Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
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Lotta Kemppinen
Abstract
Objectives
Gestational IDA has been linked to adverse maternal and neonatal outcomes, but the impact of iron supplementation on outcome measures remains unclear. Our objective was to assess the effects of gestational IDA on pregnancy outcomes and compare outcomes in pregnancies treated with either oral or intravenous iron supplementation.
Methods
We evaluated maternal and neonatal outcomes in 215 pregnancies complicated with gestational IDA (Hb<100 g/L) and delivered in our tertiary unit between January 2016 and October 2018. All pregnancies from the same period served as a reference group (n=11,545). 163 anemic mothers received oral iron supplementation, and 52 mothers received intravenous iron supplementation.
Results
Gestational IDA was associated with an increased risk of preterm birth (10.2% vs. 6.1%, p=0.009) and fetal growth restriction (FGR) (1.9% vs. 0.3%, p=0.006). The gestational IDA group that received intravenous iron supplementation had a greater increase in Hb levels compared to those who received oral medication (18.0 g/L vs. 10.0 g/L, p<0.001), but no statistically significant differences in maternal and neonatal outcomes were detected.
Conclusions
Compared to the reference group, prematurity, FGR, postpartum infections, and extended hospital stays were more common among mothers with gestational IDA, causing an additional burden on the families and the healthcare system.
Funding source: The Finnish Medical Foundation
Award Identifier / Grant number: 3611
Acknowledgments
The Finnish Medical Foundation.
Research funding: This article was supported by The Finnish Medical Foundation (3611).
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: No informed consent was required due to retrospective registry based nature of the study.
Ethical approval: The study obtained approval from the Turku Clinical Research Centre (CRC Approval 11/2018, T07/017/18).
References
1. Daru, J, Sobhy, S, Pavord, S. Revisiting the basis for haemoglobin screening in pregnancy. Curr Opin Obstet Gynecol 2019;31:388–92.10.1097/GCO.0000000000000580Suche in Google Scholar
2. World Health Organization. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: WHO; 2012.Suche in Google Scholar
3. Stevens, GA, Finucane, MM, De-Regil, LM, Paciorek, CJ, Flaxman, SR, Branca, F, et al.. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Heal 2013;1:16–25. https://doi.org/10.1016/s2214-109x(13)70001-9.Suche in Google Scholar
4. Mei, Z, Cogswell, ME, Looker, AC, Pfeiffer, CM, Cusick, SE, Lacher, DA, et al.. Assessment of iron status in US pregnant women from the national health and nutrition examination survey (NHANES), 1999–2006. Am J Clin Nutr 2011;93:1312–20. https://doi.org/10.3945/ajcn.110.007195.Suche in Google Scholar
5. Lopez, A, Cacoub, P, Macdougall, IC, Peyrin-Biroulet, L. Iron deficiency anaemia. Lancet 2016;387:907–16. https://doi.org/10.1016/s0140-6736(15)60865-0.Suche in Google Scholar
6. Tiitinen, A. Raskaus ja anemia – Duodecim [Internet]. 2018. Available from: https://www.terveysportti.fi/apps/ltk/dlk00882?search=raskausjaanemia [Accessed 26 Sep 2019].Suche in Google Scholar
7. Drukker, L, Hants, Y, Farkash, R, Ruchlemer, R, Samueloff, A, Grisaru-Granovsky, S. Iron deficiency anaemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion 2015;55:2799–806. https://doi.org/10.1111/trf.13252.Suche in Google Scholar PubMed
8. Haider, BA, Olofin, I, Wang, M, Spiegelman, D, Ezzati, M, Fawzi, WW. Anemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013;346:f3443. https://doi.org/10.1136/bmj.f3443.Suche in Google Scholar PubMed PubMed Central
9. Jung, J, Rahman, MM, Rahman, MS, Swe, KT, Islam, MR, Rahman, MO, et al.. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta-analysis. Ann N Y Acad Sci 2019;1450:69–82. https://doi.org/10.1111/nyas.14112.Suche in Google Scholar PubMed
10. Young, MF, Oaks, BM, Tandon, S, Martorell, R, Dewey, KG, Wendt, AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 2019;1450:47–68. https://doi.org/10.1111/nyas.14093.Suche in Google Scholar PubMed PubMed Central
11. Rahmati, S, Delpishe, A, Azami, M, Ahmadi, MRH, Sayehmiri, K. Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis. Int J Reprod Biomed 2017;15:125–34. https://doi.org/10.29252/ijrm.15.3.125.Suche in Google Scholar
12. Allen, LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 2000;71:1280–4. https://doi.org/10.1093/ajcn/71.5.1280s.Suche in Google Scholar PubMed
13. Dunne, JR, Malone, D, Tracy, JK, Gannon, C, Napolitano, LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res 2002;102:237–44. https://doi.org/10.1006/jsre.2001.6330.Suche in Google Scholar
14. Fowler, AJ, Ahmad, T, Phull, MK, Allard, S, Gillies, MA, Pearse, RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015;102:1314–24. https://doi.org/10.1002/bjs.9861.Suche in Google Scholar
15. Baron, DM, Hochrieser, H. Is preoperative anaemia associated with poor postoperative outcomes in non-cardiac surgery patients? Surg Chronicles [Internet] 2017;22:194–7. Available from: https://dx.doi.org/10.1093/bja/aeu098.10.1093/bja/aeu098Suche in Google Scholar
16. Rouse, DJ. Blood transfusion and cesarean delivery: Commentary. Obstet Gynecol Surv 2007;62:97–8.10.1097/01.ogx.0000253297.18218.a3Suche in Google Scholar
17. Peña-rosas, JP, De-regil, LM, Garcia-casal, MN, Dowswell, T. Daily oral iron supplementation during pregnancy (Review); 2015. (7). Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004736.pub5/epdf/abstract.10.1002/14651858.CD004736.pub5Suche in Google Scholar
18. Govindappagari, S, Burwick, RM. Treatment of iron deficiency anemia in pregnancy with intravenous versus oral iron: systematic review and meta-analysis. Am J Perinatol 2019;36:366–76. https://doi.org/10.1055/s-0038-1668555.Suche in Google Scholar
19. Neogi, SB, Devasenapathy, N, Singh, R, Bhushan, H, Shah, D, Divakar, H, et al.. Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate-to-severe anaemia in India: a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Glob Heal [Internet] 2019;7:e1706–16. Available from: https://dx.doi.org/10.1016/S2214-109X(19)30427-9.10.1016/S2214-109X(19)30427-9Suche in Google Scholar
20. Thomas, MC, MacIsaac, RJ, Tsalamandris, C, Molyneaux, L, Goubina, I, Fulcher, G, et al.. Anemia in patients with type 1 diabetes. J Clin Endocrinol Metab [Internet] 2004;89:4359–63. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2004-0678 [Accessed 1 Oct 2019].10.1210/jc.2004-0678Suche in Google Scholar PubMed
21. Soliman, AT, De Sanctis, V, Yassin, M, Soliman, N. Ron deficiency anemia and glucose metabolism. Acta Biomed [Internet] 2017;88:112–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28467345 [Accessed 5 Oct 2019].Suche in Google Scholar
22. English, E, Idris, I, Smith, G, Dhatariya, K, Kilpatrick, ES, John, WG. The effect of anaemia and abnormalities of erythrocyte indices on HbA1c analysis: a systematic review. Diabetologia [Internet] 2015;58:1409–21. Available from: http://link.springer.com/10.1007/s00125-015-3599-3 [Accessed 5 Oct 2019].10.1007/s00125-015-3599-3Suche in Google Scholar PubMed
23. Ioannou, GN, Dominitz, JA, Weiss, NS, Heagerty, PJ, Kowdley, KV. The effect of alcohol consumption on the prevalence of iron overload, iron deficiency, and iron deficiency anemia. Gastroenterology [Internet] 2004;126:1293–301. Available from: https://www.sciencedirect.com/science/article/pii/S0016508504000940 [Accessed 1 Oct 2019].10.1053/j.gastro.2004.01.020Suche in Google Scholar PubMed
24. Hailu Jufar, A, Zewde, T. Prevalence of anemia among pregnant women attending antenatal care at tikur anbessa specialized hospital, addis ababa Ethiopia. J Hematol Thromb Dis [Internet] 2014;2:1. Available from: https://www.longdom.org/open-access/prevalence-of-anemia-among-pregnant-women-attending-antenatal-care-at-tikur-anbessa-specialized-hospital-addis-ababa-ethiopia-2329-8790.1000125.pdf [Accessed 21 Oct 2019].10.4172/2329-8790.1000125Suche in Google Scholar
25. Allen, LH. Biological mechanisms that might underlie iron’s effects on fetal growth and preterm birth. J Nutr 2001;131:649S–68S. https://doi.org/10.1093/jn/131.2.581s.Suche in Google Scholar
26. Wadhwa, PD, Garite, TJ, Porto, M, Glynn, L, Chicz-DeMet, A, Dunkel-Schetter, C, et al.. Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation. Am J Obstet Gynecol [Internet] 2004;191:1063–9. Available from: https://www.sciencedirect.com/science/article/pii/S0002937804006854 [Accessed 26 Sep 2019].10.1016/j.ajog.2004.06.070Suche in Google Scholar
27. Diego, MA, Jones, NA, Field, T, Hernandez-Reif, M, Schanberg, S, Kuhn, C, et al.. Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom Med [Internet] 2006;68:747–53. Available from: https://insights.ovid.com/crossref?an=00006842-200609000-00015 [Accessed 30 Sep 2019].10.1097/01.psy.0000238212.21598.7bSuche in Google Scholar
28. Levy, A, Fraser, D, Katz, M, Mazor, M, Sheiner, E. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2005;122:182–6. https://doi.org/10.1016/j.ejogrb.2005.02.015.Suche in Google Scholar
29. Malhotra, M, Sharma, JB, Batra, S, Sharma, S, Murthy, NS, Arora, R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynecol Obstet [Internet] 2002;79:93–100. Available from: http://doi.wiley.com/10.1016/S0020-7292%2802%2900225-4 [Accessed 10 Oct 2018].10.1016/S0020-7292(02)00225-4Suche in Google Scholar
30. Chaim, W, Bashiri, A, Bar-David, J, Shoham-Vardi, I, Mazor, M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000;8:77–82. https://doi.org/10.1002/(sici)1098-0997(2000)8:2<77::aid-idog3>3.0.co;2-6.10.1002/(SICI)1098-0997(2000)8:2<77::AID-IDOG3>3.0.CO;2-6Suche in Google Scholar
31. Govindappagari, S, Burwick, RM. Treatment of iron deficiency anemia in pregnancy with intravenous versus oral iron: systematic review and meta-analysis. Am J Perinatol [Internet] 2018. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1668555 [Accessed 7 Oct 2018].Suche in Google Scholar
32. Lewkowitz, AK, Gupta, A, Simon, L, Sabol, BA, Stoll, C, Cooke, E, et al.. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. J Perinatol [Internet] 2019;39:519–32. Available from: http://www.nature.com/articles/s41372-019-0320-2 [Accessed 30 Sep 2019].10.1038/s41372-019-0320-2Suche in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
