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Satué K, Fazio E, Cravana C, Medica P. Hepcidin, ferritin and iron homeostasis in pregnant Spanish Purebred mares. Theriogenology 2023; 206:78-86. [PMID: 37201298 DOI: 10.1016/j.theriogenology.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
During pregnancy, maternal erythropoietic expansion and fetal development require greater mobilization of available iron (Fe) stores. These adjustments in Fe metabolism in humans and rodents are largely mediated by the hormone hepcidin (Hepc), which controls the expression of ferroportin (Fpn), a transporter responsible for exporting Fe from stores to extracellular fluid and plasma. These mechanisms based on the regulation of Hepc on the availability of Fe during gestation in healthy mares remain unknown. The objective of this study was to determine the existence of interrelationships among concentrations of Hepc, ferritin (Ferr), Fe, and estrone (E1) and progesterone (P4) in Spanish Purebred mares along the whole gestation. Blood samples were taken from 31 Spanish Purebred mares each month, during 11 months of pregnancy. Fe and Ferr significantly increased and Hepc decreased during pregnancy (P < 0.05). The secretion peak of estrone (E1) was reached in the 5th month and progesterone (P4) between the 2nd and 3rd months of gestation (P < 0.05). Fe and Ferr were weakly positively correlated (r = 0.57; P < 0.05). Fe and Ferr were negatively correlated with Hepc (r = -0.80 and r = -0.67, respectively) (P < 0.05). P4 was positively correlated with Hepc (r = 0.53; P < 0.05). Pregnancy in the Spanish Purebred mare was characterized by a progressive increase in Fe and Ferr and a reduction in Hepc concentrations. E1 was partially responsible for the suppression of Hepc; on the other hand, P4 induced its stimulation during pregnancy in the mare.
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Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Tirant lo Blanc, 7, Alfara del Patriarca, 46115, Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Cristina Cravana
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Via Palatucci 13, 98168, Messina, Italy
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Aidi MN, Ernawati F, Efriwati E, Nurjanah N, Rachmawati R, Julianti ED, Sundari D, Retiaty F, Fitrianto A, Nurfadilah K, Arifin AY. Spatial distribution and identifying biochemical factors affecting haemoglobin levels among women of reproductive age for each province in Indonesia: A geospatial analysis. GEOSPATIAL HEALTH 2022; 17. [PMID: 36468594 DOI: 10.4081/gh.2022.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
Anaemia is still a public health problem in Indonesia. The iron supplement program, known as Tablet Tambah Darah (Blood Add Tablet) has not yet produced optimal results. This study aimed to identify the cause of anaemia and the factors that influence it. Biochemical indicator data are haemoglobin (Hb), C-reactive protein (CRP), ferritin and serum transferrin receptor (sTfR) from 9,463 women of reproduction age. Data from the Basic Health Research (Riskesdas) project of 2013 were used for the study. ANOVA as well as global and local regression approaches (classical regression and geo-weighted regression) were used to compare the mean Hb and CRP values between provinces and to determine the factors that influence Hb concentrations. The results showed that the distribution of anaemia in Indonesia is uneven and not always caused by iron deficiency. The lowest Hb mean coupled with the highest iron deficiency was found in Papua, where there are high rates of parasitic infections. In contrast, the highest mean Hb coupled with low iron deficiency, and also low infection rates, was found in North Sulawesi. The Hb concentrations were significantly associated by ferritin, CRP and sTfR and there were varying magnitudes between provinces. Although anaemia is mainly influenced by the iron concentration, CRP, ferritin and sTfR can also affect it through their association with inflammatory reactions. Identification of all causes of anaemia in each province needs to be done in the future, while blanket iron supplementation should be reviewed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Khalilah Nurfadilah
- Institut Pertanian Bogor University, Bogor; Universitas Islam Negeri Alauddin Makassar.
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Hu Y, Lin J, Wang Y, Wu S, Wu J, Lv H, Ji X, Muyldermans S, Zhang Y, Wang S. Identification of Serum Ferritin-Specific Nanobodies and Development towards a Diagnostic Immunoassay. Biomolecules 2022; 12:biom12081080. [PMID: 36008974 PMCID: PMC9406126 DOI: 10.3390/biom12081080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
Serum ferritin (SF) is an iron-rich protein tightly connected with iron homeostasis, and the variations are frequently observed in diseased states, including iron-deficiency anemia, inflammation, liver disease, and tumors, which renders SF level an indicator of potential malignancies in clinical practice. Nanobodies (Nbs) have been widely explored and developed into theranostic reagents. Surprisingly, no reports stated the identification of anti-SF Nbs, nor the potential of such Nbs as a diagnostic tool. In this study, we generated SF-specific Nbs and provided novel clinical diagnostic approaches to develop an immunoassay. An immune library was constructed after immunizing an alpaca with SF, and five Nbs specifically targeting human SF were retrieved. The obtained Nbs exhibited robust properties including high stability, affinity, and specificity. Then, an ELISA-based test using a heterologous Nb-pair was developed. The calibration curve demonstrated a linear range of SF between 9.0 to 1100 ng/mL, and a limit of detection (LOD) of 1.01 ng/mL. The detecting recovery and coefficient variation (CV) were determined by spiking different concentrations of SF into the serum sample, to verify the successful application of our selected Nbs for SF monitoring. In general, this study generated SF-specific Nbs and demonstrated their potential as diagnostic immunoassay tools.
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Affiliation(s)
- Yaozhong Hu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing Lin
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Yi Wang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Sihao Wu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing Wu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Huan Lv
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Xuemeng Ji
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
| | - Serge Muyldermans
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Yan Zhang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
- Correspondence: (Y.Z.); (S.W.); Tel.: +86-22-8535-8445 (S.W.)
| | - Shuo Wang
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin 300071, China
- Correspondence: (Y.Z.); (S.W.); Tel.: +86-22-8535-8445 (S.W.)
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Abstract
PURPOSE OF REVIEW Anemia in pregnancy is associated with increased maternal and neonatal morbidity. There is increasing awareness amongst obstetricians about the need to screen for iron deficiency anemia (IDA), as well as growing literature on diagnosis and treatment. This review aims to summarize causes, consequences, treatment, and evaluation of IDA in pregnancy. RECENT FINDINGS National guidelines provide varying guidance on diagnosis and treatment of IDA in pregnancy. Serum ferritin is a helpful adjunct for the diagnosis of IDA. Oral iron remains an option for treatment; absorption is improved with every other day dosing and is effective for patients able to tolerate. Emerging studies on modern generations of intravenous (IV) iron demonstrate shorter infusion times and improved safety profiles. Notably, recent UK guidelines provide consideration for universal IV iron supplementation for treatment of anemia beyond 34 weeks of pregnancy. SUMMARY Iron, in dietary, oral, and IV forms, has been found effective in resolving anemia in pregnancy. Pregnant people with IDA in the third trimester are more likely to benefit from IV iron. Future studies designed and powered to assess maternal and perinatal morbidity indicators and blood transfusion rates can strengthen recommendations.
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Affiliation(s)
- Irogue Igbinosa
- Stanford University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
| | - Caroline Berube
- Stanford University, Department of Medicine, Division of Hematology, Stanford, California, USA
| | - Deirdre J Lyell
- Stanford University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
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Patel P, Balanchivadze N. Hematologic Findings in Pregnancy: A Guide for the Internist. Cureus 2021; 13:e15149. [PMID: 34164247 PMCID: PMC8214837 DOI: 10.7759/cureus.15149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/25/2022] Open
Abstract
Hematologic changes in pregnancy are common and can potentially lead to maternal and fetal morbidity. Here, we present various hematologic manifestations seen in pregnant women. Iron deficiency anemia (IDA) is the most common cause of anemia in pregnancy. Physiologically, the state of pregnancy results in increased iron demand. Iron deficiency is important to diagnose and treat early for better maternal and fetal outcomes. An algorithmic approach is used for the repletion of iron storage, starting with oral elemental iron daily and escalating to intravenous iron if necessary. Folate and cobalamin are necessary elements for deoxyribonucleic acid (DNA) synthesis, fetal growth, and maternal tissue development, and deficiency in these elements can be a cause for anemia in pregnancy. Thrombocytopenia is currently the second most common hematologic condition in pregnancy after anemia. There is a wide range of etiology for thrombocytopenia in pregnancy from benign to life-threatening causes that require prompt diagnosis and treatment. These conditions include gestational thrombocytopenia, thrombotic thrombocytopenic purpura, pregnancy-associated atypical hemolytic-uremic syndrome, and immune thrombocytopenia. Acquired bleeding disorders that can cause major complications in pregnancy include von Willebrand disease (vWD) and coagulation factor deficiencies. Women with vWD are at increased risk of pregnancy bleeding and postpartum hemorrhage. Pregnancy can also produce a physiologic hypercoagulable state, leading to life-threatening conditions like thromboembolism. Diagnosis, treatment options, and guidelines for the management of these conditions will be explored in this review.
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Affiliation(s)
- Pooja Patel
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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Sun CF, Liu H, Hao YH, Hu HT, Zhou ZY, Zou KX, Liu XM, Sheng JZ, Ding GL, Huang HF. Association between gestational anemia in different trimesters and neonatal outcomes: a retrospective longitudinal cohort study. World J Pediatr 2021; 17:197-204. [PMID: 33625695 DOI: 10.1007/s12519-021-00411-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies investigated the association between gestational anemia and neonatal outcomes. However, few studies explored whether the effects of gestational anemia could be eliminated by subsequent correction of anemia in the later stages of pregnancy. This study aimed to investigate the relationship between anemia in different trimesters and neonatal outcomes. METHODS The study was conducted in Shanghai, China, with a sample of 46,578 pregnant women who delivered between January 1, 2016 and July 1, 2019. A multivariable logistic regression model was adopted to analyse the associations between maternal anemia and neonatal outcomes. RESULTS The incidence of gestational anemia was 30.2%, including 4.4% in the first trimester, 9.6% in the second trimester, and 16.2% in the third trimester. Only 24.5% (507/2066) of anemia that occurred in the first trimester and 29.6% (1320/4457) that occurred in the second trimester could be corrected in the later stages of pregnancy. Anemia occurring in the first trimester was associated with small for gestational age [odds ratio (OR) 1.46; 95% confidence interval (CI) 1.20-1.78] and with fetal distress (OR 1.23; 95% CI 1.08-1.40). Anemia corrected in the first trimester also was associated with a higher risk of small for gestational age. CONCLUSIONS Gestational anemia is a public health problem in China impacting neonatal health. Anemia in pregnancy could be corrected in only about a quarter of the women. Anemia in the first trimester, whether corrected or not, still led to lower birth weight; therefore, the prevention of anemia prior to pregnancy is important.
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Affiliation(s)
- Chang-Fa Sun
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Han Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yan-Hui Hao
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hong-Tao Hu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhi-Yang Zhou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ke-Xin Zou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xin-Mei Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jian-Zhong Sheng
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guo-Lian Ding
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - He-Feng Huang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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Means RT. Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters. Nutrients 2020; 12:nu12020447. [PMID: 32053933 PMCID: PMC7071168 DOI: 10.3390/nu12020447] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.
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Affiliation(s)
- Robert T. Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA; ; Tel.: +1-423-439-6499; Fax: +1-423-439-6470
- Internal Medicine, Building 2/Room 109, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
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Braithwaite VS, Crozier SR, D'Angelo S, Prentice A, Cooper C, Harvey NC, Jones KS. The Effect of Vitamin D Supplementation on Hepcidin, Iron Status, and Inflammation in Pregnant Women in the United Kingdom. Nutrients 2019; 11:E190. [PMID: 30669280 PMCID: PMC6356300 DOI: 10.3390/nu11010190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/29/2022] Open
Abstract
Iron and vitamin D deficiencies are common during pregnancy. Our aim was to identify whether antenatal vitamin D₃ supplementation affects iron status (via hepcidin suppression) and/or inflammation. Using a subset of the UK multicenter Maternal Vitamin D Osteoporosis Study (MAVIDOS)-a double-blinded, randomized, placebo-controlled trial (ISRCTN82927713; EudraCT2007-001716-23)-we performed a secondary laboratory analysis. Women with blood samples from early and late pregnancy (vitamin D₃ (1000 IU/day from ~14 weeks gestation n = 93; placebo n = 102) who gave birth in the springtime (March⁻May) were selected as we anticipated seeing the greatest treatment group difference in change in 25-hydroxyvitamin D (25OHD) concentration. Outcomes were hepcidin, ferritin, C-reactive protein, and α1-acid glycoprotein concentration in late pregnancy (25OHD concentration was measured previously). By late pregnancy, 25OHD concentration increased by 17 nmol/L in the vitamin D₃ group and decreased by 11 nmol/L in the placebo group; hepcidin, ferritin, and inflammatory markers decreased but no treatment group differences were seen. In late pregnancy, positive relationships between 25OHD and hepcidin and 25OHD and ferritin in the placebo group were observed but not in the treatment group (group × 25OHD interaction, p < 0.02). Vitamin D₃ supplementation had no effect on hepcidin, ferritin, or inflammatory status suggesting no adjunctive value of vitamin D₃ in reducing rates of antenatal iron deficiency.
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Affiliation(s)
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Ann Prentice
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford OX1 2JD, UK.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge CB2 0AH, UK.
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Bah A, Pasricha SR, Jallow MW, Sise EA, Wegmuller R, Armitage AE, Drakesmith H, Moore SE, Prentice AM. Serum Hepcidin Concentrations Decline during Pregnancy and May Identify Iron Deficiency: Analysis of a Longitudinal Pregnancy Cohort in The Gambia. J Nutr 2017; 147:1131-1137. [PMID: 28424258 PMCID: PMC5443464 DOI: 10.3945/jn.116.245373] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/06/2017] [Accepted: 03/20/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Antenatal anemia is a risk factor for adverse maternal and fetal outcomes and is prevalent in sub-Saharan Africa. Less than half of antenatal anemia is considered responsive to iron; identifying women in need of iron may help target interventions. Iron absorption is governed by the iron-regulatory hormone hepcidin. Objective: We sought to characterize changes in hepcidin and its associations with indexes of iron stores, erythropoiesis, and inflammation at weeks 14, 20, and 30 of gestation and to assess hepcidin’s diagnostic potential as an index of iron deficiency. Methods: We measured hemoglobin and serum hepcidin, ferritin, soluble transferrin receptor (sTfR), and C-reactive protein (CRP) at 14, 20, and 30 wk of gestation in a cohort of 395 Gambian women recruited to a randomized controlled trial. Associations with hepcidin were measured by using linear regression, and hepcidin’s diagnostic test accuracy [area under the receiver operating characteristic curve (AUCROC), sensitivity, specificity, cutoffs] for iron deficiency at each time point was analyzed. Results: The prevalence of anemia increased from 34.6% at 14 wk of gestation to 50.0% at 20 wk. Hepcidin concentrations declined between study enrollment and 20 wk, whereas ferritin declined between 20 and 30 wk of gestation. The variations in hepcidin explained by ferritin, sTfR, and CRP declined over pregnancy. The AUCROC values for hepcidin to detect iron deficiency (defined as ferritin <15 μg/L) were 0.86, 0.83, and 0.84 at 14, 20, and 30 wk, respectively. Hepcidin was superior to hemoglobin and sTfR as an indicator of iron deficiency. Conclusions: In Gambian pregnant women, hepcidin appears to be a useful diagnostic test for iron deficiency and may enable the identification of cases for whom iron would be beneficial. Hepcidin suppression in the second trimester suggests a window for optimal timing for antenatal iron interventions. Hemoglobin does not effectively identify iron deficiency in pregnancy. This trial was registered at www.isrctn.com as ISRCTN49285450.
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Affiliation(s)
- Amat Bah
- Medical Research Council (MRC) Unit The Gambia-MRC International Nutrition Group, Banjul, Gambia;
| | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Momodou W Jallow
- Medical Research Council (MRC) Unit The Gambia-MRC International Nutrition Group, Banjul, Gambia
| | - Ebrima A Sise
- Medical Research Council (MRC) Unit The Gambia-MRC International Nutrition Group, Banjul, Gambia
| | - Rita Wegmuller
- Medical Research Council (MRC) Unit The Gambia-MRC International Nutrition Group, Banjul, Gambia
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Sophie E Moore
- Division of Women's Health, King's College London, London, United Kingdom; and
| | - Andrew M Prentice
- MRC Unit The Gambia-MRC International Nutrition Group and London School of Hygiene and Tropical Medicine, London, United Kingdom
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Tangeda PR, Patil S, Shastri N, Noorali SN. Maternal Myocardial Performance in Second Trimester of Pregnancy With Iron Deficiency Anaemia. J Clin Diagn Res 2016; 10:CC16-8. [PMID: 27134866 DOI: 10.7860/jcdr/2016/17774.7507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anaemia affects various organs in body including the heart. In anaemia, oxygen carrying capacity of blood decreases. Iron depletion and the amount of stored iron are reduced in iron deficiency anaemia which limits red cell production. However, the studies which show the effect of anaemia on myocardial function during pregnancy are few in India. AIM To study the effect of iron deficiency anaemia on myocardial function by ECG during second trimester of pregnancy and to compare ECG changes with normal pregnant women in second trimester. MATERIALS AND METHODS The study was conducted at antenatal OPD between Oct 2014 to Jul 2015. Hundred pregnant women were selected and divided into 2 groups. A total of 50 normal pregnant women (control group) in 2(nd) trimester (10-14 weeks of gestation) were compared with equal number of pregnant women with anaemia (study group) in 2(nd) trimester, aged between 20-30 years. Electrocardiogram was recorded using Philips twelve channel ECG machine model TC20 in both control and study groups to evaluate myocardial performance. Haematological parameters were analysed by SYSMEX auto analyser. Analysis of Variance (One way ANOVA) was used for comparison between study and control groups and the data was analysed by t-tests. RESULTS In our study a significant decrease in QRS duration and increase in QTc were observed in study group (p<0.05). T-wave abnormalities like flat and negative T-waves in lead II, III, avF, V2 - V4 were more frequent (p<0.05). 90% of subjects in study group had tachycardia and ECG abnormalities. There was a negative correlation between Hb level, serum ferritin and tachycardia, ECG abnormalities. CONCLUSION Pregnancy with Iron deficiency anaemia brings about various changes in ECG, suggesting that anaemia and volume overload in pregnancy is a risk factor that may lead to cardiac hypertrophy.
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Affiliation(s)
- Padmaja Rao Tangeda
- Assistant Professor, Department of Physiology, Prathima Institute of Medical Sciences , Nagunur, Karimnagar, Telangana, India
| | - Sumangala Patil
- Professor, Department of Physiology, B.L.D.E.U, Shri B.M Patil Medical College , Vijayapur, Karnataka, India
| | - Neerja Shastri
- Associate Professor, Department of Physiology, Prathima Institute of Medical Sciences , Nagunur, Karimnagar, Telangana, India
| | - Shah Navid Noorali
- Associate Professor, Department of Physiology, Prathima Institute of Medical Sciences , Nagunur, Karimnagar, Telangana, India
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Abdelrahman EG, Gasim GI, Musa IR, Elbashir LM, Adam I. Red blood cell distribution width and iron deficiency anemia among pregnant Sudanese women. Diagn Pathol 2012. [PMID: 23206545 PMCID: PMC3538607 DOI: 10.1186/1746-1596-7-168] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a major health problem during pregnancy and it has adverse effects on the mother and the newborn. Red cell distribution width (RDW), which is a quantitative measure for red cell size variation (anisocytosis), is a predictor of IDA. Little is known regarding RDW and IDA during pregnancy. METHODS A cross sectional study was conducted at the antenatal clinic of Khartoum Hospital, Sudan, to determine the performance of RDW in the diagnosis of IDA using serum ferritin as a gold standard. RESULTS Among 194 pregnant women with a gestational period of 21.4 ± 6.5 weeks, 57 (29.4%) had IDA according to serum ferritin levels (<15 μg/l) and 61 (31.4%) had IDA according to RDW (>14.5). The sensitivity, specificity, positive predictive value, and negative predictive value of RDW where serum ferritin was the gold standard were 43.8% (95% CI: 31.4-57.0%), 73.7% (95% CI: 65.8-80.5%), 41.0% (95% CI: 29.2-53.6%), and 76.0% (95% CI: 68.1-82.6%), respectively. CONCLUSIONS In this study, we found that RDW has a poor performance in diagnosing IDA among pregnant women compared with serum ferritin as the gold standard.
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Guerra Merino S, López Picado A, Muñoz Hernández H, Marín Mesa J, Lete Lasa I, Aizpuru Barandiarán F. Ensayo clínico aleatorizado para evaluar la efectividad de dos vías de administración de hierro, oral e intravenosa, en el tratamiento de la anemia ferropénica posparto. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2011.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rasmussen S, Bergsjø P, Jacobsen G, Haram K, Bakketeig LS. Haemoglobin and serum ferritin in pregnancy—correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol 2005; 123:27-34. [PMID: 16260337 DOI: 10.1016/j.ejogrb.2005.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2004] [Revised: 12/07/2004] [Accepted: 02/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known about factors which may influence haemoglobin (Hb) and ferritin levels in pregnancy. AIM To analyse if haemoglobin and ferritin levels during pregnancy are influenced by maternal age, body mass index, cigarette smoking, and iron supplementation. METHODS A random sample of 561 parous pregnant women were recruited from the catchment areas of three Scandinavian university hospitals. The analyses were based on 5024 haemoglobin and 1529 ferritin measures sampled from the first trimester to 42 weeks of gestation. Multilevel modelling was used to construct mean and percentile curves for haemoglobin and ferritin by gestational age. RESULTS Women aged 25-34 years had significantly higher haemoglobin values than older and younger women. Haemoglobin values were significantly lower for women with body mass index < 19 kg/m(2) than for women with body mass index > or =19. Smokers had significantly lower haemoglobin values throughout pregnancy compared to non-smokers, with the lowest values among women who smoked 1-9 cigarettes per day. There were no similar associations between ferritin and maternal age, body mass index, or smoking. Women with iron supplementation throughout pregnancy had a higher relative increase in haemoglobin concentration toward the end of pregnancy. In non-supplemented women the decline in ferritin concentration was significantly steeper than in those who received iron supplementation. CONCLUSIONS Haemoglobin levels during pregnancy are significantly associated with maternal age, cigarette smoking, body mass index, and iron supplementation. No such associations were found with ferritin levels, except for iron supplementation.
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Affiliation(s)
- Svein Rasmussen
- Department of Clinical Medicine, Section of Obstetrics and Gynecology, University of Bergen, Bergen, Norway.
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Casanova BF, Sammel MD, Macones GA. Development of a clinical prediction rule for iron deficiency anemia in pregnancy. Am J Obstet Gynecol 2005; 193:460-6. [PMID: 16098871 DOI: 10.1016/j.ajog.2004.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 11/20/2004] [Accepted: 12/06/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate if anemia in pregnancy caused by iron deficiency could be predicted by simple measures obtained on a complete blood count (CBC) using ferritin as the gold standard. STUDY DESIGN One hundred forty-one pregnant patients with anemia were recruited during their first prenatal visit. CBC and ferritin level were obtained and candidate-predictors identified. Receiver operator characteristic (ROC) curves, stratified analysis, and logistic regression analysis were used to develop a prediction rule with maximum specificity. RESULTS A hemoglobin level < or = 9.7 and a red cell distribution width (RDW) > or = 15 (in gestational age <20 weeks) predicted iron deficiency with high specificity. Our final model correctly classified 79.43% of the patients (area under the ROC curve of 0.88 [95%CI 0.82-0.93], specificity of 95.74%). CONCLUSION Iron deficiency anemia can be predicted in pregnancy using lower cost tests, which could be an incredibly useful tool in areas with limited resources and a high prevalence of the disease. This study was limited to a mostly African American population in an urban setting, and the results may not be generalized to other populations.
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Affiliation(s)
- Bruno F Casanova
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia 19107, USA.
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(BABA) NAHLAHWALLA, ADRA NADA, JACKSON ROBERTT. IRON DEFICIENCY IS AN IMPORTANT CONTRIBUTOR TO ANEMIA AMONG REPRODUCTIVE AGE WOMEN IN LEBANON. Ecol Food Nutr 2004. [DOI: 10.1080/03670240490274101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Serum ferritin has been used widely in clinical medicine chiefly as an indicator of iron stores and inflammation. Circulating ferritin also can have paracrine effects. Despite the clinical significance of serum ferritin, its secretion remains an enigma. The consensus view is that serum ferritin arises from tissue ferritins--principally ferritin light--which can be glycosylated. Ferritin heavy and light chains are cytosolic proteins that form cages of 24 subunits to store intracellular iron. We show that ferritin light is secreted when its expression is increased in stable, transfected HepG2 cells or adenovirus-infected HepG2 cells. Export occurs through the classical secretory pathway and some chains are N-glycosylated. Ferritins do not need to form cages prior to secretion. Secretion is blocked specifically, effectively, and rapidly by a factor in serum. The timing of this inhibition of ferritin secretion suggests that normally cytosolic ferritin L is targeted to the secretory pathway during translation despite the absence of a conventional signal sequence. Thus, secretion of glycosylated and unglycosylated ferritin is a regulated and not a stochastic process.
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Affiliation(s)
- Sharmistha Ghosh
- Molecular Medicine Unit, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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