Effect of postpartum iron supplementation on red cell and iron parameters in non-anaemic iron-deficient women: a randomised placebo-controlled study

OBJECTIVE

To investigate the effect of oral iron on postpartum red cell and iron parameters in non-anaemic women with iron deficiency.

DESIGN

Randomised study of supplementation with oral iron sulphate 80 mg daily or placebo for 12 weeks starting 24-48 hours after delivery, with visits antepartum and 1, 4, 6 and 12 weeks postpartum.

SETTING

Swiss university hospital obstetric unit.

PARTICIPANTS

Fifty-two women with antenatal iron deficiency (serum ferritin <15 microg/L) and no antenatal or postnatal anaemia (haemoglobin >11 g/dL up to 48 hours before delivery, and >10 g/dL postpartum), divided into two groups comparable in antenatal iron status.

METHODS

Supplementation was started 24-48 hours after delivery (visit 1:V1). Additional tablets were issued one week after V1 (V2), four weeks after V1 (V3) and six weeks after V1 (V4). The last visit took place 12 weeks after visit 1 and 6 weeks after visit 4 (V5). Patients were required to return blisters and boxes whether they were used and unused at each visit and compliance was assessed by counting the tablets. Blood samples for haematology and iron status testing were taken before delivery and at each visit.

MAIN OUTCOME MEASURES

Iron status (serum ferritin, hypochromic red cells, iron, transferrin saturation, soluble transferrin receptor concentration); erythropoiesis (standard parameters, including reticulocyte indices); and inflammatory response (serum neopterin, C-reactive protein, white cell count) in five-datapoint profiles.

RESULTS

Increased ferritin (P= 0.0004) and transferrin saturation (P= 0.03), decreased soluble transferrin receptors (P= 0.02); increased haemoglobin (P= 0.02) and decreased hypochromic red cells (P= 0.04) compared with placebo at 12 weeks, with no differences in other red cell or reticulocyte parameters. There was a positive correlation between C-reactive protein and postpartum ferritin. No correlation was observed in the puerperium between C-reactive protein and hypochromic red cells or soluble transferrin receptors.

CONCLUSIONS

Haemoglobin levels and iron stores in women with term gestational iron deficiency benefit significantly from iron supplementation compared with placebo, even in an industrialised population.

[Quality of life stress in patients with large tumors of the mouth. 3: Indications for preoperative assessment of individual coping capacity]

A three-part empirical study investigated in detail the effects of illness and therapy on patients with large tumors of the oral cavity (n = 50). Part 1 compared the limitations of quality of life (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). Part 2 dealt with the individual coping strategies applied by the patients. The aim of this third part was to evaluate those biopsychosocial variables which could serve preoperatively in determining whether a planned surgical intervention could benefit the patient's quality of life. For this purpose a dependent variable ("subjective burden of illness and therapy") was defined as the weighted sum of 9 scores (including "duration of survival" and LQL). 51 variables (19 medical, 7 demographic and many psychological) were chosen as potentially explanatory variables. 7 of the 8 exploratory variables correlating most strongly with the dependent variable had an emotional content: depressive personality, intensified preoperative anxiety and depression, emotional indifference, reinforced control of emotions, reservation and compulsiveness. The somatic variables with the highest correlations to the dependent variable were "more pronounced preoperative dysfunction" (4th place) and "extent of primary tumor" (9th place). The findings suggested that the primary reason for a delay (postponement of the first medical consultation) often resulting in a poorer prognosis is not the growth of the tumor in the meantime but the fact that the delay represents an existing resignation. This resignation and the reduced self-esteem generally underlying it would then be concomitant causes of poorer courses of the illness. The opportunities for the surgeon to support the patient's self-esteem are discussed.

[Quality of life stress in patients with large tumors of the mouth. 2: Dealing with the illness: coping, anxiety and depressive symptoms]

The psychosocial effects of disfigurements and dysfunctions after combined surgical and radio-oncological therapy of patients with large tumors of the oral cavity (n = 50) are investigated in a three-part study. Part 1 compared the "limitations of quality of life" (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). This second part records the coping strategies of the three groups of patients and relates them to the following variables: anxiety (STAI), depression (D-S'), despair (H-scale), self-image (GT), locus of control (KKG), intellectual capacity (shortend SPM) and psychosocial burden in early childhood (new questionnaire). The coping strategies of "compliance" and "self-encouragement" were used most often. Patients with a higher psychosocial burden in early childhood often chose defensive strategies (distrust, cognitive avoidance, distraction, reinforced control of emotions). Only few patients used strategies of healthy regression ("coasting values", A. Maslow). It seems that no specific single coping strategy (in particular not the frequently recommended "positive thinking") but an individualized selection of different strategies is of special value to patients. The self-esteem of the patient was identified as a crucial factor in increasing the effectiveness of coping strategies. The surgeon can support patients in their self-esteem by showing a genuine interest not only in their state of health but also in their personal background. The third part of the study is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

[Quality of life stress in patients with larger tumors of the mouth. A descriptive study of psychosocial effects of illness and primary surgery therapy in 3 parts--1: Quantity and quality of life]

Up to about 40 years ago, the therapy of large tumors of the oral cavity often resulted in severe disfigurement and dysfunctions. Modern resection and reconstruction techniques now enable tumors of this type to be removed in such a way that virtually normal eating and speech functions are restored and traces of the extensive surgery are barely noticeable in many patients. After rehabilitation, most of these patients seem objectively to have a high quality of life, but it is less clear whether their subjective experience is the same. In a three-part empirical study the "limitations of quality of life" (LQL) of 50 patients with large tumors of the oral cavity were investigated at four points of time: preoperatively as well as 1, 4 and 12 months postoperatively. Our self constructed questionnaire for LQL includes 241 questions covering 19 fields of limitation. The results were compared with those of a group of patients after total laryngectomy (n = 34) and a group of patients "without cancer" (n = 40). One year after surgery the limitations of quality of life of patients with large tumors of the oral cavity are still large but seem less so than those of patients after total laryngectomy. However, objectively marginal problems such as a change of body image through a minor disfigurement, slightly indistinct articulation, or a prolonged period of accustomization to dentures are experienced as a severe strain by many patients. The apparent hypersensitivity of many patients to minor discomfort is seen as an effect of the demands made by modern society for fast, subtle adaptive processes. The second part of the study deals with the coping strategies applied by patients, and the third part is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.