Iron Deficiency Anemia in Pregnancy

Real-world evaluation of an intravenous iron service for the treatment of iron deficiency with or without anemia

Intravenous (IV) iron is a guideline-recommended treatment for iron deficiency when oral iron is contraindicated, ineffective, or not tolerated, or when rapid iron delivery is necessary. However, evidence suggests that some patients receive less IV iron than needed. This retrospective audit assessed the effectiveness and safety of ferric derisomaltose (FDI), a high-dose IV iron, in 2,468 patients. Efficacy outcomes assessed at 4-12 weeks post-infusion included changes in hemoglobin (Hb) and ferritin, proportion of courses (a course was defined as the treatment episode required to administer one total dose) after which patients were non-anemic (Hb ≥ 130 g/L [men] or ≥ 120 g/L [women]), and response rate (proportion of courses after which patients were non-anemic or Hb increased by ≥ 20 g/L). Safety was assessed through adverse events. Across 2,775 FDI courses, the mean dose was 1,244 mg, but mean estimated iron need was 1,580 mg. At follow-up, mean Hb had increased by 20.9 g/L and mean ferritin by 188.8 µg/L. Patients were non-anemic after 33.4% (n = 494/1,478) of courses and responded after 65.1% (n = 962/1,478) of courses. One patient (n = 1/2,468; 0.04%) had a serious allergic reaction. Patients remained anemic after > 65% of courses, demonstrating the need to optimize dosing based on iron need.

Enhancing diagnostic accuracy for iron deficiency in pregnant women through mean reticulocyte volume

BACKGROUND AND OBJECTIVES

Women are more prone to iron deficiency (ID) anemia when pregnant. The diagnostic use of mean reticulocyte volume (MRV) in identifying ID anemia during pregnancy has not been thoroughly investigated. The objective of this study is to evaluate the effectiveness of MRV in diagnosing ID in pregnant women.

METHODS AND STUDY DESIGN

Firstly, MRV of 20 healthy female volunteers (healthy group) was measured on specific days for one month. Subsequently, clinical data from 724 pregnant women were thoroughly examined. These women were divided into two groups: 282 with ID (research group) and 442 without ID (control group). Parameters such as MRV, reticulocyte hemoglobin equivalent (RHE), red blood cell volume distribution width-standard deviation (RDW-SD), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hematocrit (HCT), reticulocyte count (RET), MRV/MCV ratio, and serum ferritin (SF) were analyzed and compared.

RESULTS

MRV remained consistent over a period of one month for 20 healthy individuals. In addition, there were significant differences in MRV, RHE, RDW-SD, MCV, MCH, MCHC, HCT, RET, and MRV/MCV between the research group and control group. The receiver operating characteristic (ROC) analysis showed that the areas under the curve (AUCs) for these measures were as follow: 0.840, 0.837, 0.676, 0.654, 0.639, 0.602, 0.571, 0.550, and 0.816, respectively. Ultimately, there was a substantial disparity in MRV prior to and following therapy with oral iron treatments.

CONCLUSIONS

In healthy women, MRV remains stable and is a reliable ID marker, which can be used to assess oral iron treatment effectiveness during pregnancy.

The Iron Enigma: Expounding Iron Deficiency in a Pregnant Woman With Hemochromatosis and Celiac Disease

Hereditary hemochromatosis (HH) is an inherited disorder, characterized by abnormal iron metabolism, resulting in systemic iron overload. The iron deposits in multiple organs including the liver, pancreas, heart, pituitary gland, joint, and skin and causes tissue damages leading to clinical manifestations. On the contrary, celiac disease (CD) is an autoimmune disorder associated with genetic and environmental triggers and frequently associated with iron deficiency. Additionally, pregnancy results in a physiological state of increased iron requirement due to volume expansion and fetus growth and development. We present an interesting case of a young female patient with concomitant CD and HH, who developed iron depletion following venesection which was further complicated by pregnancy and the postpartum period. This case highlights the rare co-existence of CD and HH, underscoring the diagnostic and therapeutic challenges in managing these concurrent conditions. Furthermore, it emphasizes the importance of patient education, clinical management, appropriate follow-up, and close monitoring of patients by multidisciplinary teams to establish the correct balance of body iron storage in order to prevent potential complications in a female patient of child-bearing age.

Iron Level in Pregnant Rats is Associated with Caries Susceptibility in Offsprings

Iron deficiency anemia (IDA) is a prevalent issue in pregnant women and children. However, the causal relationship between IDA in pregnancy and caries susceptivity in offspring remains unclear. This study aimed to explore the role of iron level during pregnancy on caries susceptivity of offsprings. Here, low-iron (LI) and high-iron (HI) models were established in maternal rats, and iron-related characteristics were examined in maternal rats and their offsprings. After induction of caries in rat offsprings, the carious lesions were evaluated by the Keyes scores, and microstructural damages in molars were observed by scanning electron microscopy. The results showed that LI in maternal rats induced IDA in rat offsprings, and HI only increased serum ferritin in offsprings. LI and HI in maternal rats had no effect on the morphological structure of salivary glands in rat offsprings. After inducing caries, rat offsprings in the LI group exhibited significant increase in enamel lesions at the smooth surface, and on enamel, slight dentinal, and moderate dentinal lesions at the sulcal surface. Only enamel lesions at the sulcal surface were significantly weakened in the HI group. Additionally, visible enamel damages were observed in the LI group. To sum up, iron deficiency during pregnancy enhances caries susceptibility in rat offsprings.

Succession of rumen microbiota and metabolites across different reproductive periods in different sheep breeds and their impact on the growth and development of offspring lambs

BACKGROUND

The microbiota and metabolites in the gastrointestinal tracts of female animals at different reproductive periods are very important to the growth, development, and health of themselves and their offspring. However, the changes in the gastrointestinal microbiota and metabolites throughout reproductive period of different sheep breeds and their effects on the growth and development of offspring lambs are still unclear. Hence, this study presents an assessment of the reproductive hormone levels, immune levels, rumen microbiota, and metabolites in Hu sheep and Suffolk ewes at different reproductive periods and their effects on the growth and development of offspring lambs.

RESULTS

Hu sheep and Suffolk during non-pregnancy, pregnancy, and lactation were used as the research objects to determine reproductive and immune indexes of ewes at different periods, analyze rumen microbiome and metabolome, and track the growth performance and development of offspring lambs. The results showed that the reproductive hormone and immune levels of Hu sheep and Suffolk underwent adaptive changes across different reproductive periods. Compared with non-pregnancy, the microbial energy metabolism and lipid metabolism function decreased during Hu sheep pregnancy, and energy metabolism function decreased during lactation. In Suffolk, energy metabolism, glycan biosynthesis, and metabolism function were enhanced during pregnancy, and the metabolism of cofactors and vitamins was enhanced during lactation. Prevotella increased in Suffolk during pregnancy and lactation (P < 0.05) and was positively correlated with the birth weight and body size of the lambs (P < 0.05). Moreover, the abundances of Butyrivibrio and Rikenellaceae_RC9_gut_group during pregnancy were positively correlated with the intestinal immunity of the offspring lambs (P < 0.05), thereby regulating the intestinal immunity level of the lambs. Metabolomic analysis revealed that the protein digestion, absorption, and amino acid metabolism of Hu sheep were enhanced during pregnancy, which provided amino acids for the growth and development of pregnant ewes and fetuses and was significantly correlated with the birth weight, body size, and intestinal immunity of lambs (P < 0.05). Simultaneously, there was an increase in acetate and propionate during the pregnancy and lactation period of both Hu sheep and Suffolk, providing energy for ewes during reproductive period. Moreover, the microbiota during the lactation period was significantly correlated with the milk quality and lambs daily gain (P < 0.05).

CONCLUSIONS

This study revealed the characteristic succession changes in the rumen microbiota and its metabolites at different reproductive periods in sheep breeds and their regulation of reproductive hormone and immune levels and identified their potential effects on the growth and development of offspring lambs. The findings provide valuable insights into the health and feeding management of different sheep breeds during the reproductive stage. Video Abstract.

Pathophysiology and management of iron deficiency anaemia in pregnancy: a review

According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother's blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.

Effects of Maternal Anemia Affecting Fetal Outcomes: A Narrative Review

This review's main objective was to assess the obstacles to anemia prevention, as well as the attitudes and behaviors of anemic women toward their condition. Since iron is crucial for neurodevelopment, iron deficiency anemia (IDA) accounts for the majority of pregnant mothers having anemia. In India and other developing countries, anemia is a serious health problem. More than half of pregnant women have anemia. The search strategy was conducted in PubMed. Few of the articles were searched without using MeSH terms. Strong correlations between mothers' anemia and that of their offspring point to intergenerational anemia with lasting consequences. Children who were underweight at birth and those who were malnourished had a higher risk of having anemia. Clinicians usually evaluate anemia, and the criteria for determining the cause of anemia are outlined in this brief review.

Current research and evidence gaps on placental development in iron deficiency anemia

Studying the effects of maternal iron deficiency anemia (IDA) is complex owing to its diverse causes, each independently impacting the placenta and fetus. Simple treatment with iron supplements does not always resolve the anemia. Therefore, delving into how IDA alters placental development at a molecular level is crucial to further optimize treatment. This review addresses the effects of IDA on placental structures and functions, including changes in oxygen levels, blood vessels, and the immune system. Profound understanding of physiological characteristics and regulatory mechanisms of placental development is key to explain the mechanisms of abnormal placental development in pregnancy-associated disorders. In turn, future strategies for the prevention and treatment of pregnancy complications involving the placenta can be devised. These studies are significant for improving human reproductive health, enhancing sociodemographic qualities, and even lifelong wellbeing, a focal point in future placental research.

Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure

This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.

How Maternal Nutritional and Mental Health Affects Child Health During Pregnancy: A Narrative Review

Throughout pregnancy, the mother's nutritional and mental health significantly influences the kid's long-term growth and wellness. This review's objective is to provide a comprehensive assessment of the literature on the link between pregnancy nutrition and a sound mind and a foetus' growth, considering factors in the physical, cognitive, emotional, and social domains. A balanced, nutrient-rich diet is crucial for the baby to grow and develop properly during pregnancy. An appropriate diet of significant macronutrients and micronutrients supports good foetal organ development, cognitive function, and immune system resiliency. For instance, studies have linked iron and omega-3 fatty acids to a reduced risk of developmental delays and improved cognitive performance. Contrarily, malnutrition in mothers, such as undernutrition or excessive weight gain, has been connected with negative results, including low birth weight, poor neurodevelopment, and increased susceptibility to chronic diseases in later life. The mother's mental health, including emotional equilibrium and psychological stability, significantly impacts the child's development. Stress, anxiety, and depression experienced by mothers during pregnancy harm the developing foetus and increase the risk of cognitive, behavioural, and emotional difficulties in the offspring. The growing foetus is exposed to high levels of stress hormones due to chronic maternal stress, which might alter the fetus's brain's shape and function. Factors influencing child development outcomes include maternal-infant attachment, breastfeeding start and duration, and general caring practices. A comprehensive approach is critical since new research indicates a synergistic relationship between maternal nutrition and mental health. Inadequate nutritional intake might result from maternal mental health problems that interfere with appetite control and eating habits. On the other hand, inadequate maternal nutrition may raise maternal stress and result in mental health problems. Therefore, integrative therapies focusing on both areas are essential to maximise child development results. In conclusion, maternal nutrition and mental health during pregnancy significantly impact a child's development in various domains. Understanding the complex relationships between maternal nutrition and mental health is necessary to develop effective therapies and promote the most remarkable results for children. Further research is needed to understand better the underlying mechanisms to develop evidence-based recommendations for optimal mother care throughout pregnancy. The need of this review is to know how maternal health, physical or mental affects the child's development and how we can further prevent it by taking precautions during pregnancy.

Interventions in Maternal Anaemia to Reduce Maternal Mortality Rate Across India

Anaemia is one of the most prevalent issues encountered throughout pregnancy, with Iron deficiency anaemia and megaloblastic anaemia being the most common causes in India. It is critical to address anaemia in pregnancy since it has been linked to adverse pregnancy outcomes like preterm delivery, low-birth-weight newborns, fetal mortality, and, in certain circumstances, maternal death. The maternal mortality rate (MMR) is one of the significant health challenges, particularly in developing countries. It has substantially impacted the population's social situation and requires quick management. In this review article, we discuss recent developments and advancements in treating maternal anaemia with the aid of some government health programs, which can help with lowering the risk of maternal mortality. The primary goal of this manuscript is to raise awareness about anaemia in pregnancy. We examined the literature on anaemia during pregnancy, with a view to offering current and unambiguous guidance for preventing and managing this illness, which, if not appropriately managed, can result in severe maternal and neonatal problems.

A Retrospective Study of Various Iron Preparations Oral Administration in Pregnant Women with Iron Deficiency Anemia

During pregnancy anemia is a common medical condition, with iron deficiency and megaloblastic anemia being the most common. The symptoms range from very mild to severe and if left without proper medical treatment, there can be serious consequences for both mother and fetus. The most frequent pregnancy problem is anemia. The term "Iron Deficiency Anemia" refers to erythropoiesis under conditions of absolute iron deficiency. This presupposes the depletion of iron stores in the body. Iron deficiency anemia or Sideropenic anemia is the most common form of anemia worldwide. Special attention must be given to nutrition during pregnancy. In the current retrospective study, it was evaluated the contribution of various iron preparations substitution during the pregnancy and puerperium.