Abstract
Objective
To investigate the prevalence, predictors, and management of anaemia in pregnancy.
Study design
A multi centre study across 11 maternity units in the UK. Data were collected over
a two week study period in 2008 on maternal history, haemoglobin (Hb) and ferritin
concentrations, iron therapy during pregnancy and in the postpartum period. Logistic
regression models were used to explore factors associated with anaemia during pregnancy.
Main outcomes included anaemia, defined as Hb < 11 g/dl at booking, Hb < 10.5 g/dl in subsequent antenatal visits, and Hb < 10 g/dl postnatally.
Results
Completed data were received on 2103 of 2155 women (97% completion rate). Of these,
24.4% (502) (95% CI 22.5–26.2%) were anaemic at some stage during the antenatal period.
Predictors for having anaemia by 32 weeks gestation included young maternal age (odds
ratio 1.96, 95% CI 1.38–2.79), non-white ethnic origin (odds ratios varied 1.37–2.89
depending on ethnic origin) and increasing parity (odds ratio 1.24, 95% CI 1.08–1.41).
Of women who had postnatal Hb levels checked, 30% (309/1031) were anaemic and, depending
on centre, 16% to 86% of these received iron therapy.
Conclusion
Anaemia was reported in nearly one in four women in the antenatal period, and nearly
one in three of the women who had a postpartum Hb checked. Despite national guidelines,
there was considerable variation in administration of iron including low utilisation
of parenteral iron therapy. Future research needs to focus on the consequences of
iron deficiency anaemia for maternal and infant health outcomes and effectiveness
of implementation strategies to reduce anaemia.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anaemia in pregnancy.Medical Clinics of North America. 1992; 76: 631-647
Worldwide prevalence of anaemia 1993–2005. WHO Global Database on Anaemia. Geneva: World Health Organization;de Benoist B, McLean E, Egli I, Cogswell [http://whqlibdoc.who.int/publications/2008/9789241596657_eng.df].
- Maternal iron deficiency anaemia affects postpartum emotions and cognition.The Journal of Nutrition. 2004; : 267-272
- Low haemoglobin level is a risk factor for postpartum depression.The Journal of Nutrition. 2003; : 4139-4142
- Prepartum anemia.Annals of Hematology. 2008; 87: 949-959
- Anemia and iron deficiency: effects on pregnancy outcome.American Journal of Clinical Nutrition. 2000; 71 (1280-4s)
Royal College of Obstetricians and Gynaecologists Blood Transfusions in Obstetrics (Green-top 47) 2007 www.rcog.org.uk.
National Institute for Healthcare and Clinical Excellence Clinical Guideline 62, Antenatal Care: routine care for the healthy pregnant woman. RCOG press March 2008.
- Treatments for iron-deficiency anaemia in pregnancy (Review).John Wiley & Sons Ltd., 2009
- A practical guide.Third Edition. Blackwell Science, 2002 (p. 179)
- A clinical evaluation of serum ferritin as an indication of iron stores.New England Journal of Medicine. 1974; 290: 1213-1216
- Prevalence of hypochromic anaemia in iron deficiency.Clinical and Laboratory Haematology. 2000; 227: 9-80
- Expert recommendations for the diagnosis and treatment of iron deficiency anaemia during pregnancy and the postpartum period in the Asia-Pacific region.Journal of Perinatal Medicine. 2011; 39 ([Epub 2010 November]): 113-121
World Health Organization (2001) Iron deficiency anaemia. Assessment, prevention and control. WHO/NHD/01.
- Inference and missing data.Biometrika. 1976; 6: 581-592
- Multiple imputation of missing values: further update of ice, with an emphasis on interval censoring.Stata Journal. 2007; 7: 445-464
- Multivariable model-building. A pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables.Wiley-Blackwell, Chichester2008 (ISBN 978-0-470-02842-1)
- Multilevel and longitudinal modeling using stata.Stata Press, TX, USA2008 (ISBN 978-1-59718-040-5)
NHS Sickle cell and Thalassaemia Screening Program 2006; National Collaboration Centre for Women's and children's health 2008 http://sct.screeening.nhs.uk/policy.
- Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum.Archives of Gynecology and Obstetrics. 2010; 282: 577-580
- Predictors of pregnancy and postpartum haemoglobin concentrations in low-income women.Public Health and Nutrition. 2004; 7: 701-711
- Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study.European Journal of Obstetric Gynaecology and Reproductive Biology. 2009; 147 ([September 4]): 151-156
- Maternal risk factors and anaemia in pregnancy: a prospective retrospective cohort study.Journal of Obstetric Gynaecology. 2010; 30: 132-136
- Prevalence and risk factors for early postpartum anaemia.European Journal of Obstetrics, Gynecology and Reproductive Biology. 2010; 150: 126-131
- High prevalence of post-partum anaemia among low income women in the United States American.Journal of Obstetrics and Gynaecology. 2001; 185: 438-443
- Maternal iron–folic acid supplementation programs: evidence of impact and implementation.Food Nutrition Bulletin. 2010; 31: 100-107
Article info
Publication history
Published online: August 08, 2011
Accepted:
July 11,
2011
Received in revised form:
June 27,
2011
Received:
March 28,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
