Iron deficiency anemia in pregnancy

Leveraging artificial intelligence chatbots for anemia prevention: A comparative study of ChatGPT-3.5, copilot, and Gemini outputs against Google Search results

Aim

This study evaluated the understandability, actionability, and readability of text on anemia generated by artificial intelligence (AI) chatbots.

Methods

This cross-sectional study compared texts generated by ChatGPT-3.5, Microsoft Copilot, and Google Gemini at three levels: "normal," "6th grade," and "PEMAT-P version." Additionally, texts retrieved from the top eight Google Search results for relevant keywords were included for comparison. All texts were written in Japanese. The Japanese version of the PEMAT-P was used to assess understandability and actionability, while jReadability was used for readability. A systematic comparison was conducted to identify the strengths and weaknesses of each source.

Results

Texts generated by Gemini at the 6th-grade level (n = 26, 86.7 %) and PEMAT-P version (n = 27, 90.0 %), as well as ChatGPT-3.5 at the normal level (n = 21, 80.8 %), achieved significantly higher scores (≥70 %) for understandability and actionability compared to Google Search results (n = 17, 25.4 %, p < 0.001). For readability, Copilot and Gemini texts demonstrated significantly higher percentages of "very readable" to "somewhat difficult" levels than texts retrieved from Google Search (p = 0.000-0.007).

Innovation

This study is the first to objectively and quantitatively evaluate the understandability and actionability of educational materials on anemia prevention. By utilizing PEMAT-P and jReadability, the study demonstrated the superiority of Gemini in terms of understandability and readability through measurable data. This innovative approach highlights the potential of AI chatbots as a novel method for providing public health information and addressing health disparities.

Conclusion

AI-generated texts on anemia were found to be more readable and easier to understand than traditional web-based texts, with Gemini demonstrating the highest level of understandability. Moving forward, improvements in prompts will be necessary to enhance the integration of visual elements that encourage actionable responses in AI chatbots.

Initial and Longitudinal Trajectories in Hemoglobin Levels Predict the Prognosis of Patients With Premature Rupture of Membranes

PROBLEM

Premature rupture of membranes (PROM) can lead to adverse maternal and neonatal outcomes. Identifying predictors of length of hospital stay (LOS) in PROM patients can aid in improving management and prognosis.

METHOD OF STUDY

The Medical Information Mart for Intensive Care IV database was searched to acquire data on PROM individuals. A univariable analysis, LASSO regression, and multivariable generalized linear model (GLM) were adopted to identify factors closely related to LOS. Next, the change trends in the key variable over multiple time points were determined using a latent class trajectory model (LCTM). The association of these trajectories with LOS was analyzed using GLMs.

RESULTS

The retrospective study finally enrolled 868 samples. The significant factors included initial hemoglobin, chorioamnionitis, premature birth, and rupture to delivery interval <24 h. Notably, higher initial hemoglobin level was independently associated with shorter LOS (β = -0.599; 95% CI = [-0.846, -0.352]; p < 0.05). The stratified analysis confirmed this association in all subgroups except those with chorioamnionitis. The LCTM identified three hemoglobin trajectories. Compared to other trajectory groups, the "lowest, declining" group had longer LOS (p < 0.05).

CONCLUSIONS

PROM patients with lower initial hemoglobin levels and the "lowest, declining" trajectory group were linked to longer LOS. Monitoring and managing hemoglobin levels is important in improving patient outcomes.

Pregnant women's knowledge, attitude, and practice toward food preservatives: a cross-sectional study

BACKGROUND

Sodium benzoate, a common food preservative, may harm fetuses, which could increase the safety concern for pregnant women, but the knowledge, attitude, and practice (KAP) of food preservatives' impact on health among pregnant women is limited. This study explored the KAP of pregnant women regarding food preservatives.

METHODS

This cross-sectional study was conducted in Henan Province between March and April 2023 among pregnant women. An investigated-designed questionnaire was administered to collect the demographic characteristics and KAP scores. Scores of < 60%, 60-79%, and ≥ 80% were considered poor, moderate, and good, respectively.

RESULTS

The study collected 515 valid questionnaires [303 (58.83%) < 30-years-old participants] for analysis. The knowledge, attitude, and practice scores were 10.21 ± 2.90 (/17; 60.06%), 29.59 ± 2.73 (/40; 73.98%), and 22.86 ± 3.56 (/30; 76.20%), respectively. The structural equation model (SEM) showed that the knowledge of food preservatives directly affected attitudes (β = 0.168, P = 0.005) and practice (β = 0.250, P = 0.021) and indirectly affected practice (β = 0.047, P = 0.004). The attitudes toward food preservatives directly affected practice (β = 0.280, P = 0.021).

CONCLUSION

Pregnant women in Henan Province have moderate knowledge, attitudes, and practices toward food preservatives. Education interventions are needed to improve the knowledge gaps identified in this study, which could also be encountered in other regions.

TRIAL REGISTRATION

Not applicable.

A Pilot Evaluation of the Adequacy of Prenatal Vitamins to Cover Dietary Deficits During Pregnancy and Lactation

Objectives

The objectives of this pilot survey were (1) to compare dietary intakes during three survey windows (25-28 weeks gestation, 28-32 weeks gestation and ≥ 3 months postpartum) with the National Institutes of Health, Office of Dietary Supplements' (NIH:ODS) established recommendations for pregnant and lactating women, and (2) to evaluate the general adequacy of commonly used prenatal vitamins (PVs) to cover the identified deficits in dietary intake.

Methods

In this longitudinal pilot survey, 39 healthy consented women, aged 18-50 years with singleton pregnancies and pre-pregnancy BMI < 30.0 kg/m2 were included. Items from self-reported dietary intakes during three survey windows were converted to nutritional content using Fooducate (LLC), a public database. Three-day mean intakes per survey window per subject were compared with NIH:ODS recommendations to determine dietary deficits. Eight commonly utilised PVs (identified via web searches of common prenatal vitamins and their availability in local stores) were evaluated for adequacy in correcting each dietary deficit.

Results

Nutrients that were ≥ 30% higher than the recommended RDA/AI were carbohydrates, sodium, vitamin A, and vitamin C in the first survey window; carbohydrates, sodium, and vitamin A in the second survey window; and sodium and iron in the third survey window. Nutrients that were ≥ 30% lower than the RDA/AI were potassium, vitamin D, and iron in the first survey window; potassium, vitamin D, and iron during the second survey window; and dietary fibre, potassium, vitamin C, and vitamin D in the third survey window. None of the evaluated PVs corrected all deficits, but two were close to the goal and only one corrected all vitamin D deficits.

Conclusion

Women who are or are planning to become pregnant should be educated on dietary recommendations during pregnancy and lactation, ideally such that supplements become unnecessary. However, it remains good practice to carefully consider prenatal vitamin content before selection.

Comparing the Treatment Outcomes of Oral and Injectable Iron Therapies for Anemia in Pregnancy: A Meta-Analysis

Iron deficiency anemia (IDA) during pregnancy is a global public health concern, associated with significant maternal and neonatal complications. Intravenous (IV) iron therapy has emerged as a potential alternative to oral iron for rapid correction of anemia, but its impact on clinical outcomes remains unclear. This meta-analysis aimed to evaluate the effectiveness and safety of IV iron compared to oral iron in improving maternal and neonatal outcomes during pregnancy. A systematic review of randomized controlled trials (RCTs) was conducted using major databases. A total of 15 studies, involving 4,215 pregnant women, met the inclusion criteria. Meta-analyses were performed to assess maternal and neonatal complications, adverse events, and hemoglobin (Hb) improvement. The findings demonstrated that IV iron therapy significantly improved Hb levels more rapidly than oral iron, with a mean rise of 2.05 g/dL for IV iron compared to 1.65 g/dL for oral iron. Women receiving IV iron experienced 21% fewer maternal complications, although the difference was not statistically significant for individual complications. Neonatal outcomes, including birth weight, cord Hb levels, and preterm births, showed no significant differences between the two groups. Adverse events were significantly less frequent in the IV group (OR 0.38; 95% CI: 0.24-0.58; p < 0.01), indicating a better safety profile. This study highlights the superior efficacy of IV iron for rapid anemia correction and reduced adverse events in pregnant women. However, no significant advantage was observed for neonatal outcomes or individual maternal complications. The evidence quality for Hb improvement was high, while that for maternal and neonatal clinical outcomes varied from moderate to low. Further research is needed to explore the impact of IV iron on critical clinical outcomes and to determine the most cost-effective regimens for anemia management during pregnancy.

Association between iron deficiency anemia and severe maternal morbidity: A retrospective cohort study

PURPOSE

We examined the association between iron deficiency anemia (IDA) and severe maternal morbidity (SMM) during delivery and up to 1-year postpartum.

METHODS

In a retrospective cohort study across 3 states, we computed adjusted relative risks (aRR) for SMM comparing individuals with IDA versus those without, using modified Poisson regression models.

RESULTS

Among 2459,106 individuals, 10.3 % (n = 252,240) had IDA. Individuals with IDA experienced higher rates of blood transfusion and non-transfusion SMM (329 and 122 per 10,000 deliveries, respectively) than those without IDA (33 and 46 per 10,000 deliveries, respectively). The risk of blood transfusion (aRR: 8.2; 95 % CI 7.9-8.5) and non-transfusion SMM (aRR: 1.9; 95 % CI: 1.8-2.0) were higher among individuals with IDA. The attributable risk per 10,000 deliveries due to IDA for blood transfusion and non-transfusion SMM during delivery were 29.5 (95 % CI: 28.9-30.0) and 5.7 (95 % CI: 5.3-6.2), respectively. Within 1-year postpartum, the relative risk of non-transfusion SMM (aRR:1.3; 95 % CI: 1.2-1.3) was 30 % higher among individuals with IDA.

CONCLUSION

IDA is associated with increased SMM risk. Addressing IDA in pregnant individuals may reduce SMM rates.

Association between anemia in pregnancy with low birth weight and preterm birth in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Anemia in pregnancy has been associated with a number of adverse birth outcomes, such as low birth weight (LBW) or preterm birth (PTB). However, the evidence from primary studies on anemia in pregnancy with LBW and PTB is contentious. Moreover, a systematic review and meta-analysis to summarize these findings have not been conducted for Ethiopia. This study aimed to synthesize the best available evidence and quantify the strength and direction of the association of anemia in Ethiopia.

METHODS

This review examined women with singleton pregnancies with low birth weight (LBW) and preterm birth (PTB). We retrieved studies from PubMed, Wiley, Cochrane databases, and Google Scholar from inception to February 2, 2024. The World Health Organization (WHO) defines anemia in pregnancy as a low blood haemoglobin (Hgb) concentration below 11 g/dl or a hematocrit level of < 33%. When the newborn's weight was below 2500 g, LBW was considered. Preterm birth refers to the birth of a baby before 37 completed weeks of gestation. Meta-analysis was conducted using fixed and random effects models. The degree of heterogeneity, publication bias, and quality of the evidence of studies was assessed.

RESULTS

There were 35 and 8 studies, with 14,319 and 3,265 respondents included in the meta-analysis for LBW and PTB, respectively. Neonates born to women who had normal Hgb levels were less likely to be LBW [pooled odds ratio (POR) = 0.22, 95% CI: (0.17, 0.28); I2 = 80%] (low-quality evidence). Neonates born to women with normal Hgb levels had a lower risk of PTB [POR = 0.22, 95% CI: 0.18, 0.28; I2 = 19%] (very low-quality evidence). The effect size estimate remained significant after sub-group analysis based on study design and province, except in two retrospective cohort studies for LBW.

CONCLUSION

The findings suggest major implications for strengthening the implementation of nutrition policies to prevent anemia during pregnancy in Ethiopia. Further research is warranted to assess interventions that are effective in combating maternal anemia to reduce rates of LBW and PTB.

Vitamin D, Folate, Vitamin B12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario

Purpose: To assess vitamin D, folate, vitamin B12, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women.Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B12, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007).Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin B12 (<148 pmol/L); serum vitamin B12 was high (>652 pmol/L) for 24%. None had vitamin B12 intakes  Collapse

Key Words

• Anabaptist
• anabaptiste
• femmes enceintes post-partum
• fer
• folate
• iron
• pregnant postpartum women
• vitamin B12
• vitamin D
• vitamine B12
• vitamine D

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MESH Headings

• Humans
• Female
• Folic Acid/blood
• Folic Acid/administration & dosage
• Vitamin B 12/blood
• Vitamin B 12/administration & dosage
• Vitamin D/blood
• Vitamin D/administration & dosage
• Vitamin D/analogs & derivatives
• Ontario
• Pregnancy
• Cross-Sectional Studies
• Adult
• Dietary Supplements
• Nutritional Status
• Postpartum Period/blood
• Iron/blood
• Iron/administration & dosage
• Protestantism
• Vitamin B 12 Deficiency/blood
• Vitamin B 12 Deficiency/epidemiology
• Young Adult
• Vitamin D Deficiency/blood
• Vitamin D Deficiency/epidemiology
• Anemia, Iron-Deficiency/blood
• Anemia, Iron-Deficiency/epidemiology

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Grants Collapse

Affiliation(s)

Janis A Randall Simpson Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
Natalee Miller Huron Perth Public Health, Stratford, ON
Taylor Hartwig Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
Jane Leach Huron Perth Public Health, Stratford, ON
Melissa Purdy Huron Perth Public Health, Stratford, ON
Emily Roth Countryside Midwifery Services, Milverton, ON
Victoria Mok Siu Department of Pediatrics, Western University, London, ON
Cynthia Soulliere Countryside Midwifery Services, Milverton, ON
Jacqui Tam Huron Perth Public Health, Stratford, ON
Ann Watt Huron Perth Public Health, Stratford, ON

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Collaborators Collapse

The Critical Role of the Early Evaluation of Iron and Vitamin B12 Deficiency in Pregnancy

Background and objective Anemia is a common hematological disorder during pregnancy, with iron deficiency (ID) being the most prevalent cause globally. It severely affects maternal and fetal health. This study aimed to investigate the prevalence of anemia and its association with iron and vitamin B12 deficiency during pregnancy. Materials and methods The study sample consisted of pregnant women attending the 3rd Clinic of Obstetrics and Gynecology, University General Hospital "Attikon", Athens, Greece, with a total of 145 women eventually analyzed. Blood samples were collected from pregnant women during the first, second, and third trimesters; hematological indices, including hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), ferritin, and vitamin B12, were recorded. Iron deficiency anemia was defined as HGB <11.0 g/dl in the first trimester and <10.5 g/dl in the second and third trimesters. Results Iron deficiency anemia is elevated in the course of pregnancy. A significant proportion of pregnant women had vitamin B12 deficiency during pregnancy, with the prevalence increasing from the first to the third trimester. The study also found that iron supplementation improved hematological indices; especially, pregnant women receiving divalent iron had significantly higher levels of HCT, HGB, and ferritin compared to those receiving trivalent iron. Conclusions Screening for iron deficiency anemia should be performed in all pregnant women, and appropriate oral iron therapy should be given as first-line treatment. Early recognition and management of low maternal iron levels are crucial and lead to improved maternal, fetal, and neonatal outcomes. Furthermore, unified international thresholds for ID are required for accurate assessments and appropriate iron supplementing. This study also recommends the screening of vitamin B12 levels as part of the systematic follow-up of pregnant women to identify potential deficiencies and provide appropriate supplementation. Further in-depth studies, particularly related to vitamin B12, are required to provide definitive conclusions and guidance.

The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility

BACKGROUND

Laboratory results are frequently abnormal in pregnant mothers. Abnormalities usually relate to pregnancy or associated complications. Hematological abnormalities and age in pregnancy may increase the likelihood for transfusion and mortality.

STUDY DESIGN AND METHODS

Hematological profiles and transfusion history of pregnant mothers presenting to a tertiary hospital, were evaluated over 2 years. Age, anemia, leukocytosis and thrombocytopenia were assessed for transfusion likelihood. Iron deficiency and coagulation were assessed in transfused patients. Anemia, leukocytosis, thrombocytopenia, human immunodeficiency virus (HIV) and transfusion were assessed for mortality likelihood.

RESULTS

There were 12,889 pregnant mothers included. Mothers <19-years-old had the highest prevalence of anemia (31.5%) and proportion of transfusions (19%). The transfusion likelihood was increased in mothers with anemia (odds ratios [OR] = 6.41; confidence intervals at 95% [95% CI] 5.46-7.71), leukocytosis (OR = 2.35; 95% CI 2.00-2.76) or thrombocytopenia (OR = 2.71; 95% CI 2.21-3.33). Mothers with prolonged prothrombin times received twice as many blood products as their normal counterparts (p = .03) and those with iron deficiency anemia five times more blood products (p < .001). Increased likelihood for mortality was seen in patients with anemia (OR = 4.15, 95% CI 2.03-8.49), leukocytosis (OR = 2.68; 95% CI 1.19-6.04) and those receiving blood transfusion (OR = 3.6, 95% CI 1.75-7.47).

DISCUSSION

Adolescence, anemia, leukocytosis and thrombocytopenia expose mothers to a high risk for transfusion and/or mortality. These risk factors should promptly trigger management and referral of patients. Presenting hematological profiles are strong predictors of maternal outcome and transfusion risk.

Hemoglobin on Admission for Childbirth and Postpartum Acute Care Use in a Southeastern Health Care System

OBJECTIVE

 Our objective was to evaluate whether hemoglobin on admission for childbirth is associated with postpartum acute care use (ACU).

STUDY DESIGN

 We conducted a retrospective cohort study of patients giving birth at a southeastern quaternary care hospital from January 2018 through June 2021 using electronic health records. Predelivery hemoglobin was categorized as <9, 9- < 10, 10- < 11, 11- < 12, and ≥12 g/dL. Acute care was defined as a visit to obstetric triage, the emergency department, or inpatient admission within 90 days postpartum. Generalized estimating equations quantified the crude and multivariable-adjusted association between predelivery hemoglobin and ACU.

RESULTS

 Among 8,677 pregnancies, 1,467 (17%) used acute care in the system within 90 days postpartum. In unadjusted models, those with predelivery hemoglobin <9 had twice the risk of postpartum ACU compared to those with hemoglobin ≥12 (95% confidence interval [CI]: 1.59-2.69), with a decrease in risk for each increase in hemoglobin category (9- < 10 g/dL: risk ratio [RR]: 1.47, CI: 1.21-1.79; 10- < 11 g/dL: RR: 1.44, CI: 1.26-1.64; 11- < 12 g/dL: RR: 1.20, CI: 1.07-1.34). The adjusted model showed a similar trend with smaller effect estimates (<9 g/dL: RR: 1.50, CI: 1.14-1.98; 9- < 10 g/dL: RR: 1.22, CI: 1.00-1.48; 10- < 11 g/dL: RR: 1.22, CI: 1.07-1.40; 11- < 12 g/dL: RR: 1.09, CI: 0.98-1.22).

CONCLUSION

 Low hemoglobin at childbirth admission was associated with increased postpartum ACU. Low hemoglobin on admission could signal to providers that additional follow-up, resources, and ongoing support are warranted to identify and address underlying health needs. Because hemoglobin is routinely assessed during the childbirth hospitalization, this indicator may be especially valuable for risk assessment among patients with limited prior engagement in health care.

KEY POINTS

· Low hemoglobin on admission for birth is associated with postpartum acute care use.. · Hemoglobin on admission may aid in risk-stratification during childbirth hospitalization.. · Point-of-care metrics may help identify high-risk patients with limited preventive health care..

Determinants of compliance to iron folate supplementation among pregnant women attending antenatal care in public health facilities of South West Ethiopia: A case-control study

Background

The prevalence of anemia among pregnant women remains high globally, particularly in low-income settings. Iron and folic acid supplementation (IFAS) during pregnancy is the most widely employed strategy to alleviate adverse pregnancy outcomes. This study aimed to explore the determinants of compliance with iron supplementation in the study area.

Aim

To identify determinants of IFAS compliance among pregnant women attending antenatal care (ANC) in Mettu town, South West Ethiopia, in 2021.

Methods

A facility-based, unmatched case-control study was conducted from May to July 2021 with a total sample size of 344 (115 cases and 229 controls). Cases and controls were selected using systematic random sampling. Data was collected using a structured, pretested interviewer-administered questionnaire, entered into Epi-data software version 3.1, and exported to SPSS version 23 for analysis. Variables with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model. Then, variables with a p < 0.05 at 95% confidence interval (CI) were declared to be statistically significant determinants of IFAS. The odds ratio was used to indicate the strength of the association.

Result

Having Previous history of anaemia (adjusted odds ratio [AOR] = 5.8, 95% CI [2.5-13.6], p < 0.01), having good knowledge about IFAS (AOR = 3.3, 95% CI [1.7-6.7], p < 0.001), being a government employee (AOR = 5.2 [2.4-11.5], p < 0.01], and receiving counseling service during ANC (2.495% CI [1.3-4.7] p < 0.01) were among determinants of adherence to IFAS.

Conclusions

Maternal knowledge about IFAS, counseling about IFAS, occupation, and history of anaemia were found to be significantly associated factors with compliance with iron folate supplementation during pregnancy. This implies that adherence to IFAS can be improved through improving maternal knowledge about importance of IFAS, quality counseling services and strengthening an overall ANC follow-up services.

Risk factors associated with anaemia among pregnant women in the Adaklu District, Ghana

Background

Anaemia during pregnancy is a major public health concern in both advanced and less-developed countries including Ghana. The prevalence of anaemia in Ghana has a serious repercussion on the country's social and economic development. This prevalence has been linked to various factors, including educational level and occupational status.

Methods

A prospective study was conducted to investigate the factors influencing anaemia among 150 pregnant women, aged 15-49 years, who attended antenatal clinics in the Adaklu District of the Volta region of Ghana. Haemoglobin levels were assessed in the first, second, and third trimesters, and a questionnaire was also used to collect data on demographic information and barriers to maintaining haemoglobin levels. The data were analysed using frequencies, percentages, and binary logistic regression.

Results

The prevalence of pregnancy anaemia in the district was 78.5%. The study found that 92% and 8% of pregnant women had excellent and good knowledge on anaemia in pregnancy, respectively. The study also identified several barriers to maintaining an appropriate haemoglobin level during pregnancy, such as long distances to healthcare facilities, non-intake of antimalarial drugs, and lack of nutritious meals. Finally, the study found that low education level, number of pregnancies, and number of children a woman had were significant determinants of anaemia during pregnancy in the district.

Conclusion

The findings of the study suggest that targeted interventions are needed to reduce the burden of anaemia during pregnancy in the district. These interventions should address the social and environmental determinants of anaemia during pregnancy, such as improving access to healthcare facilities and promoting healthy eating habits. In addition, interventions that address social determinants of health, such as education and occupation, may be effective in reducing the burden of anaemia during pregnancy in the district.

Clinical outcome post treatment of anemia in pregnancy with intravenous versus oral iron therapy: a systematic review and meta-analysis

Oral iron therapy is often the most common way of treating anaemia; however intravenous iron is considered effective due to rapid iron replenishment. We have dearth of evidence on clinical outcomes post treatment of anaemia. We have searched studies published in English in PubMed, Cochrane, Scopus, ProQuest, and Google Scholar. Our study analysed the clinical outcomes amongst neonates and mother and the adverse events post treatment and assessed the mean change in maternal haemoglobin concentration in both the groups. Forest plots for the clinical outcomes are presented. From a total of 370 studies, 34 Randomized and quasi experimental studies comparing clinical outcomes post-treatment of anaemia in pregnancy were included for quantitative evidence synthesis. Pooled results of maternal clinical outcomes using random effect model [OR: 0.79 (95% CI 0.66; 0.95); 10 outcomes; 17 studies] showed statistically significant difference among both the groups [Moderate quality evidence]; however no significant difference [OR: 0.99 (95% CI 0.86; 1.14); 7 outcomes; 8 studies] have been observed for neonatal complications [Low quality evidence]. The study found that pregnant women receiving IV iron were significantly less likely to experience adverse events as compared with those receiving oral iron [OR 0.39;  (95% CI 0.26-0.60)]; 34 studies; 13,909 women; [Low quality evidence]. Findings from meta-regression analysis showed that IV iron is more likely to reduce maternal complications by 21% compared to oral iron. Increase in odds of adverse maternal outcomes was observed due to increase in gestational age and publication year but no effect for the type of drug used. IV iron increases Hb more and at a higher pace than oral iron. Intravenous iron is more likely to avert adverse maternal outcomes and adverse reactions. However, there is no conclusive evidence on its effectiveness on individual maternal outcome or neonatal outcome/s. Protocol registered with PROSPERO CRD42022368346).

Global, Regional, and National Burden of Ectopic Pregnancy: A 30-Year Observational Database Study

Objective

To estimate global, regional, and national trends due to ectopic pregnancy as part of the 2019 Global Burden of Disease study.

Methods

We systematically reviewed trends in ectopic pregnancy burden using data from the Global Burden of Disease (GBD) database, including 21 regions, 195 countries, and territories over the past 30 years. The trends of ectopic pregnancy-related incidence, mortality, and disability-adjusted life years (DALYs) attributable to all known risk factors were also analyzed. Age-standardized rates (ASRs) and their estimated annual percentage changes (EAPCs) were also calculated.

Results

Incident cases, deaths, and DALYs of ectopic pregnancy increased worldwide in the past 30 years. The age-standardized incidence rate (ASIR) was decreasing (EAPC = -1.14, 95% confidence interval (CI): -1.29 to -0.98), and the age-standardized death (EAPC = -0.9, 95% CI: -1.03 to -0.76) and DALY rate decreased generally (EAPC = -0.83, 95% CI: -0.98 to -0.68). In addition, the burden of ectopic pregnancy is lower in areas with higher socioeconomic development, and significant positive correlations between ASRs and sociodemographic index (SDI) were observed, especially among low-middle SDI, and low SDI quintiles carried the majority burden of ectopic pregnancy.

Conclusion

Globally, the incidence, mortality, and DALY rate of ectopic pregnancy had been decreasing from 1990 to 2019. Compared with lower and decreasing ASIR in the high SDI region, ASIR in the low SDI region was always high, indicating the need for ectopic pregnancy treatment improvement and the establishment of more targeted and specific strategies in low SDI countries to reduce the incidence of ectopic pregnancy.

Barriers to adequate nutrition in pregnant adolescent Colombian females

Pregnant adolescent females face nutritional challenges. The nutritional demands of a growing fetus, when added to the requirements for growing adolescent bodies, are risk factors for undernutrition. An adolescent expectant mother's nutritional status therefore affects both the mother's and the child's future growth, development, and potential development of diseases later in life. In Colombia, the rate of female adolescent pregnancies is higher than neighboring countries and the global average. The most recent data suggest that approximately 21 % of all pregnant adolescent females in Colombia are underweight, 27 % suffer from anemia, 20 % suffer from vitamin D deficiency, and 19 % suffer from vitamin B12 deficiency. Contributing factors to these nutritional deficiencies during pregnancy may be the region in which the female lives, the female's ethnicity, and the female's socioeconomic and educational status. In rural parts of Colombia, limitations regarding access to prenatal care and food choices that include animal source proteins may also contribute to nutritional deficiencies. To help remedy this, recommendations include encouraging nutrient dense food sources with higher protein content, eating one additional meal per day, and taking a prenatal vitamin throughout the pregnancy. Making healthy eating choices can be difficult for adolescent females with limited resources and education; therefore, it is recommended that discussions about nutrition begin at the first prenatal visit for optimum benefits. These factors should be considered for the development of future health policies and interventions in Colombia and other low-income and middle-income countries where pregnant adolescent females may be experiencing similar nutritional deficiencies.

Maternal Pregnancy Intention and Antenatal Care Seeking Behaviors in Bangladesh: Evidence From Bangladesh Demographic and Health Survey, 2018

Objective: This study aimed to examine the association between pregnancy intention and antenatal care (ANC)-seeking behaviors among women in Bangladesh. Methods: ANC-related data of 5,012 women, from the 2018 Bangladesh Demographic and Health Survey (BDHS), who had a live birth within 3 years preceding the survey were analyzed in the study. Multivariate logistic regression models were used to assess the association of pregnancy intention with ANC utilization. Results: Approximately one-fifth (20.9%) of the women had unintended pregnancy. Among all the women, 40.4% received their first ANC visit within the first three months of pregnancies, 47% had at least four ANC visits, 26.1% received all the components of ANC services, and 22.2% received an adequate dosage of supplementary iron-folic acid tablets/syrup. Women with unintended pregnancy were less likely to receive their first ANC visit within the first 3 months, four or more ANC visits, and all ANC services than those with intended pregnancy. Conclusion: Unintended pregnancy was inversely associated with the proper utilization of ANC among women in Bangladesh. Appropriate measures to reduce unintended pregnancy might foster the utilization of optimum antenatal care.

Prevalence of Low Birth Weight and its Association With Anemia in White Nile State, Sudan: A Cross-Sectional Study

Introduction

Low birth weight (LBW) remains a global health concern, especially in sub-Saharan African countries with fewer resources, such as Sudan. Despite ongoing preventive measures, LBW is still one of the main health problems and it is a leading risk factor for several adverse perinatal and neonatal outcomes.

Objective

To assess the prevalence of and factors associated (mainly maternal anemia) with LBW at Rabak Maternity Hospital, White Nile, Central Sudan.

Methods

A cross-sectional study was conducted involving live singleton newborns and their mothers who presented to Rabak Maternity Hospital from September to December 2021. Questionnaires were completed via face-to-face interviews to gather maternal information (maternal age, parity, history of miscarriage, educational status, and level of antenatal care [ANC]). Maternal hemoglobin levels were measured using an automated hematology analyzer. The neonate's birth weight and sex were recorded.

Results

Two hundred and fifty-three newborns were enrolled in this study, 40 (15.8%) of whom were LBW neonates. The median (interquartile range) maternal age and parity were 25 (21.0-30.0) years and 2 (1-4), respectively. While gestational age, maternal hemoglobin, and maternal anemia were associated with LBW, maternal age, parity, a history of miscarriage, education level, and level of ANC were not associated with LBW in the univariate analysis. Multivariate analysis showed that gestational age (adjusted odds ratio [AOR] = 0.80, 95% confidence interval [CI] = 0.66-0.96) and maternal hemoglobin (AOR = 0.76, 95% CI = 0.52-0.86) were inversely associated with LBW. Maternal anemia was associated with LBW (AOR = 4.70, 95% CI = 2.06-10.94).

Conclusion

LBW is a major health concern in White Nile, Sudan. Maternal age and maternal anemia are associated with LBW. Preventive measures for managing maternal anemia may help reduce the incidence of LBW.

Ferric Carboxymaltose in the Management of Iron Deficiency Anemia in Pregnancy: A Subgroup Analysis of a Multicenter Real-World Study Involving 1191 Pregnant Women

BACKGROUND

Real-world evidence of the efficacy and safety of ferric carboxymaltose (FCM) infusion in Indian pregnant women with iron deficiency anemia (IDA) is lacking.

OBJECTIVE

To assess the efficacy and safety of intravenous (IV) FCM in Indian pregnant women with IDA in 4 weeks in a real-life scenario.

METHODS

This is a subgroup analysis of our previously conducted retrospective, multicenter, observational, real-world PROMISE study. Data on demographic and hematological parameters, patient-reported adverse events, and physicians' clinical impressions of efficacy and safety were analysed at 4 ± 1 week.

RESULTS

This subgroup analysis included 1191 pregnant women in whom IV FCM resulted in a significant increase in hemoglobin (Hb) by 2.8 g/dL and serum ferritin by 30.03 μg/L at 4 weeks (P < 0.001 for both). In 103 pregnant women with severe IDA, there was a significant increase in Hb by 3.6 g/dL (P < 0.001), and serum ferritin by 16.96 μg/L (P=0.12). In 978 pregnant women with moderate IDA, significant improvement in Hb by 2.74 g/dL and serum ferritin by 33 μg/L (P < 0.001 for both) was noted. Similarly, there was a significant increase in red blood cell count, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin (P < 0.001 for all). In pregnant women with mild IDA (n = 26), Hb increased significantly by 1.99 g/dL (P < 0.001). Adverse effects were reported in 8.6% of pregnant women. No new safety signals or serious adverse effects were observed. Based on physicians' global assessment, good to very good efficacy and safety of IV FCM was noted in 99.2% and 98.6% of pregnant women, respectively.

CONCLUSIONS

IV FCM rapidly corrected anemia in a short period of 4 weeks with favorable safety in the second and third trimester of pregnancy with all severities of IDA (severe, moderate, and mild). The physicians' favorable global assessment of FCM's efficacy and safety in pregnant women with IDA supports its use in daily clinical practice. This trial is registered with CTRI/2021/12/039065.

Iron and Folic Acid Supplementation in Pregnancy: Findings from the Baseline Assessment of a Maternal Nutrition Service Programme in Bangladesh

Effective coverage of antenatal iron and folic acid (IFA) supplementation is important to prevent adverse maternal and newborn health outcomes. We interviewed 2572 women from two rural districts in Bangladesh who had a live birth in the preceding six months. We analysed the number of IFA tablets received and consumed during pregnancy and examined the factors influencing IFA consumption by multiple linear regression and user adherence-adjusted effective coverage of IFA (consuming ≥180 IFA tablets) by Poisson regression. Overall, about 80% of women consumed IFA supplements in any quantity. About 76% of women received antenatal care at least once, only 8% received ≥180 IFA tablets, and 6% had user adherence-adjusted coverage of antenatal IFA supplementation. Multivariable analysis showed a linear relationship between the number of antenatal care (ANC) visits and the number of IFA supplements consumed, which was modified by the timing of the first ANC visit. Women’s education, free IFA, and advice on IFA were also associated with higher IFA consumption. Interventions targeting at least eight ANC contacts, starting early in pregnancy, providing advice on the importance of IFA, and providing IFA supplements in higher quantity at ANC contacts are likely to increase effective coverage of antenatal IFA supplementation.

Evaluation of obstetric and neonatal outcomes and cesarean section rates of Syrian and Turkish adolescent pregnant women according to the Robson ten group classification system

Aim: Our research has two purposes. To begin with, we sought to determine whether there were any differences in maternal and newborn outcomes between Syrian adolescent and adult pregnant women living in Turkey after the Syrian civil war and Turkish adolescent and adult pregnant women. Second, we wanted to examine and compare the rates of cesarean section (CS) and spontaneous vaginal delivery (SVD) in adolescent and adult pregnant women using the Robson ten group classification system (RTGCS). Material and Method: Our study investigated data from a retrospective cross-sectional study of 1823 Turkish and Syrian pregnant women who gave birth between September 2020 and August 2021 in a tertiary reference hospital in Turkey's Mediterranean area. Our study enrolled 838 pregnant adolescent girls between the ages of 13 and 19 and 985 pregnant adult women between the ages of 20 and 47. Results: The probability of adolescent pregnancy is 3.081 times greater among Syrian refugees than among Turkish natives (p

Factors influencing quality nutrition service provision at antenatal care contacts: Findings from a public health facility-based observational study in 21 districts of Bangladesh

Malnutrition during pregnancy is associated with increased maternal morbidity and mortality and has a long-term negative impact on child growth and development. Antenatal care (ANC) is the formal point of contact for pregnant women to receive preventive health and nutrition services. We assessed the quality of nutrition service delivery during ANC and examined its influencing factors related to the health facility, health care provider (HCP) and client characteristics. We conducted a cross-sectional assessment in 179 facilities, including 1,242 ANC observations and exit interviews of pregnant women from 21 districts in Bangladesh. We considered four essential nutrition services at each ANC contact including maternal weight measurement, anaemia assessment, nutrition counselling and iron-folic acid (IFA) supplement provision. We defined a composite ‘quality nutrition service’ outcome by counting the number of services (out of four) provided at each ANC from observation data. We explored both the supply-side and the client-level factors of quality nutrition service using multilevel Poisson regression. Overall, only 15% of clients received all four nutrition services. Performance of weight measurement (79%) was higher than IFA provision (56%), anaemia assessment (52%) and nutrition counselling (52%). The multivariable analysis showed that quality nutrition service delivery is positively associated with good logistical readiness of the facilities (aIRR: 1.23, 95% CI: 1.08–1.39), consultation by paramedics (aIRR 1.23, 95% CI: 1.06–1.42) and community health care providers (aIRR 1.32, 95% CI: 1.12–1.57), HCPs’ knowledge on maternal nutrition (aIRR 1.04; 95% CI: 1.01–1.08), better HCP-client communication (aIRR 1.14; 95% CI: 1.04–1.26) and use visual aids or ANC card (aIRR 1.18; 95% CI: 1.11–1.27). We found limited associations between HCP training and external supervision with the quality of nutrition services. In conclusion, the quality of nutrition service provision during ANC is suboptimal. Public health nutrition programmers should ensure the facilities’ logistical readiness, and revisit and reinforce the content and modality of training and supportive supervision of the HCPs. They should also emphasize positive HCP-client communication and the use of job aids to improve the quality of nutrition service provision during ANC.

Effect of Eel Cookie Supplementation on the Hemoglobin Status of Pregnant Women with Anaemia: A Pilot Study

Background

Anaemia in pregnancy is a major global health problem. Iron and folic acid (IFAS) and animal-based supplement consumption could improve the hemoglobin status of pregnant women. This study is aimed at determining the effect of eel cookie supplementation on hemoglobin levels of pregnant women.

Methods

This pilot study with pretest–posttest design was conducted in Tamanjaya Public Health Center, Geopark Ciletuh, Sukabumi District, West Java Province, Indonesia. A total of 40 voluntary pregnant women were divided into two groups: an intervention group that received 11 pieces of eel cookies and control group that received the same number of cookies without eel. The women's hemoglobin level was analysed using t-test, Mann-Whitney, Wilcoxon, and analysis of covariance tests.

Results

After consuming the eel cookies for 1 month, there was a significantly greater increase in the hemoglobin levels in the intervention group than those in the control group, which were 1.69 and 0.69 g/dL, respectively. Improvement in percentage of mean hemoglobin was higher in the intervention group than in the control group, which was 17.21% and 6.53%, respectively.

Conclusions

Supplementation with eel cookies and IFAS for 1 month could improve the hemoglobin status in pregnant women with anaemia.

A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

Iron Deficiency Anaemia and Atonic Postpartum Haemorrhage Following Labour

The purpose of this retrospective cohort study is to determine if iron deficiency anaemia (IDA) is associated with increased atonic postpartum haemorrhage (PPH) following labour. Women with singleton pregnancy carried to 24 or more weeks gestation, who were delivered under our care from 1997 to 2019, constituted the study population. A diagnosis of IDA was based on the finding of haemoglobin <10 g/dL and serum ferritin <15 μg/L in the absence of haemoglobinopathies. Women with elective caesarean section were excluded. Maternal characteristics, use of oxytocin, labour outcome and occurrence of PPH were compared between women with and without a diagnosis of IDA. The 1032 women (0.86%) with IDA exhibited slightly but significantly different maternal characteristics and had significantly higher incidence of total (4.5% versus 3.2%, p = 0.024) and atonic PPH (3.1% versus 2.0%, p = 0.011) despite similar incidences of labour induction, augmentation, and instrumental and intrapartum caesarean delivery. Multivariate analysis with adjustment for the effects of age, body mass index, height, parity, abortion history, labour induction and augmentation, instrumental delivery and infant macrosomia demonstrated that IDA was independently associated with total PPH (adjusted relative risk, aRR: 1.455, 95% confidence ratio, CI: 1.040-2.034) and atonic PPH (aRR: 1.588, 95% CI: 1.067-2.364). Our results indicate that despite the low prevalence in our population, IDA was independently associated with atonic PPH, probably consequent to placental adaptive changes in the presence of IDA. The correction and prevention of IDA could be the most important measure in countering the rising global prevalence of atonic PPH.

Husband’s Perception on Anemia among Pregnant Women based on Cultural Perspective: A Qualitative Study

BACKGROUND: Anemia is one of the most common nutritional problems during pregnancy. Husbands have an important role in supporting their wives in pregnancy to prevent complications. Husband’s culture and beliefs will affect support for the health status of pregnant women. AIM: This study aims to explore husbands’ perceptions regarding anemia and cultural beliefs related to pregnancy. METHODS: This qualitative study was conducted using twelve in-depth interviews (IDIs) with husbands who have pregnant wives who were recruited through a purposive sampling method. Data were collected through IDIs using open-ended questions to gain insight about Husband’s Perception on Anemia among Pregnant Women based on Cultural Perspective. Data analysis was conducted by an inductive content analysis method to evaluate, encode, and analyze the interview’s result. RESULTS: Four themes emerged from interviews: (1) Husbands’ happiness and support to their wives during pregnancy; (2) Husbands’ perceptions and actions related to anemia symptoms; (3) Cultural beliefs during pregnancy believed by Acehnese people; and (4) the importance of local wisdom-based counseling. CONCLUSIONS: Our findings provide new insights into how husbands’ perceptions on anemia during pregnancy, how they support their pregnant wives, and what their believed in cultural views about pregnancy. These findings would assist in developing/adapting more strategic policies to prevent anemia in pregnancy.

Determinants of Anemia in The Third Trimester of Pregnancy in Mojokerto

Background: Anemia is a pregnancy complication that increases the morbidity and mortality of mother and baby during pregnancy and until puerperium. In 2015, the incidence of anemia in Indonesia was 23%. Purpose: The aim of this study was to determine factors that influence anemia in the third trimester of pregnancy. Methods: The study was conducted on pregnant women in Mojokerto. This study used a case-control design. The sample calculation results obtained 70 cases and 70 controls. The primary and secondary data were obtained from the MCH book and from interviews conducted according to questionnaire guidelines. Data were analyzed via chi-squared test and logistic regression test. Results: The factors that influence anemia in the third trimester of pregnancy were found to be age (p value = 0.04; OR 2.08; 95% CI = 1.04–4.16), occupation (p value = 0.02; OR = 2.27; 95% CI = 1.15–4.47), birth interval (p value = 0.03; OR = 2.25; 95% CI 1.08-4.69), nutritional status (p value = 0.02; OR = 2.33; 95% CI = 1.14- 4.82), knowledge [about anemia] (p value = 0.01; OR = 3.17; 95% CI = 1.41-7.09), income per month (p value = 0.03, OR = 2.25; 95% CI =1.08–4.69), smoking activity (p value = 0.04; OR = 2.00; 95% CI = 1.02–3.92), perception (p value = 0.02; OR = 2.20; 95% CI = 1.10–4.40) , and spousal support (p value = 0.01; OR = 2.63; 95% CI = 1.16 – 5.93) Conclusion: The most influential factors on anemia in the third trimester of pregnancy were birth interval, nutritional status, and knowledge.

Incidence and predictors of iron deficiency anaemia in parturients undergoing elective caesarean section at a tertiary hospital in New Zealand: a retrospective, observational cohort study

Background

Worldwide, iron deficiency anaemia in pregnancy is a significant problem which can be especially problematic when delivery is by caesarean section, a procedure associated with significant blood loss. Optimising iron stores pre-delivery remains an overarching goal. We aim to measure the incidence of iron deficiency anaemia in patients undergoing elective caesarean section at our institution and determine any associated predictors, as well as adverse outcomes.

Methods

A retrospective, observational cohort study of patients presenting for elective caesarean section over a two-year period. Patient data was collected from hospital electronic records. Iron deficiency anaemia was defined a haemoglobin < 110 g/L and a ferritin < 30 μg/L in the three-month period prior to delivery. The primary aim was to establish the incidence of iron deficiency anaemia at the time of delivery and any associated predictors. Secondary outcomes included any association between the primary outcome and complications defined by the hospital discharge complication coding system, as well as an evaluation of the number of blood tests carried out antenatally per trimester.

Results

One thousand and ninety-three women underwent caesarean section over the study period and 16.2% had iron deficiency anaemia. Patients with iron deficiency anaemia were more likely to be of Māori and Pacific Island ethnicity, have a greater booking body mass index, be younger and have a greater parity. Pre-operative anaemia was associated with a greater likelihood of post-operative blood transfusion.

Conclusions

There remains potential for optimisation of iron deficiency anaemia in our local population undergoing elective caesarean section.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04121-9.

The Effect of Pumpkin Seeds Biscuits and Moringa Extract Supplementation on Hemoglobin, Ferritin, C-reactive protein, and Birth Outcome for Pregnant Women: A Systematic Review

BACKGROUND: According to the WHO data, 40% of maternal mortality in developing countries is related to anemia in pregnancy. Most anemia in pregnancy is caused by iron deficiency and acute bleeding, sometimes even the two interact. The incidence of anemia in pregnancy in Indonesia is quite high, which is around 67% of all pregnant women, with variations depending on each region. About 10–15% of pregnant women are classified as severe anemia which of course will affect the growth and development of the fetus in the womb. Most of the anemia in pregnant women occurs due to malnutrition. AIM: The objective of the study was to review journals related to the effect of pumpkin seed biscuits and Moringa capsules on hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels in pregnant women and also the prevention of stunting. METHODS: Study of literature by collecting relevant literature using online journal data based on PUBMED, Google Search, ELSEVIER, MDPI, DOAJ (Direct Directory of Open Access Journals), or from the bibliography of the articles being searched. RESULTS: Supplementary food was given to pregnant women by giving pumpkin seeds and Moringa leaf extract impact on improving nutritional status, Hb, ferritin, and CRP levels in pregnant women, as well as preventing adverse pregnancy outcomes such as low birth weight. CONCLUSION: The provision of pumpkin seed biscuits and Moringa leaf extract to pregnant women can affect Hb, ferritin, and CRP levels and can affect maternal nutritional status and affect pregnancy outcomes.

Perinatal outcomes of women with hypertensive disorders of pregnancy in Jimma Medical Center, southwest Ethiopia: Retrospective cohort study

BACKGROUND

Hypertensive disorders of pregnancy (HDP) increases adverse perinatal outcomes in women with the disorder. About 16% of all still births and 10% of early neonatal deaths are accounted by HDP. In Ethiopia, HDP complicates about 6% of all pregnancies. Hence, the objective of this study was to determine the risk of adverse perinatal outcomes among women with HDP in Jimma Medical Center, southwest Ethiopia.

METHODS

A retrospective cohort study was conducted on a total of 777 women who gave birth from June 2017 to March 2020 at Jimma Medical Center, southwest Ethiopia. Women with HDP and normotensive women who gave birth at or after 28 weeks of gestation were enrolled as exposed and unexposed respectively. Simple random sampling technique was used to select study participants. Data were reviewed using structured data collection performa that was prepared after reviewing relevant literatures. Data were entered to Epi-Data then exported to STATA version 13 for analysis. The adverse perinatal outcomes risk were examined using log binomial and modified Poisson regression model with robust standard errors.

RESULTS

In this study, the overall incidence of adverse perinatal outcome was higher among women with hypertensive disorders of pregnancy (HDP) than normotensive women (64.1% versus 32.8%). After adjusting for confounders, women with HDP were at higher risk of babies with low birth weight (adjusted RR = 2.88 (2.2, 3.75)), preterm birth(aRR = 2.31(1.7, 3.14)), fifth minute low Apgar score (aRR = 2.6(1.53, 4.42)), admission to neonatal intensive care unit (aRR = 1.77(1.32, 2.37), stillbirth (aRR = 2.02(1.11, 3.01)), and perinatal mortality (aRR = 3.88(1.97, 7.66)) than normotensive women.

CONCLUSION

Women with hypertensive disorder of pregnancy were at higher risk of adverse perinatal outcomes than normotensive women who gave birth at Jimma Medical Center, southwest Ethiopia. Therefore, health care providers should strengthen prevention, early diagnosis and prompt management of HDP in order to reduce adverse perinatal outcomes.

Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013 and 2017

Background

Malaria in endemic countries is often asymptomatic during pregnancy, but it has substantial consequences for both the mother and her unborn baby. During pregnancy, anaemia is an important consequence of malaria infection. In Burkina Faso, the intensity of malaria varies according to the season, albeit the prevalence of malaria and anaemia as well as their risk factors, during high and low malaria transmission seasons is underexplored at the household level.

Methods

Data of 1751 pregnant women from October 2013 to March 2014 and 1931 pregnant women from April 2017 to June 2017 were drawn from two cross-sectional household surveys conducted in 24 health districts of Burkina Faso. Pregnant women were tested for malaria in their household after consenting. Asymptomatic carriage was defined as a positive result from malaria rapid diagnostic tests in the absence of clinical symptoms of malaria. Anaemia was defined as haemoglobin level less than 11 g/dL in the first and third trimester and less than 10.5 g/dL in the second trimester of pregnancy.

Results

Prevalence of asymptomatic malaria in pregnancy was estimated at 23.9% (95% CI 20.2–28.0) during the high transmission season (October–November) in 2013. During the low transmission season, it was 12.7% (95% CI 10.9–14.7) between December and March in 2013–2014 and halved (6.4%; 95% CI 5.3–7.6) between April and June 2017. Anaemia prevalence was estimated at 59.4% (95% CI 54.8–63.8) during the high transmission season in 2013. During the low transmission season, it was 50.6% (95% CI 47.7–53.4) between December and March 2013–2014 and 65.0% (95% CI 62.8–67.2) between April and June, 2017.

Conclusion

This study revealed that the prevalence of malaria asymptomatic carriage and anaemia among pregnant women at the community level remain high throughout the year. Thus, more efforts are needed to increase prevention measures such as IPTp–SP coverage in order to reduce anaemia and contribute to preventing low birth weight and poor pregnancy outcomes.

Salivary cystatin SN is a factor predicting iron bioavailability after phytic acid rich meals in female participants

Phytic acid is an inhibitor of iron bioavailability, but it has been suggested that individuals may adapt to phytic acid over time, and that the salivary protein, cystatin SN, may be involved. This study evaluated the relationship between human cystatin SN levels and iron bioavailability after a phytic acid rich meal. Three groups of ten women consumed meals with: (1) 500 mg phytate sprinkles, (2) 500 mg phytate capsules, or (3) no phytic acid. Iron bioavailability was measured by the mealtime percentage of maximum iron recovery; cystatin SN was measured pre-and post-meal by enzyme-linked immunosorbent assay. Pre-to-post meal cystatin SN was positively correlated with improved iron bioavailability in group 1. Pre-to-post meal cystatin SN was correlated with improved iron absorption in groups 1 and 2. Cystatin SN recovery after phytic acid rich meals may be a physiological factor predicting iron bioavailability.

First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia

Introduction

Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting.

Objective

This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (Sysmex^R). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR).

Result

One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, p < 0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml.

Conclusion

This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.

Modification of the effects of prenatal manganese exposure on child neurodevelopment by maternal anemia and iron deficiency

BACKGROUND

We evaluated: (1) associations of prenatal manganese (Mn) levels with child neurodevelopment at 4-6 years; (2) effect modification by maternal anemia and iron deficiency; and (3) sex-specific effects.

METHODS

We measured blood Mn, hemoglobin, and serum ferritin in mothers at the second trimester, third trimester, and at birth, and in cord blood from a prospective birth cohort in Mexico City (n = 571). McCarthy Scales of Children's Abilities were measured at 4-6 years. Using linear regression, we estimated associations between prenatal Mn and neurodevelopment, examined anemia and iron deficiency as effect modifiers, and analyzed associations by child sex.

RESULTS

No direct associations were observed between Mn, anemia, or iron deficiency and McCarthy Scales. Second trimester iron deficiency and third trimester anemia modified the effect of Mn on child neurodevelopment. For instance, second trimester Mn was positively associated child memory scores in mother's with normal ferritin (1.85 (0.02, 3.45)), but negatively associated in mother's with low ferritin (-2.41 (-5.28, 0.47), interaction P value = 0.01), a pattern observed across scales. No effect modification at birth or in cord blood was observed.

CONCLUSIONS

Anemia/iron deficiency during pregnancy may modify Mn impacts on child neurodevelopment, particularly in boys.

Prevalence and Correlates of Asymptomatic Malaria and Anemia on First Antenatal Care Visit among Pregnant Women in Southeast, Tanzania

Asymptomatic malaria and anemia during pregnancy increase the risk of negative birth outcomes. This cross-sectional study investigated the prevalence and correlates of asymptomatic malaria and anemia during first antenatal care (ANC) visit among pregnant women in a rural district, Tanzania. HIV-uninfected pregnant women without symptoms of malaria (n = 819) attending their first ANC at Kibiti Health Centre were enrolled from February 2017 to February 2018. Asymptomatic malaria was detected by malaria rapid-diagnostic tests (mRDT) and real-time PCR. Hemoglobin concentration was determined by HemoCue Hemoglobin 201+. The study outcomes were the prevalence of asymptomatic malaria and anemia (Hemoglobin level <11 g/dL). The overall prevalence of asymptomatic malaria was 36.4% (95% CI: 33.1, 39.8). The monthly prevalence of asymptomatic malaria remained >25% throughout the year, and the highest prevalence (40%) was recorded during the rainy season. Asymptomatic malaria was significantly associated with primigravida, younger maternal age, and anemia. The prevalence of anemia was 68.5% (95% CI: 65.2, 71.6). Asymptomatic malaria, primigravida, younger maternal age and low Body Mass Index were significant predictors of low hemoglobin concentration. We report high prevalence of asymptomatic malaria and anemia among pregnant women on the first ANC visit. Screening of malaria and anemia during the first ANC visit is recommended for targeted interventions.

The role of iron repletion in adult iron deficiency anemia and other diseases

Iron deficiency anemia (IDA) is the most prevalent and treatable form of anemia worldwide. The clinical management of patients with IDA requires a comprehensive understanding of the many etiologies that can lead to iron deficiency including pregnancy, blood loss, renal disease, heavy menstrual bleeding, inflammatory bowel disease, bariatric surgery, or extremely rare genetic disorders. The treatment landscape for many causes of IDA is currently shifting toward more abundant use of intravenous (IV) iron due to its effectiveness and improved formulations that decrease the likelihood of adverse effects. IV iron has found applications beyond treatment of IDA, and there is accruing data about its efficacy in patients with heart failure, restless leg syndrome, fatigue, and prevention of acute mountain sickness. This review provides a framework to diagnose, manage, and treat patients presenting with IDA and discusses other conditions that benefit from iron supplementation.

Heart rate variability is reduced in normal pregnancy irrespective of trimester: A cross-sectional study from Gujarat, India

Background:

Pregnancy is associated with profound cardiovascular adaptation with altered cardiac autonomic balance. It can be studied by heart rate variability (HRV) which indicates beat to beat RR interval variation on ECG.

Objective:

We studied 5 min HRV in normal pregnant females divided by trimesters, compared to matched control.

Methodology:

We recruited 89 normal pregnant females and 30 age matched controls. Five minutes resting HRV was measured by Variowin HR, software-based instrument, by standard protocols to yield time-domain, frequency domain, and Poincare plot parameters. They were further compared between groups for difference.

Results:

Case groups (three based on trimesters) and control group were comparable. There was reduced HRV in case than control group, with statistical significance for all, more for frequency domain than time-domain or Poincare plot parameters. There was no pattern of HRV trend across three trimesters, but mostly second trimester was associated with major decline. Primipara revealed significantly reduced HRV than multipara, but anemia or working status was not significantly associated with HRV in case group.

Conclusion:

There is global HRV reduction in normal pregnancy across all trimesters, associated with primiparity. This indicates pregnancy as a significant risk with reference to altered cardiac balance and use of HRV as a good tool to assess the same.

The Association between Maternal Dietary Iron Intake during the First Trimester of Pregnancy with Pregnancy Outcomes and Pregnancy-Related Complications

In this study, we investigated the associations of maternal dietary iron intake during the first trimester of pregnancy and pregnancy outcomes and related complications in pregnant women of Isfahan, Iran. In this prospective study, 812 healthy first-trimester singleton pregnant women were selected randomly from 20 various health centers across Isfahan city during 2015–2016. The maternal dietary iron classified into 2 groups, including heme and non-heme iron. Factors including pre-eclampsia, gestational hypertension, gestational diabetes mellitus, intrauterine growth restriction (IUGR), and nausea and vomiting in pregnancy considered as the pregnancy-related complications. Infant's birth weight, birth height, and birth head circumference were also determined as the pregnancy-outcomes. There was a significant association between total iron consumption and infant head circumference (p = 0.01). Total maternal iron (the sum of heme and non-heme iron) was negatively associated with both infant's birth height (p = 0.006) and birth weight (p = 0.02). Non-heme iron consumption is positively associated with high-risk of IUGR (p = 0.004). Heme intake was associated with an increased risk of maternal fasting blood sugar (FBS) (p = 0.04). Higher heme, non-heme, and total iron intake were associated with lower risk of pre-eclampsia (heme: crude p = 0.05; non-heme iron: adjusted p = 0.02; total iron: adjusted p = 0.05). Maternal total iron intake was directly associated with infant head circumference, whereas, negatively associated with both birth weight and birth height. High non-heme iron intake may increase the risk of IUGR, and a high intake of heme iron may increase FBS.

Prenatal Zinc and Vitamin A Reduce the Benefit of Iron on Maternal Hematologic and Micronutrient Status at Delivery in Tanzania

BACKGROUND

Zinc and vitamin A supplementation have both been shown to affect iron status, hemoglobin (Hb) concentration, and anemia in animal and human studies. However, evidence on their combined use in pregnancy, in the context of iron-folic acid (IFA) supplementation, remains limited.

OBJECTIVE

This study determined the effects of prenatal zinc, vitamin A, and iron supplementation on maternal hematologic and micronutrient status at delivery in Tanzania.

METHODS

We analyzed 2 large randomized controlled trials, using generalized estimating equations, and examined the effect of daily zinc (25 mg) and vitamin A (2500 IU) supplementation starting in the first trimester of pregnancy compared with placebo (n = 2500), and separately evaluated the safety and efficacy of daily iron (60 mg) supplementation among iron-replete pregnant women (n = 1500). Blood samples from baseline and delivery were tested for Hb, serum ferritin, soluble transferrin receptor, plasma zinc, and zinc protoporphyrin.

RESULTS

Zinc and vitamin A supplementation were associated with lower Hb concentrations at delivery of  -0.26 g/dL (95% CI: -0.50, -0.02 g/dL) and -0.25 g/dL (95% CI: -0.49, -0.01 g/dL), respectively. Vitamin A increased mean ferritin concentrations at delivery (14.3 μg/L, 95% CI: 1.84, 29.11 μg/L), but was associated with increased risk of severe anemia (RR: 1.41; 95% CI: 1.06, 1.88). Among women who were iron replete at baseline, iron supplementation reduced the risk of iron depletion at delivery by 47% (RR: 0.53; 95% CI: 0.43, 0.65). There was no effect of zinc or iron supplements on plasma zinc concentrations.

CONCLUSIONS

Our findings support existing WHO guidelines on prenatal iron, vitamin A, and zinc supplementation among pregnant women. In this setting, scaling uptake of prenatal iron supplements is warranted, but prenatal zinc and vitamin A supplementation did not benefit maternal hematologic status at delivery. In settings where vitamin A deficiency is endemic, the efficacy and safety of the WHO recommended prenatal vitamin A supplementation require further evaluation.

Addressing anemia among women in India-an informed intervention using Facebook Ad Manager

BACKGROUND

Women in India continue to have high rates of anemia, especially in critical periods of adolescence and pregnancy. Anemia persists despite decades of government programs aimed at combatting anemia, including through the provision of iron folic acid tablets (IFA). With growing access to mobile phones and social media, even among women, mobile interventions hold potential for influencing knowledge and behaviors. Social media consumption, including on Facebook, is high in India. However, little research has explored if women can be reached with health messages using social media, if data can be collected through this mechanism, and if interventions using social media impact knowledge and behaviors surrounding important health issues such as anemia. The aims of this study were to test an advertising campaign on Facebook about anemia and IFA to women, collect data through social media, and measure its impact.

METHODS

A baseline survey and two follow-up surveys were sent to women via Facebook in 2019 in two states of India: Madhya Pradesh and Uttar Pradesh. Between each round of data collection, a set of advertisements based on gaps in knowledge and practices identified in the baseline on anemia and IFA were delivered to more than 3 million women on Facebook. Using this data, we analyze current knowledge and behaviors around anemia and IFA and look at differences by socio-demographics including age, marital status, and pregnancy. Using logistic regression models, we then look for evidence of a significant change in knowledge and behaviors between rounds of data collection.

RESULTS

We find that while general knowledge about anemia was high, especially related to its importance in pregnancy, misperceptions persist, such as that it makes babies large and delivery difficult. Only about 15% of the population was currently taking IFA, although nearly 50% noted that they had at some point. Younger women had lower levels of knowledge and practices. Findings about the impact of the Ad campaigns were mixed, with some indicators changing in positive and some in negative directions and no clear trend between surveys. Two indicators that were of high focus in the Ad campaigns changed in the desired direction after both ad campaigns (iron can make labor/delivery difficult and iron supplements are only for women who have anemia).

CONCLUSIONS

Overall, this study shows that a social media campaign about anemia has the potential to reach a large number of women in India, including young women, who are hard to reach if they are not in school or currently pregnant and seeing a physician. This study shows that it is possible to collect data from women through social media and measure the impact of an intervention. More research is needed to know if social media is an effective approach to actually change attitudes and behaviors related to anemia, or other important health concerns.

Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders

Importance

Given the critical role that iron plays in neurodevelopment, an association between prenatal iron deficiency and later risk of neurodevelopmental disorders, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability (ID), is plausible.

Objective

To test the a priori hypothesis that anemia diagnosed in mothers during pregnancy is associated with an increased risk of ASD, ADHD, and ID in offspring and that the magnitude of the risk varies with regard to the timing of anemia in pregnancy.

Design, Setting, and Participants

This cohort study used health and population register data from the Stockholm Youth Cohort to evaluate 532 232 nonadoptive children born from January 1, 1987, to December 31, 2010, in Sweden, with follow-up in health registers until December 31, 2016. Data analysis was performed from January 15, 2018, to June 20, 2018.

Exposures

Registered diagnoses of anemia during pregnancy. Gestational timing of the first recorded anemia diagnosis (≤30 weeks or >30 weeks) was considered to assess potential critical windows of development.

Main Outcomes and Measures

Registered diagnoses of ASD, ADHD, or ID or co-occurring combinations of these disorders.

Results

The cohort included 532 232 individuals (272 884 [51.3%] male) between 6 and 29 years of age at the end of follow-up (mean [SD] age, 17.6 [7.1] years) and their 299 768 mothers. The prevalence of ASD, ADHD, and ID was higher among children born to mothers diagnosed with anemia within the first 30 weeks of pregnancy (4.9% ASD, 9.3% ADHD, and 3.1% ID) compared with mothers with anemia diagnosed later in pregnancy (3.8% ASD, 7.2% ADHD, and 1.1% ID) or mothers not diagnosed with anemia (3.5% ASD, 7.1% ADHD, and 1.3% ID). Anemia diagnosed during the first 30 weeks of pregnancy but not later was associated with increased risk of diagnosis of ASD (odds ratio [OR], 1.44; 95% CI, 1.13-1.84), ADHD (OR, 1.37; 95% CI, 1.14-1.64), and ID (OR, 2.20; 95% CI, 1.61-3.01) in offspring in models that included socioeconomic, maternal, and pregnancy-related factors. Early anemia diagnosis was similarly associated with risk of ASD (OR, 2.25; 95% CI, 1.24-4.11) and ID (OR, 2.59; 95% CI, 1.08-6.22) in a matched sibling comparison. Considering mutually exclusive diagnostic groups, we observed the strongest association between anemia and ID without co-occurring ASD (OR, 2.72; 95% CI, 1.84-4.01). Associations of these disorders with anemia diagnosed later in pregnancy were greatly diminished.

Conclusions and Relevance

In contrast to maternal anemia diagnosed toward the end of pregnancy, anemia diagnosed earlier in pregnancy was associated with increased risk of the development of ASD, ADHD, and particularly ID in offspring. Given that iron deficiency and anemia are common among women of childbearing age, our findings emphasize the importance of early screening for iron status and nutritional counseling in antenatal care.

Nutritional Gaps and Supplementation in the First 1000 Days

Optimized nutrition during the first 1000 days (from conception through the 2nd birthday) is critical for healthy development and a healthy life for the newborn. Pregnancy and the postpartum period are accompanied by physiological changes, increased energy needs, and changing requirements in the nutrients critical for optimal growth and development. Infants and toddlers also experience physiological changes and have specific nutritional needs. Food and nutrition experts can provide women of childbearing age with adequate dietary advice to optimize nutrition, as well as guidance on selecting appropriate dietary supplements. Considering the approaching 2020-2025 Dietary Guidelines for Americans (DGA) will be making specific recommendations for children, it is important to provide accurate scientific information to support health influencers in the field of nutrition. The purpose of this review is to summarize the nutrition and supplementation literature for the first 1000 days; to highlight nutritional and knowledge gaps; and to educate nutrition influencers to provide thoughtful guidance to mothers and families. Optimal nutrition during pregnancy through early childhood is critical for supporting a healthy life. Nutrition influencers, such as dietitians, obstetricians/gynecologists, and other relevant health professionals, should continue guiding supplement and food intake and work closely with expectant families and nutrition gatekeepers.

Prenatal manganese and cord blood mitochondrial DNA copy number: Effect modification by maternal anemic status

INTRODUCTION

Manganese (Mn) is an essential nutrient but also a toxicant at high exposures, when it can induce oxidative stress (OS). Mn uptake is inversely correlated with iron status, therefore anemic individuals may be more susceptible to Mn overload induced-OS, which can manifest as changes in mitochondrial DNA copy number (mtDNA CN). Our objectives were to: 1) determine stage-specific associations of prenatal Mn exposure with cord blood MtDNA CN; and 2) investigate effect modification by maternal anemia, ferritin, and mean corpuscular volume (MCV).

MATERIALS AND METHODS

We measured whole blood Mn, hemoglobin, serum ferritin, and MCV in the 2nd and 3rd trimester, in maternal blood at birth, and in cord blood from a prospective birth cohort in Mexico City, Mexico (n = 485). We then extracted DNA from cord blood leukocytes to determine mtDNA CN. We used robust regression to measure associations between Mn and mtDNA CN at each trimester and at birth. Anemia (hemoglobin ≤11 g/dL), iron deficiency (ferritin ≤15 ng/mL) and MCV (stratified at median), were examined as effect modifiers.

RESULTS

Mn levels increased throughout pregnancy, and Mn was inversely correlated with ferritin. We observed a positive association between Mn in the 3rd trimester and Mn in cord blood and mtDNA CN (β = 0.04-0.05; 95% CI = 0.01, 0.08). Anemia significantly modified the association between mtDNA CN and Mn in the 2nd trimester. We found a positive association between 2nd trimester Mn and mtDNA CN in mothers with normal hemoglobin, and a negative association in those with low hemoglobin. (βhigh = 0.06; 95% CI = 0.01, 0.11; p = 0.01 and βlow = -0.06; 95% CI = 0.03, -0.13; p = 0.06). No associations were detected between anemia, iron deficiency and MCV and mtDNA CN.

CONCLUSIONS

Maternal blood Mn in the 3rd trimester and in cord blood was positively associated with mtDNA CN, suggesting that higher late pregnancy prenatal Mn exposures can impact newborn mitochondria by promoting OS. Furthermore, 2nd trimester Mn was positively associated with mtDNA in non-anemic mother-child pairs but inversely associated in anemic individuals, indicating potential interactions between Mn and chronic anemia.

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy: A Cohort Study

Background

The effect of maternal weights on the risk of iron deficiency anemia (IDA) during pregnancy remains unclear. The study aimed to investigate the association between maternal weight indicators and IDA during pregnancy.

Methods

We conducted a cohort study to examine the association between maternal weight indicators, including prepregnancy body mass index and the rate of gestational weight gain (GWG), and the risk of IDA among Chinese pregnant women. Data about new-onset IDA at different trimesters from a national cross-sectional survey were collected; information regarding baseline variables and rate of GWG from women participating in the survey were retrospectively collected. Tested IDA and reported IDA were documented. Multilevel logistic regression to examine the association between maternal weight indicators and the risk of IDA after adjusting for potential confounders was conducted.

Results

This study enrolled 11,782 pregnant women from 24 hospitals from September 19, 2016, to November 20, 2016. Among those, 1515 (12.9%) IDA events were diagnosed through test (test IDA); 3915 (33.3%) were identified through test and patient reporting (composite IDA). After adjusting for confounders and cluster effect of hospitals, underweight pregnant women, compared with normal women, were associated with higher risk of test IDA (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.17-1.57 and composite IDA (aOR: 1.35, 95% CI: 1.21-1.51); on the contrary, overweight and obese women had lower risk of test IDA (aOR: 0.68, 95% CI: 0.54-0.86 overweight; aOR: 0.30, 95% CI: 0.13-0.69 obese) and composite IDA (aOR: 0.77, 95% CI: 0.67-0.90 overweight; aOR: 0.34, 95% CI: 0.21-0.55 obese). The higher rate of GWG was associated with higher risk of IDA (test aOR: 1.86 95% CI: 1.26-2.76; composite aOR: 1.54, 95% CI: 1.16-2.03).

Conclusions

Pregnant women who are underweight before pregnancy and who have faster GWG are more likely to develop IDA. Enforced weight control during pregnancy and use of iron supplements, particularly among underweight women, may be warranted.

Maternal anemia and pediatric neurological morbidity in the offspring - Results from a population based cohort study

OBJECTIVE

Maternal anemia (Hemoglobin, <11 mg/dl) has been shown to affect fetal growth and pregnancy outcome. We aimed to study a possible association between maternal anemia and the risk for neurological morbidity in the offspring, during a follow-up period of up to 18 years.

STUDY DESIGN

A population-based cohort analysis was performed at the Soroka University Medical Center (SUMC), a single regional tertiary center comparing total and specific subtypes of neurological morbidities associated with hospitalizations among children stratified by three maternal post-partum hemoglobin categories: ≥11 mg/dl (no anemia); 11.0 mg/dl > Hb ≥ 7 mg/dl (mild-to-moderate anemia) and <7 mg/dl (severe anemia). Data on pregnancy course and outcome, and later offspring hospitalizations, were compared between the three study groups. All singleton deliveries between the years 1991-2014 were included in the analysis, and congenital malformations were excluded. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence based on maternal anemia status, and a Weibull survival multivariable hazard model was constructed to adjust for confounding variables.

RESULTS

The study population included 217,358 deliveries of which 50.6% were in mothers who were not anemic, 49.0% in mothers with moderate anemia and 0.4% in mothers with severe anemia. During the follow up period (0-18 years, median 10.22 years), 2.1% of offspring were hospitalized with a neurological diagnoses. Neurological hospitalization incidence decreased from 2.95/1000 person years, in the severe anemia group, to 2.32/1000 person years and 2.01/1000 person years, among the mild-to-moderate and no anemia groups, respectively (p = 0.007). The association between maternal anemia and offspring long-term pediatric neurological morbidity remained significant in a Weibull hazards model controlled for gestational age, delivery mode, SGA and insufficient prenatal care (adjusted HR 1.55; 1.05-2.31 and adjusted HR 1.13; 1.06-1.20; among the severe and mild-to-moderate anemia, vs. no anemia, respectively).

CONCLUSION

Children born to anemic mothers are at an increased risk for pediatric neurological-related hospitalizations.

Efficacy of ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia with pregnancy: a randomized double-blind clinical trial

Objective: The aim of this study is to compare the efficacy and tolerability of oral ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia (IDA) with pregnancy.Methods: A randomized double-blind clinical trial (NCT02590224) conducted at a tertiary University Hospital in the period between 1 January 2016 and 31 July 2017 included pregnant women at 14-18 weeks of gestation with mild to moderate IDA. Patients were randomized into two groups: (Group I) received oral ferrous bis-glycinate tablets once daily for eight consecutive weeks and (Group II) received oral ferrous glycine sulfate capsules in the same dose and duration. The primary outcome of the study was the rate of increase of hemoglobin (HB) level after 8 weeks of iron treatment.Results: The study included 187 women in the final analysis. The mean increase in HB level after 8 weeks of treatment in ferrous bis-glycinate group was 2.48 ± 0.12 g/dL versus 1.32 ± 0.18 g/dL in ferrous glycine sulfate group (p ≤ .0001). The percentage of women with HB level more than 11 g/dL after 8 weeks of treatment was 89.2% in ferrous bis-glycinate group versus 71.3% in ferrous glycine sulfate group (p < .0001). The rate of adverse effects was significantly higher in ferrous glycine sulfate group (p = .001).Conclusions: Pregnant women with second trimester IDA could be supplied with ferrous bis-glycinate which is more efficient in increasing HB level. Moreover, it has tolerable adverse effects and high compliance than ferrous glycine sulfate.

Early Postpartum Hemoglobin Less Than 10 g/dL Is Associated with Future Maternal Atherosclerotic Morbidity

OBJECTIVE

Anemia is associated with increased cardiovascular morbidity in the general population. Anemia is common during pregnancy. We examined the association between anemia at the very early postpartum period and long-term atherosclerotic-related morbidity.

PATIENTS AND METHODS

A retrospective study including women who gave birth between 1988 and 2013 was conducted. The women were divided into two groups according to hemoglobin (Hb) value on the first day after delivery: Hb <10 g/dL and Hb ≥10 g/dL. We examined the rates of hospitalization due to atherosclerotic-related morbidity, which were classified into minor and major events. The follow-up period was from the index birth until either hospitalization or the end of study period. Survival estimates were calculated by Kaplan-Meier survival analysis. Cox proportional hazards models were used to evaluate whether Hb <10 gr/dL is an independent risk factor for long-term atherosclerotic events.

RESULTS

The study population included 30,088 (37.40%) women with Hb <10 g/dL and 50,354 (63%) women with Hb ≥10 g/dL at the index birth. The hospitalization incidence density was higher in the Hb <10 g/dL group versus the Hb ≥10 g/dL group, for total atherosclerotic- related hospitalizations (4.35 vs. 3.76, p < 0.001), and hospitalization for major events (1.83 vs. 1.51, p < 0.001) and minor events (2.60 vs. 2.31, p < 0.001). In Cox proportional hazards models, it was demonstrated that Hb <10 g/dL was independently associated with total hospitalizations (HR 1.13; CI: 1.04-1.24 p = 0.004) and hospitalizations for major events (HR 1.16; CI: 1.01-1.34 p = 0.034) Conclusions: Hb <10 g/dL at the very early postpartum period might be a marker for long-term atherosclerotic-related morbidity.

Iron Nutriture of the Fetus, Neonate, Infant, and Child

Iron is a key nutrient and is essential for the developing fetus, neonate, infant, and child. Iron requirements are high during early stages of life because it is critically important for the production of new red blood cells and muscle cells as well as brain development. Neonates, infants, and children obtain iron from dietary sources including breast milk (lactoferrin) and heme- and non-heme-containing foods. Iron deficiency (ID) is the most common micronutrient deficiency in children and pregnant women worldwide. ID and iron deficiency anemia (IDA) can affect growth and energy levels as well as motor and cognitive performance in the developing child. The fetus is completely dependent on maternal iron crossing through the placenta and, although it is generally well protected against deficiency at birth, ID in mothers can increase the risk of ID and IDA in their children as early as 4 months. This review will discuss the uses of iron, iron requirements, and the sources of iron from conception through childhood. In addition, it will describe the prevalence and clinical manifestations of ID and IDA in children and discuss recommendations for iron supplementation of children and pregnant women.