Anemia during pregnancy and treatment with intravenous iron: Review of the literature
Anemia, the decrease of the hemoglobin concentration with a consequent decrease in the hematocrit level, is a common disorder complicating pregnancies and is mostly due to iron deficiency. The increase of iron requirements, plasma volume, and the poor intake of iron constitute the principal causes of this deficiency. The present review summarizes the current literature regarding anemia during pregnancy and the parenteral iron therapy options.
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- "Moreover, pregnancies complicated by PIH are at high risk and fetal body growth is reduced overall because of a deficiency in oxygen and substrates. Maternal anemia is a common disorder during pregnancy   . Several studies have found an association between severe MA and adverse pregnancy outcomes including low birth weight, preterm delivery, low Apgar score, and perinatal death     . "
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ABSTRACT: Abstract Aim: To examine how complex and irregular fetal heart rate (FHR) dynamics differ between fetuses of normal pregnancies and those of pregnancies complicated by maternal anemia (MA), and to place this in the context of high-risk pregnancies. Methods: Our study population consisted of 97 pregnant women affected by MA, 118 affected by pregnancy-induced hypertension (PIH), 88 affected by gestational diabetes mellitus (GDM), 53 with preterm premature rupture of membranes (pPROM), and 356 normal pregnancies as controls. We calculated approximate entropy (ApEn), sample entropy (SampEn), and correlation dimension (CD) to quantify irregularity and the chaotic dynamics of each FHR time series. Results: The ApEn in the fetuses of the MA and PIH groups was significantly lower than that of the normal controls (P<0.05). The SampEn was significantly lower in the high-risk groups, except for the pPROM group, than in the normal controls (P<0.05). The CD in the PIH and severe MA groups was significantly lower than that of the normal controls (P<0.05, respectively). In the MA group, the dynamic indices showed a highly significant positive correlation with hemoglobin (Hb) levels (P<0.0001). Conclusion: The decreased complexity and/or irregularity in the FHR from pregnancies with MA may reflect abnormalities in the complex, integrated cardiovascular control. The irregularity and complexity of the FHR increased together with Hb levels in pregnancies with MA. Our data suggest that the integrity of the nervous system in the fetuses compromised by severe MA might result directly in adverse outcomes.
- "In the present study, 5-9 g% Hb was taken as cut-off. Intravenous iron is superior to oral iron with respect to faster increase in Hb and faster replenishment of body iron stores15. Also, it reduces the need of blood transfusions16, and it can be given at outpatient basis. "
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ABSTRACT: Background & objectives:
Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement. In India, women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anaemia are to be treated with parentral iron therapy. This study was undertaken to evaluate the response and effect of intravenous iron sucrose complex (ISC) given to pregnant women with IDA.
A prospective study was conducted (June 2009 to June 2011) in the department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. One hundred pregnant women with haemoglobin between 5-9 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron sucrose complex in a dose of 200 mg twice weekly schedule after calculating the dose requirement.
The mean haemoglobin raised from 7.63 ± 0.61 to 11.20 ± 0.73 g% (P<0.001) after eight wk of therapy. There was significant rise in serum ferritin levels (from 11.2 ± 4.7 to 69 ± 23.1 μg/l) (P<0.001). Reticulocyte count increased significantly after two wk of starting therapy (from 1.5 ± 0.6 to 4.6±0.8%). Other parameters including serum iron levels and red cell indices were also improved significantly. Only one woman was lost to follow up. No major side effects or anaphylactic reactions were noted during study period.
Interpretation & conclusions:
Parentral iron therapy was effective in increasing haemoglobin, serum ferritin and other haematological parameters in pregnant women with moderate anaemia. Intravenous iron sucrose can be used in hospital settings and tertiary urban hospitals where it can replace intramuscular therapy due to injection related side effects. Further, long-term comparative studies are required to recommend its use at peripheral level.
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- "Therefore, adding maternal health measures to infant health measures in a study of pregnancy outcomes seems highly relevant. Placental abruption, anemia, and pregnancy-related hypertension have all been identified in the medical and public health literatures as important causes of maternal morbidity that are sensitive to interventions during the prenatal period (Laditka et al. 2005, Bashiri et al. 2003, Makrides et al. 2003, Villar et al. 2003, Scholl et al. 1994, Haas et al. 1993, Sachs et al. 1988). As such, these morbidities are among those most likely to be affected by the economic environment women face. "
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ABSTRACT: Are recessions good for pregnancy? In this paper, I investigate the relationship between unemployment fluctuations, prenatal care utilization, and infant and maternal health. Analyzing the US Natality Detail Files data for the period 1989-99 aggregated by county, year, and race, I find the overall effects of unemployment to be beneficial but conclude that at least some of the apparent benefits may be attributable to the Medicaid 'safety net'.
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