Current concepts in postpartum anemia management

PURPOSE OF REVIEW

Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment.

RECENT FINDINGS

Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age.

SUMMARY

Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.

Could ferritin, vitamin B12, and vitamin D play a role in the etiopathogenesis of fibromyalgia syndrome?

Introduction. Fibromyalgia syndrome (FS) comprises general body pain, sleep disturbances, and fatigue. Vitamin B₁₂ (VB), vitamin D (VD), and iron deficiencies lead to similar complaints. First, this study aimed to evaluate the VB, VD, and ferritin levels of patients with FS. Second, it aimed to investigate whether there was a relationship between these parameters and FS severity. Material and methods. The study included 58 female patients with FS and 58 healthy females as a control group. The patients completed the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), fatigue questionnaire, Pittsburgh sleep quality scale, and the Short Form-36 (SF-36). This study examined the VD, VB, and ferritin levels of the patient and control groups. Results. The VB (240.0 [110.0-394.0] vs 291.0 [210.0-609.0] pg/ml, p<0.001), VD (12.5 [3.0-45.0] vs 20.0 [5.0-54.0] ng/ml, p=0.013), and ferritin levels (21.2 [4.0-86.0] vs 32.0 [7.1-120.0], ng/ml, p=0.009) of the FS patients were determined to be significantly lower than those of the control group. A negative correlation was determined between the number of tender points and VB, VD, and ferritin levels. In the regression analysis, we found low ferritin levels (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.015-1.058, p<0.001) and VB (OR 1.010, CI 1.002-1.018, p=0.010) to be an independent risk factor for FS. Conclusions. There may be a relationship between VB, VD, and ferritin levels and the number of tender points in patients with FS. Levels of iron and VB may play a vital role in FS etiopathogenesis. However, VD levels may not be a risk factor for FS etiopathogenesis.

Serum hepcidin response as a marker of iron deficiency during second trimester of pregnancy: A multicenter cohort study in Lahore

Iron deficiency diagnosis is a key health priority during pregnancy. The precise determination of indicators is needed for the evaluation of iron deficiency. In the present study, we investigated the diagnostic features of hepcidin concentration as an iron deficiency assay during the second trimester of pregnancy. We collected 401 venous blood samples of pregnant females from 4 separate birthing hospitals. All the females were within 13-26 weeks of their pregnancy and without any comorbid conditions. The complete blood count, total iron binding capacity, ferritin, serum iron and serum hepcidin were determined. The women were categorized as being non-iron deficient (N-ID), iron deficient (ID), or with iron deficiency anemia (IDA). The mean hepcidin values for examined groups were, i.e., non-iron deficiency was 31.45±4.70 (μg/L), iron deficiency 20.47±2.48 (μg/L) and iron deficiency anemia was 17.33±1.90 (μg/L). The N-ID's hemoglobin mean levels were 13.05±0.10g/dL, ID 12.66±0.05g/dL and the IDA 8.11±00.12g/dL. In this article variations in hepcidin levels between N-ID, ID and IDA women are uncovered and it is reported that the lower hepcidin levels diagnosed in IDA are closely linked to hemoglobin in Pakistani women. Hence it is concluded that hepcidin can be a valuable marker in identifying iron deficiency and iron deficiency anemia during the second trimester of pregnancy, according to the Pearson's correlation data.

Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals

Importance

Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide.

Objective

To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data.

Design, Setting, and Participants

In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021.

Exposure

Anemia defined according to WHO Hb cutoffs.

Main Outcomes and Measures

To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 μg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia.

Results

A total of 79 950 individuals were included in the original surveys. The final healthy sample was 13 445 children (39.9% of the original sample of 33 699 children; 6750 boys [50.2%]; mean [SD] age 32.9 [16.0] months) and 25 880 women (56.0% of the original sample of 46 251 women; mean [SD] age, 31.0 [9.5] years). Survey-specific Hb fifth percentile among children ranged from 7.90 g/dL (95% CI, 7.54-8.26 g/dL in Pakistan) to 11.23 g/dL (95% CI, 11.14-11.33 g/dL in the US), and among women from 8.83 g/dL (95% CI, 7.77-9.88 g/dL in Gujarat, India) to 12.09 g/dL (95% CI, 12.00-12.17 g/dL in the US). Intersurvey variance around the Hb fifth percentile was low (3.5% for women and 3.6% for children). Pooled fifth percentile estimates were 9.65 g/dL (95% CI, 9.26-10.04 g/dL) for children and 10.81 g/dL (95% CI, 10.35-11.27 g/dL) for women. The Hb-for-sTfR curve demonstrated curvilinear associations with sTfR inflection points occurring at Hb of 9.61 g/dL (95% CI, 9.55-9.67 g/dL) among children and 11.01 g/dL (95% CI, 10.95-11.09 g/dL) among women.

Conclusions and Relevance

Current WHO cutoffs to define anemia are higher than the pooled fifth percentile of Hb among persons who are outwardly healthy and from nearly all survey-specific estimates. The lower proposed Hb cutoffs are statistically significant but also reflect compensatory increased erythropoiesis. More studies based on clinical outcomes could further confirm the validity of these Hb cutoffs for anemia.

Associations of maternal characteristics and dietary factors with anemia and iron-deficiency in pregnancy

OBJECTIVE

Anemia and iron deficiency during pregnancy influence maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. This study aimed to examine the association with sociodemographic, maternal factors, supplement use and dietary intakes, and anemia and iron deficiency in pregnancy.

METHODS

A cross-sectional study was conducted on 165 pregnant women aged between 19 and 45 years who were interviewed, and dietary intake was assessed by 24-hours dietary recall, supplement records and food frequency questionnaire. Learning Vector Quantization feature selection method which is one of the machine learning techniques was used to extract important variables from sociodemographic, maternal, and dietary factors.

RESULTS

The prevalence of anemia was 15.2% and prevalence of iron deficiency was 65.5%. Total intake of iron, phosphorus, vitamin B₁ and B₂ were importance factors for iron deficiency while age, number of births, use of folic acid supplement, dietary folate equivalent and total iron intake were importance factors for anemia.

CONCLUSIONS

Maternal and dietary characteristics were the most crucial risk factors for anemia while dietary factors were the most important risk factor for iron deficiency in pregnancy. The development of anemia and iron deficiency is associated with the coexistence of many nutrient deficiencies.