Background. Over half of all women in the world experience anemia during their pregnancy. Our aim was to investigate the relation between hemoglobin and iron status examined in second trimester and pregnancy outcome. Methods. In a prospective longitudinal study, 382 pregnant women were included. Blood samples were examined for hematological status and serum ferritin between 16 and 20 weeks and for hemoglobin before delivery. The adverse maternal and perinatal outcomes were determined. Regression analysis was performed to establish if anemia and low serum ferritin are risk factors for pregnancy complications. Results. There was no increase of complications in women with mild anemia and in women with depleted iron stores. The finding showed that mild iron deficiency anemia and depleted iron stores are not risk factors for adverse outcomes in iron supplemented women. Conclusions. Mild anemia and depleted iron stores detected early in pregnancy were not associated with adverse maternal and perinatal outcomes in iron supplemented women. 1. Introduction Over half of all women in the world experience anemia during their pregnancy [1–4]. The association between the gestational age at which anemia is diagnosed and adverse pregnancy outcomes is an important issue [5, 6]. Some of the increase in anemia and iron deficiency anemia (IDA) with gestation is a consequence of the normal physiological changes of pregnancy [7]. To avoid the difficulties in anemia detection caused by plasma volume increase, the examination should be conducted until 20 weeks of gestation. Findings from the studies on the relationship between anemia and adverse pregnancy outcome are contradictory. Several studies have shown that preterm delivery, small for gestational age, and low birth weight are increased for women with anemia during the 1st trimester and risk depends on the severity of the hemoglobin deficit [6, 8–11]. Women with hemoglobin between 8.0 and 9.9？g/dL had significantly higher risk for low birth weight, preterm birth, and small for gestational age than women with hemoglobin between 10.0 and 11.9？g/dL [12]. The observation by Scholl et al. showed that only iron deficiency anemia, not any other anemia, was related to preterm birth, which suggests that some iron specific mechanism may be at play [12]. Severe anemia is also associated with adverse maternal outcome and may contribute directly or indirectly to a significant proportion of maternal cardiac failure, hemorrhage, and infection. On the other hand, higher rates of placental problems (abnormal placentation and placental
References
[1]
E. DeMaeyer and M. Adiels-Tegman, “The prevalence of anaemia in the world,” World Health Statistics Quarterly, vol. 38, no. 3, pp. 302–316, 1985.
[2]
T. O. Scholl, “Iron status during pregnancy: setting the stage for mother and infant,” The American Journal of Clinical Nutrition, vol. 81, no. 5, pp. 1218S–1222S, 2005.
[3]
A. C. Looker, P. R. Dallman, M. D. Carroll, E. W. Gunter, and C. L. Johnson, “Prevalence of iron deficiency in the United States,” The Journal of the American Medical Association, vol. 277, no. 12, pp. 973–976, 1997.
[4]
F. E. Viteri, “The consequences of iron deficiency and anaemia in pregnancy on maternal health, the foetus and the infant,” SCN News, no. 11, pp. 14–18, 1994.
[5]
L.-M. Zhou, W.-W. Yang, J.-Z. Hua, C.-Q. Deng, X. Tao, and R. J. Stoltzfus, “Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China,” American Journal of Epidemiology, vol. 148, no. 10, pp. 998–1006, 1998.
[6]
H. H？m？l？inen, K. Hakkarainen, and S. Heinonen, “Anaemia in the first but not in the second or third trimester is a risk factor for low birth weight,” Clinical Nutrition, vol. 22, no. 3, pp. 271–275, 2003.
[7]
M. F. McMullin, R. White, T. Lappin, J. Reeves, and G. MacKenzie, “Haemoglobin during pregnancy: relationship to erythropoietin and haematinic status,” European Journal of Haematology, vol. 71, no. 1, pp. 44–50, 2003.
[8]
F. W. Lone, R. N. Qureshi, and F. Emmanuel, “Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan,” Eastern Mediterranean Health Journal, vol. 10, no. 6, pp. 801–807, 2004.
[9]
M. Malhotra, J. B. Sharma, S. Batra, S. Sharma, N. S. Murthy, and R. Arora, “Maternal and perinatal outcome in varying degrees of anemia,” International Journal of Gynecology & Obstetrics, vol. 79, no. 2, pp. 93–100, 2002.
[10]
A. Levy, D. Fraser, M. Katz, M. Mazor, and E. Sheiner, “Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 122, no. 2, pp. 182–186, 2005.
[11]
V. R. Lops, L. P. Hunter, and L. R. Dixon, “Anemia in pregnancy,” American Family Physician, vol. 51, no. 5, pp. 1189–1197, 1995.
[12]
T. O. Scholl, M. L. Hediger, R. L. Fischer, and J. W. Shearer, “Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study,” The American Journal of Clinical Nutrition, vol. 55, no. 5, pp. 985–988, 1992.
[13]
A. F. Fleming, “Maternal anemia and fetal outcome in pregnancies complicated by thalassemia minor and “stomatocytosis”,” American Journal of Obstetrics and Gynecology, vol. 116, no. 3, pp. 309–319, 1973.
[14]
Centers for Disease Control, “CDC criteria for anaemia in children and childbearing-aged women,” Morbidity and Mortality Weekly Report, vol. 38, pp. 400–404, 1989.
[15]
S. Hercberg, P. Preziosi, and P. Galan, “Iron deficiency in Europe,” Public Health Nutrition, vol. 4, no. 2, pp. 537–545, 2001.
[16]
X. Xiong, P. Buekens, S. Alexander, N. Demianczuk, and E. Wollast, “Anemia during pregnancy and birth outcome: a meta-analysis,” American Journal of Perinatology, vol. 17, no. 3, pp. 137–146, 2000.
[17]
P. Steer, M. A. Alam, J. Wadsworth, and A. Welch, “Relation between maternal haemoglobin concentration and birth weight in different ethnic groups,” British Medical Journal, vol. 310, no. 6978, pp. 489–491, 1995.
[18]
K. M. Rasmussen, “Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?” Journal of Nutrition, vol. 131, no. 2, pp. 590S–601S, 2001.
[19]
O. I. Fareh, D. E. E. Rizk, L. Thomas, and B. Berg, “Obstetric impact of anaemia in pregnant women in United Arab Emirates,” Journal of Obstetrics & Gynaecology, vol. 25, no. 5, pp. 440–444, 2005.
[20]
S. Patra, S. Pasrija, S. S. Trivedi, and M. Puri, “Maternal and perinatal outcome in patients with severe anemia in pregnancy,” International Journal of Gynecology and Obstetrics, vol. 91, no. 2, pp. 164–165, 2005.
[21]
K. S. Scanlon, R. Yip, L. A. Schieve, and M. E. Cogswell, “High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age,” Obstetrics & Gynecology, vol. 96, no. 5, pp. 741–748, 2000.
[22]
G. T. Bondevik, R. T. Lie, M. Ulstein, and G. Kvale, “Maternal hematological status and risk of low birth weight and preterm delivery in Nepal,” Acta Obstetricia et Gynecologica Scandinavica, vol. 80, no. 5, pp. 402–408, 2001.
[23]
A. Kumar, S. Jain, N. P. Singh, and T. Singh, “Oral versus high dose parenteral iron supplementation in pregnancy,” International Journal of Gynecology and Obstetrics, vol. 89, no. 1, pp. 7–13, 2005.
[24]
N. Milman, “Iron prophylaxis in pregnancy—general or individual and in which dose?” Annals of Hematology, vol. 85, no. 12, pp. 821–828, 2006.
[25]
R. M. Schaefer, R. Huch, A. Krafft et al., “The iron letter—an update on the treatment of iron deficiency anemia,” Praxis, vol. 95, no. 10, pp. 357–364, 2006.
[26]
T. G. Sanghvi, P. W. J. Harvey, and E. Wainwright, “Maternal iron-folic acid supplementation programs: evidence of impact and implementation,” Food and Nutrition Bulletin, vol. 31, no. 2, pp. S100–S107, 2010.
