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19DETERMINATION OF IRON DEFICIENCY ANEMIA IN FIRST
PREGNANCY
Guzalya Mashrapovna Maxmatkulova
Students of Samarkand State Medical Institute
Moxigul Shodikulovna Raxmonova
Students of Samarkand State Medical Institute
Mirza Murodovich Yusupov
Senior Lecturer of Samarkand State Medical Institute
ABSTRACT
According to the World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide. Furthermore, iron deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this report was to present the experiences of a multidisciplinary expert group, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum period.
Keywords: World Health Organization (WHO), iron deficiency anemia (IDA), Anemia, iron deficiency, oral ferrous sulfate, pregnancy, prevention.
INTRODUCTION
Due to different lifestyles and socioeconomic conditions between cultures, the prevalence of anemia during pregnancy is highly variable. According to a WHO review of nationally representative surveys from 1993 to 2005, anemia affects approximately 42% of pregnant women worldwide (52 and 23% in developing and developed countries, respectively). Although an estimated 1.6 billion individuals worldwide have anemia, it is generally assumed that 50% of cases of anemia are due to iron deficiency and about twice as many individuals are estimated to be affected by iron deficiency.
METHODOLOGY
Anemia and iron deficiency are common during pregnancy. A small decrease in hemoglobin (Hb) is a normal physiological consequence of the increase in blood plasma volume during pregnancy. Normally, after an initial increase (due to the cessation of menstruation), Hb levels decrease by around 20 g/l and reach their lowest level during the second trimester, returning to pre-pregnancy levels as the pregnancy advances toward term. The increase in iron requirements during pregnancy results from increased total blood cell volume, the requirements of the fetus and placenta and, during labor, blood loss.
In the case of iron deficiency anemia during pregnancy, there are several possible risks to the mother, including increased fatigue, short-term memory loss, decreased attention span and decreased performance at work, increased pressure on the cardiovascular system due to insufficient Hb and low blood oxygen saturation levels, lower resistance to infections and a reduced tolerance to significant blood loss and to surgical interventions during labor. The presumed risks of iron deficiency for the fetus relate to the fact that low iron levels increase the risk of reduced Hb levels, and therefore oxygen, to the uterus, placenta and the fetus during development. Moreover, iron-deficient neonates have been shown to have a statistically significant increment in both cognitive and behavioral abnormalities up to 10 years after iron repletion. Iron deficiency anemia, even if mild to moderate, can be associated with unfavorable obstetric outcomes, notably, premature birth, low birth weight and fetal death.
DISCUSSION
Daily supplementation with oral ferrous sulfate is effective in preventing maternal anemia and iron deficiency during pregnancy, and reducing the risk of low birthweight. Indeed, international guidelines recommend universal iron supplementation for the management of iron deficiency and iron deficiency anemia during pregnancy. Although iron deficiency and anemia lead to serious consequences for health and well-being, as well as social and economic repercussions, there is currently a lack of available French data on the prevalence of these conditions in pregnancy. The objective of the current observational study was to explore the prevalence of iron deficiency and anemia among pregnant women in France according to French practitioner daily practice and to identify reasons for the prescription of medication for iron deficiency and anemia in this population. The study consisted of two parts: first, a registry study (monitoring program) was performed to explore the prevalence of iron deficiency with or without anemia during pregnancy; consequently, a cohort study was performed to assess how treatment was chosen and the impact of treatment on patient's quality of life. The results of the cohort study are not presented in this publication.
RESULT
Overall, investigators estimated that almost 60% of women were at moderate or significant risk of iron deficiency (59.3 vs 40.7% [no risk]). Of note, the proportion of women classified with a moderate or significant risk of iron deficiency increased with increasing duration of pregnancy (48.4% [first trimester] vs 68.4% [third trimester]) photo 1
■ Significant
■ Moderate
■ None
100-i 9080-
20 10-
<16 >16 to <28 >28
Pregnancy duration (weeks)
In patients estimated to have a significant or moderate risk of iron deficiency, treatment (any) was prescribed in 97.8 and 73.6% of patients, respectively. In line with the increased estimated risk of iron deficiency with more advanced pregnancy, more patients received a prescription for treatment in the final trimester than in the first trimester Photo 2
iW
Pregnancy duration (weeks)
CONCLUSION
Anemia, a leading cause of disability worldwide, represents one of the most serious public health problems globally.Although anemia and iron deficiency are common during pregnancy, there is a lack of current data regarding the prevalence of iron deficiency and anemia among pregnant women.This observational study explored the risk of iron deficiency and anemia among more than 1500 pregnant women and identified reasons for the prescription of medication.Investigators (gynecologists/obstetricians and midwives) estimated that almost 60% of women were at moderate or significant risk of iron deficiency, with the risk increasing with increased pregnancy duration. Treatment (any) was prescribed to virtually all (97.8%) pregnant women who were estimated to have a significant risk of iron deficiency. Iron alone (95.8%) represented virtually all prescribed treatment in patients with anemia. Overall, data regarding hemoglobin levels were available for the majority of all pregnant women and, of these, 15.8% were determined to have anemia. Data regarding ferritin levels
(assessment of iron deficiency) were available for approximately half of the pregnant women.
REFERENCES
1. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 123(5), 615-624 (2014).
2. WHO 2009. Global Health Risks. Mortality and burden of disease attributable to selected major risks. www.who.int/healthinfo
3. Harvey LJ, Armah CN, Dainty JR, et al. Impact of menstrual blood loss and diet on iron deficiency among women in the UK. Br. J. Nutr. 94(4), 557-564 (2005).
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5. de Benoist B, McLean E, Egli I, Cogswell M. Worldwide Prevalence Of Anaemia 1993-2005: Who Global Database On Anaemia. WHO, Geneva, Switzerland: (2008).
6. Sanghvi TG, Harvey PW, Wainwright E. Maternal iron-folic acid supplementation programs: evidence of impact and implementation. Food Nutr. Bull. 31(Suppl. 2), S100-S107 (2010).
