Anemia Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo21
, , , , , , We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron.
EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women.
Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected.
Two reviewers independently extracted data from nine selected trials
The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron.
Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo21
, , , , , , We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron.
EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women.
Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected.
Two reviewers independently extracted data from nine selected trials
The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron.
Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):782-788
, , , , , , , To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia.
Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control.
We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial.
Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters.
Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):782-788
, , , , , , , To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia.
Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control.
We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial.
Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters.
Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):384-396
To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women.
A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb < 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels.
The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15;95%CI: 1.43-18.50); multiparity (OR = 2.27;95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care.
In the present study, the chance of occurrence of anemia in pregnant women was significantly higher,mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(8):384-396
To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women.
A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb < 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels.
The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15;95%CI: 1.43-18.50); multiparity (OR = 2.27;95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care.
In the present study, the chance of occurrence of anemia in pregnant women was significantly higher,mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(3):94-101
Anemia is a very frequent event among pregnant women. There are evidences of differences in the incidence of dental caries between pregnant and nonpregnant women, but the relationship between salivary iron (Fe) and serummarkers of anemia and caries development has not been investigated.
To evaluate the correlation between salivary (Fe) and serum iron (Fe, ferritin and hemoglobin) parameters in pregnant women with the development of dental caries.
A prospective cohort was conducted with 59 women. The outcome of interest was represented by new dental caries lesions during pregnancy, using the Nyvad criteria. Pregnant women were evaluated at three clinical times: up to the 16th week of gestational age (GA) (T1), in the last trimester of pregnancy (T2), and postpartum (T3), at the Mother and Child Unit ofUniversityHospital of the Universidade Federal doMaranhão.A stimulated saliva sample was collected for biochemical analysis of salivary Fe, and a blood sample was collected early in the morning. The correlation between salivary and serum Fe was evaluated through the Pearson correlation test. Analysis of variance (ANOVA) and Kruskal-Wallis were used to compare the means of anemia parameters at different times. The Student's t and Mann-Whitney tests were used to compare the anemia parameters between the groups of pregnant women (with and without new caries lesions).
SerumFe concentrationswere higher in the first trimester of pregnancy and lower after delivery (p = 0.036). It was also observed that the ferritin concentrations were higher in the first trimester and lower at the end of gestation (p = 0.011). Therewas no association between the expositions of salivary iron and anemia, and the development of dental caries. There was a positive correlation between serum Fe in T1 and salivary Fe in T2 (p < 0.05).
The serummarkers of anemiaweremore prevalent in the last trimester of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(3):94-101
Anemia is a very frequent event among pregnant women. There are evidences of differences in the incidence of dental caries between pregnant and nonpregnant women, but the relationship between salivary iron (Fe) and serummarkers of anemia and caries development has not been investigated.
To evaluate the correlation between salivary (Fe) and serum iron (Fe, ferritin and hemoglobin) parameters in pregnant women with the development of dental caries.
A prospective cohort was conducted with 59 women. The outcome of interest was represented by new dental caries lesions during pregnancy, using the Nyvad criteria. Pregnant women were evaluated at three clinical times: up to the 16th week of gestational age (GA) (T1), in the last trimester of pregnancy (T2), and postpartum (T3), at the Mother and Child Unit ofUniversityHospital of the Universidade Federal doMaranhão.A stimulated saliva sample was collected for biochemical analysis of salivary Fe, and a blood sample was collected early in the morning. The correlation between salivary and serum Fe was evaluated through the Pearson correlation test. Analysis of variance (ANOVA) and Kruskal-Wallis were used to compare the means of anemia parameters at different times. The Student's t and Mann-Whitney tests were used to compare the anemia parameters between the groups of pregnant women (with and without new caries lesions).
SerumFe concentrationswere higher in the first trimester of pregnancy and lower after delivery (p = 0.036). It was also observed that the ferritin concentrations were higher in the first trimester and lower at the end of gestation (p = 0.011). Therewas no association between the expositions of salivary iron and anemia, and the development of dental caries. There was a positive correlation between serum Fe in T1 and salivary Fe in T2 (p < 0.05).
The serummarkers of anemiaweremore prevalent in the last trimester of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(5):208-215
DOI 10.1590/SO100-720320150005321
To describe the evolution of the prevalence of anemia in pregnant adolescents
attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013.
A retrospective cross-sectional study with 628 pregnant/postpartum women divided
into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013).
Information about anthropometric, clinical, sociodemographic data and obstetric
and prenatal care of adolescents was obtained from medical records of the pregnant
women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data
were analyzed statistically by the chi-square test, Student's t-test and ANOVA,
and the post hoc Tukey test.
The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80)
and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1%
(n=258). The occurrence of anemic pregnant women increased with the progression of
pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of
anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with
anemia were number of prenatal visits and prenatal nutritional assistance, place
of residence, pre-pregnancy BMI, and gestational weight gain.
The results showed that the prevalence of anemia among pregnant adolescents seen
at a public maternity is high. There was no reduction of anemia during the study
period and other factors in addition to iron deficiency were involved in the
genesis of anemia in this population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(5):208-215
DOI 10.1590/SO100-720320150005321
To describe the evolution of the prevalence of anemia in pregnant adolescents
attended at a public maternity in the city of Rio de Janeiro from 2004 to 2013.
A retrospective cross-sectional study with 628 pregnant/postpartum women divided
into 3 groups: Group A (2004-2006), Group B (2007-2010) and Group C (2013).
Information about anthropometric, clinical, sociodemographic data and obstetric
and prenatal care of adolescents was obtained from medical records of the pregnant
women. A hemoglobin concentration n<11 g/dL was considered to be anemia. Data
were analyzed statistically by the chi-square test, Student's t-test and ANOVA,
and the post hoc Tukey test.
The prevalence of gestational anemia over the years was 43% (GA=138), 36% (GB=80)
and 47.1% (GC=40) and the overall prevalence for the 2004-2013 period was 41.1%
(n=258). The occurrence of anemic pregnant women increased with the progression of
pregnancy; however, in the 3rd quarter there was a decrease in the prevalence of
anemia in GB (29.3%) compared to GA (38.7%; p=0.04). Factors associated with
anemia were number of prenatal visits and prenatal nutritional assistance, place
of residence, pre-pregnancy BMI, and gestational weight gain.
The results showed that the prevalence of anemia among pregnant adolescents seen
at a public maternity is high. There was no reduction of anemia during the study
period and other factors in addition to iron deficiency were involved in the
genesis of anemia in this population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):176-181
DOI 10.1590/S0100-72032011000400005
PURPOSE: to evaluate changes in the nutritional status of lactating adolescents in different postpartum weeks. METHOD: this is an analytical, observational, longitudinal study. Lactating adolescents were followed-up from the 5th to the 15th postpartum week (PPW). The nutritional status was evaluated in the 5th, 10th and 15th PPW by the Body Mass Index (BMI/age). A colorimetric method was used to determine hemoglobin level and microcentrifugation to define hematocrit. ANOVA with repeated measures was used to compare means, followed by the Tukey post-test. The level of significance was 5%. RESULTS: modification in nutritional status was observed from the pregestational period to the 15th PPW, with a reduction in the frequency of lactating adolescents with low weight (from 21% to 9%) and a rise in the frequency of overweight (21% to 27%) and eutrophic (58% to 64%) adolescents. Although mean hemoglobin (12.3±1.7 g/dL) and hematocrit (39.0±4.0%) levels were normal, a high frequency of anemia (30%) was observed throughout the study period. CONCLUSION: the present results show that the body weight of lactating adolescents rises during the lactation period and could lead to a higher frequency of obesity among adolescents. Anemia is still a nutritional problem, not only during pregnancy, but also during the postpartum period. It is necessary to prevent and treat probable subclinical nutritional deficiencies at this biological time.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(4):176-181
DOI 10.1590/S0100-72032011000400005
PURPOSE: to evaluate changes in the nutritional status of lactating adolescents in different postpartum weeks. METHOD: this is an analytical, observational, longitudinal study. Lactating adolescents were followed-up from the 5th to the 15th postpartum week (PPW). The nutritional status was evaluated in the 5th, 10th and 15th PPW by the Body Mass Index (BMI/age). A colorimetric method was used to determine hemoglobin level and microcentrifugation to define hematocrit. ANOVA with repeated measures was used to compare means, followed by the Tukey post-test. The level of significance was 5%. RESULTS: modification in nutritional status was observed from the pregestational period to the 15th PPW, with a reduction in the frequency of lactating adolescents with low weight (from 21% to 9%) and a rise in the frequency of overweight (21% to 27%) and eutrophic (58% to 64%) adolescents. Although mean hemoglobin (12.3±1.7 g/dL) and hematocrit (39.0±4.0%) levels were normal, a high frequency of anemia (30%) was observed throughout the study period. CONCLUSION: the present results show that the body weight of lactating adolescents rises during the lactation period and could lead to a higher frequency of obesity among adolescents. Anemia is still a nutritional problem, not only during pregnancy, but also during the postpartum period. It is necessary to prevent and treat probable subclinical nutritional deficiencies at this biological time.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(12):615-620
DOI 10.1590/S0100-72032009001200007
PURPOSES: to evaluate the influence of maternal hemoglobin (Hb) levels in the patterns of fetal heart rate (FHR) and in the fetal biophysical profile (FBP) in term gestations. METHODS: pregnant women with anemia (Hb<11.0 g/dL) were prospectively evaluated between the 36th and the 40th week of gestation, from January 2008 to March 2009. The Control Group was composed of term and healthy pregnant women, with normal values of hemoglobin (Hb>11,0 g/dL). Cases of anomalies or fetal growing restrictions were excluded. The FHR evaluation was performed by computerized cardiotocography (8002 System-Sonicaid), and by record analysis during 30 minutes of exam. The FBP was done in all the patients. Student's, χ2 and Fisher's exact tests were used, with 0.05 significance level. RESULTS: The average of maternal Hb in the group with anemia (n=18) was 9.4 g/dL (DP=1.4 g/dL), and in the control group, 12.4g/dL (DP=1.3 g/dL). There has been no significant mean differences between groups concerning the cardiotocography parameters, respectively: basal FHR(131.3 versus 133.7 bpm, p=0.5), FHR accelerations > 10b pm (7.9 versus 8.2, p=0.866), FHR accelerations > 15 bpm (5.2 versus. 5.4, p=0.9), episodes of high variation of the FHR (17.1 versus 15.5 min, p=0,5), episodes of variation of the FHR (4.4 versus 3.6 min, p=06), and short term variation (10.5 versus 10.9 ms, p=0.5). In both groups, all patients presented normal FBP. CONCLUSIONS: this study suggests that light or moderate maternal anemia, without other maternal or fetal comorbidity, is not associated with abnormalities in the parameters of fetal biophysical profile and of the FHR analyzed by computerized cardiotocography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(12):615-620
DOI 10.1590/S0100-72032009001200007
PURPOSES: to evaluate the influence of maternal hemoglobin (Hb) levels in the patterns of fetal heart rate (FHR) and in the fetal biophysical profile (FBP) in term gestations. METHODS: pregnant women with anemia (Hb<11.0 g/dL) were prospectively evaluated between the 36th and the 40th week of gestation, from January 2008 to March 2009. The Control Group was composed of term and healthy pregnant women, with normal values of hemoglobin (Hb>11,0 g/dL). Cases of anomalies or fetal growing restrictions were excluded. The FHR evaluation was performed by computerized cardiotocography (8002 System-Sonicaid), and by record analysis during 30 minutes of exam. The FBP was done in all the patients. Student's, χ2 and Fisher's exact tests were used, with 0.05 significance level. RESULTS: The average of maternal Hb in the group with anemia (n=18) was 9.4 g/dL (DP=1.4 g/dL), and in the control group, 12.4g/dL (DP=1.3 g/dL). There has been no significant mean differences between groups concerning the cardiotocography parameters, respectively: basal FHR(131.3 versus 133.7 bpm, p=0.5), FHR accelerations > 10b pm (7.9 versus 8.2, p=0.866), FHR accelerations > 15 bpm (5.2 versus. 5.4, p=0.9), episodes of high variation of the FHR (17.1 versus 15.5 min, p=0,5), episodes of variation of the FHR (4.4 versus 3.6 min, p=06), and short term variation (10.5 versus 10.9 ms, p=0.5). In both groups, all patients presented normal FBP. CONCLUSIONS: this study suggests that light or moderate maternal anemia, without other maternal or fetal comorbidity, is not associated with abnormalities in the parameters of fetal biophysical profile and of the FHR analyzed by computerized cardiotocography.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):196-200
DOI 10.1590/S0100-72032008000400007
PURPOSE: to obtain an equation to estimate the volume of red blood cells concentrate to be infused to correct anemia in fetuses of pregnant women with Rh factor isoimmunization, based in parameters obtained along the cordocentesis previous to intrauterine transfusion. METHODS: a transversal study analyzing 89 intrauterine transfusions to correct anemia in 48 fetuses followed-up in the Centro de Medicina Fetal do Hospital das Clínicas da Universidade de Minas Gerais. The median gestational age at the cordocentesis was 29 weeks and the average number of procedures was 2.1. Fetal hemoglobin was assayed before and after cordocentesis, leading to the volume of transfused red blood cells concentrate. The determination of an equation to estimate the blood volume necessary to correct the fetal anemia was based in the blood volume necessary to raise the fetal hemoglobin in 1 g% (the difference between the final and the initial hemoglobin concentration divided by the transfused volume) and in the volume of the amount necessary to reach 14 g%, in the multiple regression analysis. RESULTS: the concentration of pre-transfusion hemoglobin varied between 2.3 and 15.7 g%. The prevalence of fetal anemia (Hb<10 g%) was 52%. The regression equation obtained in the determination of blood volume necessary to reach the concentration of 14 g% of Hb was: transfusion volume (mL)=18.2 - 13.4 x pre- intrauterine transfusion hemoglobin + 6.0 x gestational age in weeks. This equation was statistically significant (p<0.0001). CONCLUSIONS: the study has shown that it is possible to estimate the transfusion volume necessary to correct fetal anemia, based on easily obtainable parameters: gestational age and level of pre-transfusion hemoglobin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(4):196-200
DOI 10.1590/S0100-72032008000400007
PURPOSE: to obtain an equation to estimate the volume of red blood cells concentrate to be infused to correct anemia in fetuses of pregnant women with Rh factor isoimmunization, based in parameters obtained along the cordocentesis previous to intrauterine transfusion. METHODS: a transversal study analyzing 89 intrauterine transfusions to correct anemia in 48 fetuses followed-up in the Centro de Medicina Fetal do Hospital das Clínicas da Universidade de Minas Gerais. The median gestational age at the cordocentesis was 29 weeks and the average number of procedures was 2.1. Fetal hemoglobin was assayed before and after cordocentesis, leading to the volume of transfused red blood cells concentrate. The determination of an equation to estimate the blood volume necessary to correct the fetal anemia was based in the blood volume necessary to raise the fetal hemoglobin in 1 g% (the difference between the final and the initial hemoglobin concentration divided by the transfused volume) and in the volume of the amount necessary to reach 14 g%, in the multiple regression analysis. RESULTS: the concentration of pre-transfusion hemoglobin varied between 2.3 and 15.7 g%. The prevalence of fetal anemia (Hb<10 g%) was 52%. The regression equation obtained in the determination of blood volume necessary to reach the concentration of 14 g% of Hb was: transfusion volume (mL)=18.2 - 13.4 x pre- intrauterine transfusion hemoglobin + 6.0 x gestational age in weeks. This equation was statistically significant (p<0.0001). CONCLUSIONS: the study has shown that it is possible to estimate the transfusion volume necessary to correct fetal anemia, based on easily obtainable parameters: gestational age and level of pre-transfusion hemoglobin.
