IDA) in the real world. Methods: A retrospective analysis was performed on 1792 pregnant patients with IDA who received oral iron supplements from 12 hospitals in Shandong Province from 1 April to 31 June 2021; follow-up and adverse reactions were recorded. They were divided into six groups according to the treatment drugs. Results: The overall adverse reaction rate was 15.4%, and the main adverse reaction site was the digestive system. The incidence of all kinds of oral iron adverse reactions from high to low in order: compound ferrous sulfate and folic acid tablets (21.88%); iron proteinsuccinylate oral solution (20.90%); ferrous succinate tablets (19.76%); ferrous succinate sustained-release tablets (18.00%); iron polysaccharide complex capsule (12.06%); and iron dextran oral solution (6.94%). It was found that there was a significant difference in the incidence of adverse reactions among the six drugs (p < 0.05). Pairwise comparison showed that the incidence of adverse reactions was higher in the iron proteinsuccinylate oral solution than that in the iron polysaccharide complex capsule (p < 0.05). There was no significant difference in the incidence of adverse reactions in different ages (p > 0.05), but there was a significant difference in the incidence of adverse reactions in different gestational ages (p < 0.05). In Adverse Drug Reaction (ADR) patients, the adverse reaction result of most patients is recovery or improvement, and there was no serious adverse reaction outcome such as sequela and death. Conclusion: All the adverse reactions of oral iron were mainly gastrointestinal adverse reactions, and no heavy adverse reactions were found. Iron proteinsuccinylate oral solution has a higher incidence of adverse reactions than iron polysaccharide complex capsule. The results showed that oral iron was safer for anemia patients during pregnancy.

Safety of oral iron in the treatment of iron-deficiency anemia during pregnancy Introduction: The safety of different oral iron agents varies. At present, the safety evaluation of iron supplements in the treatment of anemia during pregnancy is mainly focused on intravenous iron supplements, and there is no comprehensive study on the safety of commonly used oral iron supplements. This study compared the safety of six commonly used oral iron supplements in the treatment of iron-deficiency anemia during pregnancy, aiming to provide a reference for clinical medication. Methods: We conducted a study involving 1792 patients in 12 hospitals in Shandong Province from 1 April to 31 June 2021. Results: Among the six groups, 276 ADR patients reported 302 adverse reactions. There were significant differences in the rates of adverse reactions among the six oral iron agents, and the incidence of adverse reactions in the iron proteinsuccinylate oral solution was significantly higher than that of iron polysaccharide complex capsules. The main incidence of adverse reactions was constipation (6.96%), and most of the outcomes were cured or improved. Conclusion: In this study, there were no heavy adverse reactions. The incidence of adverse reactions of iron proteinsuccinylate oral was higher than that of iron polysaccharide compound capsule. The results showed that oral iron had a good safety in patients with anemia during pregnancy.

Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women.

BACKGROUND: Anemia is a common disorder among pregnant women; however, the effect of anemia on hemoglobin A1c (HbA1c) levels has not been adequately explored. We aim to examine the influence of anemia on the HbA1c concentration and investigate the relationship between erythrocyte indices and HbA1c levels during pregnancy. METHODS: We performed a retrospective analysis of 1369 pregnant Chinese women. The clinical and analytical data were collected. Independent t-test and Analysis of Variance were used for comparative studies, and multiple linear regression analysis was used to identify the association between erythrocyte indices and HbA1c. RESULTS: The differences in HbA1c between non-anemia and mild anemia were negligible, and the differences in HbA1c between non-anemia and moderate anemia were well within the allowable variability for clinical practice (≥0.5% absolute changes). Mean corpuscular hemoglobin (MCH) correlated with HbA1c significantly, independent of pregnancy, trimester, and anemia. The distinction of HbA1c levels between grades of Hb became no significant (P = 0.955), while differences between trimesters persisted after adjusting for MCH. CONCLUSION: Mild and moderate anemia should not be the primary concern when using HbA1c to monitor blood glucose in pregnancy. MCH showed negative correlations with HbA1c independently, suggesting a previously unknown mechanism affecting HbA1c levels.

Mapping the Cord Blood Transcriptome of Pregnancies Affected by Early Maternal Anemia to Identify Signatures of Fetal Programming.

CONTEXT: Anemia during early pregnancy (EP) is common in developing countries and is associated with adverse health consequences for both mothers and children. Offspring of women with EP anemia often have low birth weight, which increases risk for cardiometabolic diseases, including type 2 diabetes (T2D), later in life. OBJECTIVE: We aimed to elucidate mechanisms underlying developmental programming of adult cardiometabolic disease, including epigenetic and transcriptional alterations potentially detectable in umbilical cord blood (UCB) at time of birth. METHODS: We leveraged global transcriptome- and accompanying epigenome-wide changes in 48 UCB from newborns of EP anemic Tanzanian mothers and 50 controls to identify differentially expressed genes (DEGs) in UCB exposed to maternal EP anemia. DEGs were assessed for association with neonatal anthropometry and cord insulin levels. These genes were further studied in expression data from human fetal pancreas and adult islets to understand their role in beta-cell development and/or function. RESULTS: The expression of 137 genes was altered in UCB of newborns exposed to maternal EP anemia. These putative signatures of fetal programming, which included the birth weight locus LCORL, were potentially mediated by epigenetic changes in 27 genes and associated with neonatal anthropometry. Among the DEGs were P2RX7, PIK3C2B, and NUMBL, which potentially influence beta-cell development. Insulin levels were lower in EP anemia-exposed UCB, supporting the notion of developmental programming of pancreatic beta-cell dysfunction and subsequently increased risk of T2D in offspring of mothers with EP anemia. CONCLUSIONS: Our data provide proof-of-concept on distinct transcriptional and epigenetic changes detectable in UCB from newborns exposed to maternal EP anemia.

Influencing factors for anemia in the third trimester of pregnancy / 预防医学

Objective @#To explore the influencing factors for maternal anemia during the third trimester of pregnancy, so as to provide the evidence for the effective prevention of anemia.@*Methods @#Data of parturients, who received prenatal care and delivered at Hangzhou Women＇s Hospital from October to December of 2019 were retrospectively collected and analyzed. The obstetric electronic medical record system of this hospital was used to collect general information of the subjects. Serum ferritin, serum vitamin B12, serum folic acid and hemoglobin were determined at the second and third trimester. A multivariate logistic regression model was used to analyze the influencing factors for anemia in the third trimester. @*Results @#A total of 1 143 parturients were enrolled, with a median age of 29 ( interquartile range: 4 ) years. Among them, 1 050 cases had normal weight before pregnancy, accounting for 91.86%; 267 cases were multiparas, accounting for 23.36%; 74 cases of anemia occurred during the third trimester of pregnancy, accounting for 6.92%.Multivariate logistic regression analysis indicated that the multipara（OR=1.714,95%CI: 1.032-2.848）, iron deficiency duiring the second trimester（OR=3.301,95%CI: 1.401-7.781）, iron deficiency during the third trimester （OR=14.134,95%CI: 1.944-102.774）and folate deficiency during the third trimester（OR=2.960,95%CI: 1.295-6.766）were influencing factors for anemia during the third trimester.@*Conclusion@#Anemia during the third trimester of pregnancy is related to iron deficiency during the second and third trimesters, folic acid deficiency during the third trimester, and multipara.

Comparison the effect of Shengxuening tablets and ferrous succinate in treating pregnancy with anemia / 中国生化药物杂志

Objective To compare the clinical efficacy and safety of anemia during pregnancy of Shengxuening tablets and ferrous succinate treatment for clinical treatment in patients with anemia .Methods 212 cases of pregnancy in early pregnancy patients with anemia from March 2015 to February 2016 in our hospital,numbered according to the order of treatment, were randomly divided the patients into group A and group B,106 cases in each group,group A with Shengxuening tablets treatment, group B with ferrous succinate tablets treatment,two groups of patients were treated with the same program of diet guidance,all patients were treated for three months.Each patient was followed up to the end of delivery, and the two groups of patients before and after pregnancy treatment to the end of pregnancy anemia and pregnancy outcomes were compared.Comparison of two groups of patients before and after treatment for one,two and three months of hemoglobin (Hb) level,red blood cell count (RBC),serum ferritin (SF),total iron binding rate (TIBC) changes;finishing treatment of the two groups during the three follow-up of Hb, RBC, SF TIBC, which returned to normal levels at the time and, after three months of treatment and evaluate the clinical efficacy of the two groups were collected and compared during the treatment of adverse drug reactions of two groups were compared.Results After treatment for one,two and three months, levels of Hb,RBC and SF in two groups of patients were significantly higher than those before treatment,TIBC was lower than that before treatment (P<0.05);After treatment for one and two months,RBC,SF and Hb in group B were significantly higher than those in group A,TIBC lower than group A(P <0.05);After treatment for three months,the levels of Hb, RBC, SF and TIBC in two groups were back to normal,and there was no significant difference between the two groups.Hb, RBC,SF,TIBC index recovery time of group B was significantly shorter than the group A (P<0.05).After treatment for three months,there was no significant difference in clinical efficacy between two groups.The adverse drug reaction rate was significantly higher in the group B than in the group A during the treatment period (P<0.05).The end of the treatment to the end of pregnancy, five cases of group A were again the parallel treatment of anemia, 11 cases of group B were again anemia and pregnancy outcome in patients with treatment ,the adverse pregnancy rate in group A was higher than that of group B, the difference was statistically significant (P<0.05).Conclusion Shengxuening tablets and succinate iron treatment of early pregnancy anemia have advantages and disadvantages,clinical can consider the combined treatment of anemia in pregnancy,improve the clinical efficacy and safety.

Clinical efficacy of polysaccharide iron combined with folic acid in treatment of anemia in gestation women and its effect on neonatal outcomes / 中国生化药物杂志

Objective To investigate the clinical efficacy of polysaccharide iron combined with folic acid in treatment of anemia in gestation women and its effect on neonatal outcomes.Methods 82 cases of pregnant women with iron deficiency anemia were selected and randomly divided into two groups, each had 41 cases.All patients received discontinuation of iron supplementation two weeks pre-treatment, control group received compound ferrous sulfate and folic Acid Tablets (4 tablets, tid), the treatment group received with Iron Polysaccharide Complex Capsules (0.15 g~0.30 g, qd) and Folic Acid Tablets (0.4 m, qd) .Levels of serum Hb, SF and SI between two groups were compared, and the pregnancy outcomes, neonatal outcomes, and effect and safety were observed.Results Compared with pre-treatment, levels of RBC, HCT and Ret, levels of Hb, SF and SI in two groups were all increased (P<0.05),and those indexes in treatment group were higher than control group (P<0.05).Compared with control group, birth outcomes in cesarean section, the rate of postpartum hemorrhage and neonatal distress rate in treatment group were lower (P<0.05), scores of neonatal muscle tension, pulse, respiration, skin frowning were higher ( P <0.05 ), the total efficiency and safety were higher ( P <0.05 ). Conclusion Polysaccharide iron combined with folic acid in treatment of anemia in gestation women was accurate , it can significantly improve the neonatal outcomes.

Effect of Yi Xuesheng Jiaonang combined with Iron Sucrose Injection on serum transferrin receptor and pregnancy outcome with anemia patients in pregnancy / 中国生化药物杂志

Objective To explore the effect of Yi Xuesheng Jiaonang combined with Iron Sucrose Injection on anemia in pregnancy on serum transferrin receptor and pregnancy outcome.Methods 78 patients with anemia in pregnancy form December 2014 to December 2015 of the third people’s Hospital of Cixi were collected and randomly divided into control group and treatment group,each had 39 cases.Control group was given 200 mg Iron Sucrose Injection with 100 mL 0.9%sodium chloride injection intravenous infusion,2 times a week; experiment group were treated on the base of control group with 4 pills of Yi Xuesheng Jiaonang,3 times daily.The course was 28d,and two groups all with a course treatment.After the end of treatment,clinical curative effect,serum transferrin receptor level,liver and renal function and the incidence of adverse pregnancy outcome were observed and compared. Results Serum transferrin receptor levels were increased in two groups after treatment (P<0.05),compared with control group,serum transferrin receptor level of treatment group was even higher (P<0.05), alanine aminotransferase (ALT),aspartate aminotransferase (AST),serum creatinine (Cr) and urea nitrogen ( BUN) and other indicators of liver and kidney function of experiment group had no statistical significance.Adverse pregnancy outcome rate betwen two groups was not statistically significant.Conclusion Yi Xuesheng Jiaonang combined with Sucrose Iron Injection therapy for patients with anemia of pregnancy can significantly increased serum transferrin receptor levels,has higher safety and low adverse pregnancy outcomes rate.

Blood transfusion practice in obstetric and gynecology: impact of educational programs to create awareness for judicious use of blood components.

The study presents the data analysis (1) To find out the trend of blood component use during the period 2003-2010 and to determine impact of component awareness programs on reduction in whole blood (WB) and single unit transfusions. (2) To determine Hb trigger. The details about blood units issued were entered in the integrated blood bank management software as well as in Microsoft Excel. The data of 4,838 cases of pregnancy anemia; 2,244 receiving blood for obstetric (Ob) hemorrhage including 270 cases of disseminated intravascular coagulation; 1,413 women having Gynecological (Gy) bleeding; 911 Ob, 2,032 Gy and 740 surgeries for Gy malignancy were analyzed. During the years 2003-2010 there was gradual increase in component utilization for pregnancy anemia, Ob/Gy surgeries and Ob/Gy bleeding and significant reduction in WB transfusions due to component awareness programs. But single unit transfusions showed comparatively lower trend of reduction. The mean Hb was 6.4 g/dL for pregnancy anemia, 8.1 g/dL for surgeries and 7.3 g/dL for Ob/Gy bleeding.

Influence of maternal anemia during pregnancy on placenta and newborns.

INTRODUCTION: Sideropenic anemia is a common pregnancy disorder. Depending on severity, maternal anemia can significantly influence morphometric characteristic of placental tissue, pregnancy course and outcome. OBJECTIVES: to estimate if maternal anemia a) results with significant placental changes; b) influence on newborn weight, length and vitality. PATIENTS MATERIAL AND METHODS: Research included 100 women and their newborns, 50 anemic, and 50 women in the control group. Sixty placentas were collected, placental mass and volume was determined, and blood vessels of terminal villi were stereologically analyzed. Newborns mass and body length, and Apgar scores within 1 and 5 minutes after delivery were recorded. THE RESULTS: Placentas of anemic pregnant women showed significant increase of terminal villi blood vessels (224,18 vs. 197,00 cm(3); p<0,0001), but total placental mass and volume did not differ significantly. Anemic mothers' newborns were significantly shorter (51,76 vs. 55,54 cm; p<0,0001), smaller body mass (3048,00 vs. 3615,60 g; p<0,0001) and delivered one week early (38,2 vs. 39,2 GW; p<0,0001), but not significantly poorer vitality (p>0,05) comparing with the control group. CONCLUSION: Sideropenic anemia increase placental maturity, that could be a possible cause of earlier spontaneous delivery among anemic women. The anemic mothers' newborns are shorter and lower body mass, but not poorer vitality index.

Iron sucrose versus oral iron therapy in pregnancy anemia.

BACKGROUND: Iron deficiency anemia (IDA) is the most common medical problem in pregnancy. Parenteral iron is a useful treatment, although iron dextran use decreased due to anaphylaxis. Iron sucrose is a newer agent that has overcome the shortcomings of iron dextran. OBJECTIVE: The aim of this study was to compare the efficacy and tolerance of intravenous iron sucrose (IVIS) therapy with oral iron (OI) therapy in pregnant women with IDA and to study the factors influencing treatment. MATERIALS AND METHODS: This prospective, randomized clinical trial included pregnant women between 14 and 36 weeks with established IDA who were treated with IVIS or OI (ferrous fumarate). All patients were monitored for laboratory response and adverse effects. Independent sample-t test, Chi square test and ANOVA were used for statistical analysis. P < 0.05 was considered significant. RESULTS: Although hemoglobin increased in both the groups, increase in the reticulocyte count and percentage increase in hemoglobin was significantly higher in the IVIS group than in the OI group (23.62% vs. 14.11%). Serum ferritin was significantly higher in the IVIS group than in the OI group (P = 0.000). The IVIS group had no major side-effects. Compliance was good with OI, although 23% had gastrointestinal side-effects. Patient weight, gestation at diagnosis, initial hemoglobin and ferritin levels did not influence the response to treatment. CONCLUSION: IVIS is safe and effective in the treatment of IDA during pregnancy. Iron stores increased better with IVIS compared with OI.

Prevalência e fatores associados à anemia em gestantes da região semi-árida do Estado de Alagoas / Prevalence and factors associated with anemia in pregnant women from the semiarid region of Alagoas, Brazil

OBJETIVO: determinar a prevalência e fatores de risco associados à anemia em gestantes da região semi-árida de Alagoas. MÉTODOS: estudo de caráter transversal envolvendo amostra (n=150) obtida, considerando a prevalência estimada pela Organização Mundial da Saúde de 52 por cento, com erro de 8 por cento e intervalo de confiança de 95 por cento. O processo de amostragem foi realizado em três estágios: 15 dentre os 38 municípios da região, quatro setores censitários por município e 24 domicílios por setor. Nestes, eram elegíveis todas as gestantes residentes, das quais se coletaram dados socioeconômicos, demográficos, antropométricos e de saúde. 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 linear múltipla. RESULTADOS: a prevalência de anemia foi de 50 por cento. Setenta e oito por cento das gestantes estavam sob acompanhamento pré-natal. Destas, 79,3 por cento se encontravam no segundo ou terceiro trimestre de gestação. Contudo, apenas 21,2 por cento faziam uso de suplemento de ferro. As variáveis associadas (p<0,05) de forma independente à anemia (gestantes anêmicas versus não anêmicas) foram: maior número de membros na família (4,5±2,3 versus 4,3±2,3; p=0,02), menor faixa etária da gestante (23,9±6,3 versus 24,7±6,7; p=0,04), bem como de seu companheiro (34,5±15,8 versus 36±17,5; p=0,03), não possuir vaso sanitário em casa (30,7 versus 24 por cento; p<0,001), história de perda de filho por abortamento e/ou mortalidade (32,4 versus 16,4 por cento; p<0,001), residência em zona rural (60 versus 46,7 por cento; p=0,03), renda per capita

PURPOSE: to determine the prevalence and risk factors associated to anemia in pregnant women from the semiarid region of Alagoas, Brazil. METHODS: transversal study comprising a sample (n=150) obtained taking into consideration the prevalence estimated by World Health Organization of 52 percent, an error of 8 percent and a confidence interval of 95 percent. Sampling has been done in three stages: 15 towns among the 38 in the region, four census sectors by town and 24 residences by sector. All the resident pregnant women were eligible, and their socio-economic, demographic, anthropometric and health data have been collected. Anemia was identified at the <11 g/dL hemoglobin level (Hemocue®), and its association with risk factors, tested by multiple linear regression analysis. RESULTS: anemia prevalence was 50 percent. Seventy eight per cent of the pregnant women were under pre-natal care. From those, 79.3 percent were in the second or third trimester of gestation. Nevertheless, only 21.2 percent of them were taking iron supplementation. Variables (p<0.05) independently associated with anemia (anemic versus not-anemic pregnant women) were: larger number of family members (4.5±2.3 versus 4,3±2.3; p=0.02), lower age group of the pregnant woman (23.9±6.3 versus 24.7±6.7; p=0.04), or of her partner (34.5±15.8 versus 36±17.5; p=0.03), no toilet in the house (30.7 versus 24 percent; p<0.001), history of child abortion and/or death (32.4 versus 16.4 percent; p<0.001), living in the country (60 versus 46.7 percent; p=0.03), average per capita income

Severe anemia of pregnancy, recent experience.

We undertook this study to determine the current prevalence of anemia in pregnancy and its impact on maternal and perinatal mortality and morbidity, and to suggest ways to make the anemia prevention programs more effective. The incidence of pregnancy anemia was determined by a population-based survey (1990-1994) of rural and urban areas using a cluster sample design. Mortality and morbidity data were gathered from our own hospital records (1982-1994). The survey data showed that 86.1% of pregnant women (n = 4752) were anemic (Hb < 11 g/dl); 56.0% had severe anemia (Hb < 7 g/dl); and 1.9% were decompensated (Hb < 4 g/dl). The hospital-based analysis revealed that severe anemia contributed to 34.5% of all maternal deaths (case fatality ratio = 1769). Hypertensive disorders were found in 28.2% of severe anemia cases. The incidence of preterm labor was 31.2% in these cases and the birthweight 2.23 ± 1.13 kg (mean ± SD), while perinatal mortality was 65 compared to overall rates of 7.9%, 2.78 ± 1.32 kg and 46, respectively. We conclude that severe anemia of pregnancy is still rampant and its adverse consequences remain unabated. The risk-care approach is advocated as an alternative strategy.