Nursing care to pregnant women with iron deficiency anemia

This study was carried out with the following objectives: to set up a protocol of data survey and nursing diagnosis, and to detect the most frequent nursing diagnosis among pregnant women with iron deficiency anemia. The protocol was applied in 52 nursing visits to pregnant women who presented hemoglobin values lower than 11.0 g/dl. The most frequent nursing diagnosis were: altered nutrition, risk to infection, impaired maintenance of the home; knowledge deficit on adequate feeding; risk to fetal injury regarding decrease in uteroplacental perfucion; non-compliance risk. Based on nursing diagnoses, interventions and nursing expected results with its application were planned.     

Prevalence of iron deficiency and anemia among healthy women of reproductive age in Bhaktapur, Nepal

OBJECTIVE: To determine the prevalence of anemia and iron status as assessed by biochemical markers and to explore the associations between markers of iron status and iron intake. STUDY AREA AND POPULATION: Five hundred healthy women of reproductive age from the Bhaktapur district of Nepal were included in the study. METHODS: A cluster sampling procedure was applied for this cross-sectional study. Women without any ongoing infection aged 13-35 years were selected randomly from the population. We measured the plasma concentration of hemoglobin (Hb), ferritin and transferrin receptors. Dietary information was obtained by a food frequency questionnaire and two 24-h dietary recalls. RESULTS: The prevalence of anemia (Hb concentration <12 g/dl) was 12% (n=58). The prevalence of depleted iron stores (plasma ferritin <15 microg/l) was 20% (n=98) whereas the prevalence of iron deficiency anemia (anemia, depleted iron stores with elevated transferrin receptor i.e. >1.54 mg/l) was 6% (n=30). Seven percent (n=35) of women were having iron-deficient erythropoiesis (depleted iron stores and elevated transferrin receptor but normal Hb). Out of the 58 anemic women, 41 (71%) and 31 (53%) were also having elevated plasma transferrin receptor and depleted iron stores, respectively. Fifty-four percent of the women ate less than the recommended average intake of iron. The main foods contributing to dietary iron were rice, wheat flour and green and dry vegetables. CONCLUSIONS: The prevalence of anemia in our study was substantially lower than the national figure for non-pregnant women. Only about half of the women with anemia were also having depleted iron stores, suggesting that other causes of anemia may be prevalent in this population. SPONSORSHIP: Norwegian Universities Committee for Development, Research and Education (NUFU).     

Risk factors associated with anemia and iron deficiency among Kuwaiti pregnant women

A cross-sectional study was carried out to identify the risk factors of anemia and iron deficiency in Kuwaiti pregnant women. Pregnant women (n = 465) aged 18-47 years, of 4-39 weeks at gestation were recruited during antenatal visits from six health facilities in Kuwait. Socio-demographic, pregnancy-related and dietary information were collected. Hemoglobin, serum ferritin and serum C-reactive protein concentrations were determined. Logistic regression analysis revealed that iron deficiency and not taking iron-folate tablets or taking them occasionally were the two most important risk factors associated with anemia. Pregnant women with higher gestational age, short birth spacing ( ≤ 2 years), not taking iron-folate tablets or taking them occasionally, not consuming fruit juice, and consuming brown bread, tea and/or coffee were significant risk factors associated with iron deficiency. In conclusion, various factors including dietary habits appeared to be associated with poor iron status, which is the most important risk factor for anemia among Kuwaiti pregnant women.     

Risk factors associated with anemia and iron deficiency among Kuwaiti pregnant women

A cross-sectional study was carried out to indentify the risk factors of anemia and iron deficiency in Kuwaiti pregnant women. Pregnant women (n = 465) aged 18–47 years, of 4–39 weeks at gestation were recruited during antenatal visits from six health facilities in Kuwait. Socio-demographic, pregnancy-related and dietary information were collected. Hemoglobin, serum ferritin and serum C-reactive protein concentrations were determined. Logistic regression analysis revealed that iron deficiency and not taking iron-folate tablets or taking them occasionally were the two most important risk factors associated with anemia. Pregnant women with higher gestational age, short birth spacing ( ≤ 2 years), not taking iron-folate tablets or taking them occasionally, not consuming fruit juice, and consuming brown bread, tea and/or coffee were significant risk factors associated with iron deficiency. In conclusion, various factors including dietary habits appeared to be associated with poor iron status, which is the most important risk factor for anemia among Kuwaiti pregnant women.     

孕妇缺铁性贫血与铁相关指标调查分析

目的 了解武汉市江岸区孕妇缺铁性贫血患病率及影响因素,制定干预措施.方法 对280例孕妇进行血液分析,检测内容包括血红蛋白、血清铁蛋白和全血铁含量,并对结果 进行分析.结果 孕妇贫血检出率为10.00%,全血铁缺乏率为32.14%,血清铁蛋白缺乏率为3.21%,不同文化程度孕妇的贫血发生率不同,差异有统计学意义(χ2=282.00,P<0.05),非贫血组孕妇不同孕期的全血铁缺乏发生率不同,差异有统计学意义(χ2=106.00,P<0.05).结论 缺铁性贫血的发病率在江岸区依然较高,应做好该病的预防干预措施.     

维生素A在铁缺乏及缺铁性贫血治疗中的作用

近几年研究发现维生素A缺乏与铁缺乏具有显著的相关性,维生素A治疗缺铁性贫血和铁缺乏也取得了较好的临床效果.本文就维生素A缺乏与铁缺乏的相关性和作用机制,以及维生素A治疗缺铁性贫血的临床疗效和研究进展进行了综述,为维生素A用于儿童缺铁性贫血的防治提供依据,同时为降低我国儿童缺铁性贫血及铁缺乏的发病率提供更有效的防治措施.     

Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies

In sub-Saharan Africa, anaemia in pregnancy results from multiple causes including malaria, iron deficiency and haemoglobinopathies. In a cross-sectional study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrations of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha-globin genotypes. Anaemia (haemoglobin [Hb] < 11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. Ferritin levels were considerably influenced by malaria and inflammatory processes (CRP > 0.6 mg/dL). Depending on the definition applied, the prevalence of iron deficiency ranged between 5% and 46%. The HbAS trait was observed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta-thalassaemia was present in 1% of the women and alpha(+)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS had higher malaria parasite densities than those with HbAA. In individuals with highly elevated HbF (> 10%), parasitaemia occurred in 27% only. Low gravidity, second trimester of pregnancy, malaria, raised CRP levels, and homozygous alpha(+)-thalassaemia were independent risk factors for anaemia in multivariate analysis. alpha(+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women. Iron deficiency appears not to be a major health problem in this population. Haemoglobinopathies are common but, except for homozygous alpha(+)-thalassaemia, do not substantially contribute to anaemia in pregnancy. alpha(+)-Thalassaemia ameliorates malarial anaemia in pregnant women.     

Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands

INTRODUCTION: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries. OBJECTIVE: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands. SUBJECTS AND METHODS: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children. RESULTS: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia. CONCLUSIONS: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.     

sTfR与孕妇、新生儿、婴儿亚临床缺铁及缺铁性贫血前瞻性纵向研究

【目的】 通过前瞻性纵向监测贫血孕妇及其新生儿、婴儿的Hb,sTfR,分析孕妇贫血对婴儿6月龄时铁代谢的影响。 【方法】 随机抽取Hb<100 g/L的56例临产孕妇作为研究组,选取56例Hb>110 g/L的同孕周临产孕妇作为对照组,两组孕妇所生各56例新生儿、婴儿为子代研究组、子代对照组,婴儿于出生时、42 d、4个月、6个月进行定期体检,孕妇、新生儿、6月龄婴儿抽血检测Hb、sTfR。 【结果】 与对照组比较,贫血孕妇及其所生婴儿6月龄时的Hb、sTfR值差异有统计学意义(P<0.01),新生儿Hb、sTfR值差异无统计学意义(P>0.05)。贫血孕妇所生婴儿6月龄时IDA检出率为60.8%%,正常孕妇所生婴儿为21.6%,差异有统计学意义(P<0.01)。 【结论】 孕妇贫血是导致6月龄婴儿SID及IDA的主要危险因素。     

Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal

OBJECTIVE: To determine the extent and causes of iodine deficiency among women during pregnancy and lactation in the southeastern plains of Nepal. DESIGN, SETTING AND SUBJECTS: Urinary iodine (UI) was assessed as an indicator of iodine status in spot urine samples of women participating in a field trial in three rural communities in the plains of southeastern Nepal. Samples were collected during pregnancy (n=1021) and during lactation at 3-4 months postpartum (n=1028) at a central clinic; 613 women were assessed at both times. Salt iodine (SI) content was assessed semiquantitatively at 6-7 months postpartum in households (n=1572). RESULTS: During pregnancy and lactation, median UI concentrations were 0.756 and 0.483 micromol/l, respectively, indicating mild iodine deficiency. UI and SI concentrations covaried markedly by season and were highest during hot, dry, premonsoon months and lowest during and following the humid monsoon season. Within women who contributed urine samples during both pregnancy and the postpartum period, iodine status determined by UI was not correlated. The percentage of households with adequately iodized salt (30 ppm) ranged from 85 to 44% from the hot, dry to the humid seasons, respectively. CONCLUSIONS: In the rural southern plains of Nepal, iodine deficiency remains a mild-to-moderate public health problem among pregnant and lactating women despite the availability of iodized salt. Marked seasonality in SI content may account for the lack of intraindividual correlation between maternal iodine status during pregnancy and postpartum periods and contribute to periodicity in the risk of iodine deficiency.     

1139例妊娠期妇女缺铁性贫血的调查分析

目的调查了解武汉市中心城区孕妇缺铁性贫血概况及其相关因素,提出干预措施,提高围产保健质量。方法对在武汉市江岸区妇幼保健院围产保健门诊进行产前检查的1139例孕妇进行膳食问卷调查,并统一由检验科进行采血样检验。结果妊娠期妇女缺铁性贫血总发生率为9．4％,其中,轻度贫血占贫血总数的96．3％,中度贫血占3．7％,无重度贫血患者。随着孕期的增加,贫血患病率增高,孕晚期发病率最高（14．9％）,各孕期孕妇贫血患病率比较差异有统计学意义∥值分别为9．180、4．038、24．281,P〈0．01或〈0．05。孕妇贫血还与年龄、文化程度密切相关,随着孕妇年龄的增大、文化程度的降低,贫血的发生率逐渐升高。结论妊娠期妇女缺铁性贫血发病率较高,且多发生在中、晚孕期。因此,应加强孕期保健宣传工作,制定干预措施,并从孕早期开始补充铁剂,降低孕妇贫血发生率,从而减少贫血对孕妇和胎儿的不良影响。     

孕妇缺铁性贫血发生情况及影响因素分析

目的 探析孕妇缺铁性贫血（IDA）发生情况及影响因素。方法 以2019年3月至2020年2月首次在株洲市某医院建立生育档案的孕妇为调查对象进行问卷调查、血红蛋白（Hb）和血清铁蛋白（SF）水平检测,采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对IDA发生影响因素进行分析。结果 本研究共调查1 624名孕妇,年龄21~43岁,平均（28.72 ± 4.69）岁。文化程度以中专或高中为主,占50.00%。家庭年收入以8~19万元为主,占45.07%。初产妇占55.36%,检出孕期IDA 176例,发生率为10.84%。多因素Logistic回归分析结果显示孕妇年龄30~34、35~39、40~44岁（OR=4.998、10.455、7.745）、家庭年收入<8万元（OR=2.134）、孕中期及孕晚期（OR=1.728、4.315）、居住地为郊区（OR=3.027）、经产妇（OR=6.197）、流产次数1~2、≥3次（OR=2.139、12.203）、饮食习惯不正常（OR=2.055）、铁剂补充≤每周1次（OR=14.939）的孕妇发生IDA的风险较大,中专或高中以上文化程度（OR=0.277、0.570）孕妇发生IDA风险较小。结论 株洲市孕妇IDA发生情况较为普遍,孕妇发生IDA可受年龄、孕周、文化程度、家庭经济、居住环境、流产、分娩史,孕期膳食结构及铁剂补充情况等诸多因素影响,需加强孕妇妊娠保健教育,保证母婴健康。     

缺铁性贫血对孕妇免疫功能及感染性疾病的影响

目的探讨妊娠期缺铁性贫血(IDA)特别是边缘性铁缺乏对妇女免疫功能和感染易感性的影响。方法从孕检的280名孕30～38周第一胎妇女中,通过测定血红蛋白、红细胞内游离原卟啉和血清铁蛋白诊断出69名IDA孕妇、随机抽取52名正常孕妇和50名婚检非孕妇女作为研究对象,检测其细胞免疫的T淋巴细胞亚群CD+3、CD+4、CD+8和自然杀伤(NK)细胞CD16活性及IL2水平,以及体液免疫的IgA、IgG、IgM和补体C3水平;记录妇女妊娠期和分娩1周内感染性疾病的患病情况,SAS软件进行统计分析。结果本调查IDA孕妇Hb值均数为(102.00±6.00)gL,其CD+3、CD+4细胞的百分比、CD+4CD+8比值及IL2水平低于正常孕妇(P<0.01,P<0.05,P<0.05,P<0.01),IDA孕妇IgG水平低于正常孕妇(P<0.01),且随孕妇Hb值的下降,这些指标水平呈下降趋势;孕中期开始IDA孕妇感染性疾病的总发病率高于正常孕妇(P<0.05)。结论IDA孕妇T细胞亚群数量及因子水平和部分免疫球蛋白水平改变,感染性疾病发病率增高;对NK细胞活性和产褥期感染易感性的影响,尚需增加样本数进一步观察。     

A micronutrient-fortified beverage prevents iron deficiency,reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women

Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries, despite longstanding efforts to fortify foods or to distribute medicinal supplements to pregnant women. The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients (iron, iodine, zinc, vitamin A, vitamin C, niacin, riboflavin, folate, vitamin B-12, vitamin B-6 and vitamin E) on the hemoglobin, iron and vitamin A status of pregnant women in Tanzania. A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a randomized double-blind controlled trial in which study women received 8 wk of supplementation. Hemoglobin, ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period. The supplement resulted in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56%, respectively. The risk of iron deficiency was reduced by 70% among those who had iron deficiency at baseline and by 92% among those who had adequate stores. The micronutrient-fortified beverage may be a useful and convenient preventative measure, one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies.     

Coffee consumption as a factor in iron deficiency anemia among pregnant women and their infants in Costa Rica

The influence of coffee consumption on hematological and trace element status was studied in two groups of pregnant, low-income Costa Rican women: coffee drinkers (greater than or equal to 450 mL/d, n = 22) and coffee nondrinkers (0 mL/d, n = 26). Groups had similar income, education, prenatal care, age, parity, weight, height, pregnancy weight gain, prenatal iron supplementation, energy, protein, Fe, and vitamin C intake and infant sex and gestational age. Maternal hemoglobin (Hb) and hematocrit (Hct) at 8 mo gestation, cord blood Hb and Hct, infant birth weight and Hb and Hct at 1 mo of age, and breast-milk Fe concentration were significantly lower in the coffee group than in the noncoffee group. The association of coffee with infant Hb and Hct was independent of maternal Fe status and birth weight. These results are consistent with our previously reported data in rats and indicate that maternal coffee intake may contribute to maternal and infant anemia.     

妊娠妇女补充核黄素、VA对缺铁性贫血影响

目的 探讨补充核黄素、维生素A(VA)对妊娠妇女缺铁性贫血的影响.方法 将贫血孕妇分为补铁组、补铁 核黄素组、补铁 VA组、补铁 核黄素 VA组.补充上述营养素60 d,观察补充前后血红蛋白、血清铁蛋白、血清转铁蛋白受体的变化情况.结果 单独补铁、补铁 核黄素、补铁 VA、补铁 核黄素 VA均能显著提高妊娠妇女血红蛋白水平;补铁 VA组的血清铁蛋白明显高于补铁组(P<0.05);补铁 核黄素 VA组的血清铁蛋白明显高于补铁组、补铁 核黄素组、补铁 VA组(P<0.05),血清转铁蛋白受体显著低于补铁组、补铁 核黄素组、补铁 VA组(P<0.05).结论 单独补铁、补铁 核黄素、补铁 VA对改善缺铁性贫血均有明显效果,但铁、核黄素、VA等3种营养素同时补充,效果最好.     

Nutritional factors and infectious disease contribute to anemia among pregnant women with human immunodeficiency virus in Tanzania

The objective of this cross-sectional study was to identify risk factors for anemia among human immunodeficiency virus (HIV)-positive pregnant women in Dar es Salaam, Tanzania. Baseline data from 1064 women enrolled in a clinical trial on the effect of vitamin supplementation in HIV infection were examined to identify potential determinants of anemia. The mean hemoglobin (Hb) level was 94 g/L, and the prevalence of severe anemia (Hb < 85 g/L) was 28%; 83% of the women had Hb < 110 g/L. Iron deficiency and infectious disease appeared to be the predominant causes of anemia. Significant independent associations with severe anemia were observed for women with body mass index (BMI) < 19 kg/m(2) compared with women with BMI > 24 kg/m(2) [odds ratio (OR) 3.13, 95% confidence interval (CI): 1. 37-7.14); malaria parasite densities > 1000/mm(3) (OR 2.70, CI: 1. 58-4.61) compared with women with no parasites; eating soil during early pregnancy (OR 2.47, CI: 1.66-3.69); CD4+ cell count < 200/microL compared with CD4+ count > 500/microL (OR 2.70, CI: 1. 42-5.12); and serum retinol levels < 70 micromol/L (OR 2.45, CI: 1. 44-4.17) compared with women with retinol levels > 1.05 micromol/L. The most significant risk factors associated with severe anemia in this population are preventable. Public health recommendations include increasing the effectiveness of iron supplementation and malaria management during pregnancy, and providing health education messages that increase awareness of the potentially adverse nutritional consequences of eating soil during pregnancy.     

口服铁剂改善妊娠缺铁性贫血效果及铁储备状态的研究

目的:探讨口服铁剂改善孕期贫血及铁储备状态的作用。方法:选择144例妊娠贫血孕妇(贫血组,口服多糖铁复合物胶囊150 mg/次,2次/天)、100例正常孕妇(预防组,口服多糖铁复合物胶囊150 mg/次,1次/天)和50例正常孕妇(对照组,膳食补铁),测定血红蛋白(Hb)、红细胞计数(RBC)、血清铁蛋白(SF)、血清铁(SI)。结果:贫血组和预防组Hb和RBC呈现早-中期下降(P<0.05)、中-晚期上升(P<0.05)的变化,对照组各孕周Hb、RBC呈逐渐下降趋势(P<0.05)。整个孕周3组孕妇SF均呈进行性下降(P<0.01)。3组孕妇SI早-中期下降较为明显(P<0.01)。结论:单纯膳食补铁不能满足孕期对铁的需求。孕期铁储备处于持续消耗状态。需重视孕早期及孕中期铁剂补充。     

Responsiveness of dark-adaptation threshold to vitamin A and beta-carotene supplementation in pregnant and lactating women in Nepal

BACKGROUND: Impaired dark adaptation occurs commonly in vitamin A deficiency. OBJECTIVE: We sought to examine the responsiveness of dark-adaptation threshold to vitamin A and beta-carotene supplementation in Nepali women. DESIGN: The dark-adapted pupillary response was tested in 298 pregnant women aged 15-45 y in a placebo-controlled trial of vitamin A and beta-carotene; 131 of these women were also tested at 3 mo postpartum. Results were compared with those for 100 nonpregnant US women of similar age. The amount of light required for pupillary constriction was recorded after bleaching and dark adaptation. RESULTS: Pregnant women receiving vitamin A had better dark-adaptation thresholds (-1.24 log cd/m(2)) than did those receiving placebo (-1.11 log cd/m(2); P: = 0. 03) or beta-carotene (-1.13 log cd/m(2); P: = 0.05) (t tests with Bonferroni correction). Dark-adaptation threshold was associated with serum retinol concentration in pregnant women receiving placebo (P: = 0.001) and in those receiving beta-carotene (P: = 0.003) but not in those receiving vitamin A. Among women receiving placebo, mean dark-adaptation thresholds were better during the first trimester (-1.23 log cd/m(2)) than during the second and third trimesters (-1.03 log cd/m(2); P: = 0.02, t test). The mean threshold of nonpregnant US women (-1.35 log cd/m(2)) was better than that of all 3 Nepali groups (P: < 0.001, t test, for all 3 groups). CONCLUSIONS: During pregnancy, pupillary dark adaptation was strongly associated with serum retinol concentration and improved significantly in response to vitamin A supplementation. This noninvasive testing technique is a valid indicator of population vitamin A status in women of reproductive age.