Apportioning black-white hemoglobin and hematocrit differences during pregnancy

Maternal and Perinatal Effects of Adolescent Childbearing

The developmental consequences of adolescent childbearing were investigated in a group of 60 low income, pregnant adolescents under the age of 18, and a low income control group of 60 pregnant adult women aged 20 to 29 with equal numbers of blacks and whites in each group. The adolescents were matched to controls of the same race and parity who initiated prenatal care at the same point in pregnancy. Antepartum and postpartum measures of state and trait anxiety, depression, and hostility were taken from both groups of mothers. Data were also obtained on the antepartum, delivery, and postpartum performance of the mothers, along with data on infant status within each maternal group. No differences were found in the incidence of either maternal or infant complications between adolescent mothers and controls. Furthermore, adolescents under the age of 17 did not differ significantly from 17 year olds on maternal and infant complications. Multiple regression analysis did indicate that an adolescent under 17 was more likely to have an infant of low birth weight if she has a low prepregnancy weight, a lower than average weight gain during pregnancy, a low delivery hemoglobin, and sought prenatal care late in pregnancy. No group differences were found on maternal emotionality measures. While maternal emotionality trait scores remained stable across antepartum and postpartum periods, maternal emotionality state scores were found to be lower in the postpartum period. Whereas, adolescents did not differ significantly from controls on emotionality, a significant age by race interaction was found for depression, with white controls showing less depression than white adolescents and black controls. Adolescents and black controls did not differ significantly. Possible explanations and implications are discussed.

Postpartum hemorrhage and transfusion of blood and blood components

Postpartum hemorrhage (PPH) is one of the top 5 causes of maternal mortality in developed and developing countries. The incidence of PPH is 40% after vaginal delivery and 30% after cesarean section. Criteria for PPH are based on the amount of blood loss. In clinical obstetrics, exact measurement of blood loss is often difficult. The most important treatment of PPH is red blood cell (RBC) transfusion. In the past few years, increasing concern has arisen about this treatment. Despite the introduction of several new guidelines, transfusion criteria still vary widely between clinicians. The decision whether to prescribe RBC transfusion is mostly based on postpartum hemoglobin (Hb) values. RBC transfusion should be aimed to reduce morbidity and especially to improve health-related quality of life (HRQoL). In this review, etiology, epidemiology, treatment, and prevention of postpartum hemorrhage are described. Special attention is given to the role of RBC transfusion in the treatment of PPH and the effects of RBC transfusion on HRQoL.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to summarize the new guidelines related to transfusion criteria, explain the importance of reducing morbidity related to improving quality of life issues, and list infectious and noninfectious complications of a red blood cell transfusion.

Separate hemoglobin standards for blacks and whites: a critical review of the case for separate and unequal hemoglobin standards

There have been a number of reports that suggest mean differences between the hemoglobin (Hgb) levels of black and white Americans. Many of those reports have had as their basis various national US nutrition surveys. Early reports indicated that blacks had a 1.0 g/dl lower mean Hgb than whites. Later reports put the mean Hgb difference between 0.5 and 0.73 g/dl. Recent reports, in which either iron intake or iron status have been measured and controlled, indicate a mean Hgb difference of between 0.2 and 0.3 g/dl. Despite the variability in these mean Hgb differences, some reports call for the establishment of separate Hgb standards for black Americans. The need for separate Hgb standards is critically reviewed in light of alternative interpretations of early data and newer knowledge about the development, detection, and significance of iron deficiency. The suitability of national cross-sectional survey data to answer questions about Hgb standards without adequate experimental studies in questioned, especially since no genetic studies have been performed to indicate genetic differences in Hgb levels. Policy implications of a change from current standards are also discussed.

The effect of race on serum ferritin during parturition

The purpose of this study was to determine whether differences in ferritin levels due to race were large enough to alter interpretation of ferritin test results during pregnancy. Patients were screened for hemoglobinopathies and other diseases known to affect ferritin levels. Maternal blood samples were obtained at delivery and analyzed for hemoglobin, hematocrit, and ferritin. One hundred thirty-four white and 69 black parturients were studied. Race was found to significantly affect serum ferritin levels p less than 0.001). Whereas blacks had a mean hemoglobin level 0.6 g/dl lower than whites, their mean serum ferritin level was 7.6 ng/ml higher (18.97 +/- 13.6 vs 11.41 +/- 9). No differences were found in the number of red blood cells, smoking status, or most other clinical variables. The mean serum ferritin level of anemic black parturients was higher, although not significantly different, than that of white nonanemic parturients (14.2 +/- 9.5 vs 12.1 +/- 9.4 ng/ml). Furthermore, increasing parity significantly decreased serum ferritin in both races (p less than 0.004). This was not due to differences in the interval between pregnancies. The results show conclusively that black parturients have significantly higher ferritin levels than white parturients. Therefore, different norms need to be established for blacks and whites if ferritin is used to screen for anemia during pregnancy.

Racial contrasts in hemoglobin levels and dietary patterns related to hematopoiesis in children: the Bogalusa Heart Study

Racial differences in hemoglobin (Hgb) levels were explored in two groups of children at different maturational stages, the pre-adolescent (10-year-olds: Whites n = 160, Blacks n = 56,) and the adolescent (15-year-olds; Whites n = 60, Blacks n = 44). Mean Hgb levels were higher for Whites than Blacks in both age groups. When all the dietary components (i.e., iron, zinc, copper, folacin, ascorbic acid and vitamins B12, E and B6) were considered as a group, they accounted for 8.4 per cent of the Hgb variance in 10-year-olds and 10.1 per cent of variance in 15-year-olds. However, even after controlling for the variations in dietary patterns of the adolescents and pre-adolescents, race still accounted for a notable proportion of Hgb variance in both age groups (9.1 per cent in 10-year-olds and 7.0 per cent in 15-year-olds). Within each race, gender accounted for a greater percentage of the Hgb variance in the adolescents than in the pre-adolescents. Our results indicate that in all likelihood racial differences in Hgb levels during childhood exist independent of racial differences in intake of specific "blood building" nutrients and maturational changes.