بسم الله الرحمن الرحيم



بسم الله الرحمن الرحيم

Maternal Iron-Deficiency Anemia and pregnancy outcomes

Retrospective Study

Submitted by 4th year student

Faculty of Nursing

Name of student:

Ahmed Shaarawi

Ahmed Ishtia

Hana Odeh

Salah Mnazel

Supervised by:

Dr. Adnan Sarhan

Mariam Altell

Supervisor Name:

Miss. Najwa Subuh

1st semester 2008-2009

Is there a Causal Relationship between Iron- Deficiency Anemia and Weight at Birth, Length of Gestation and Perinatal Mortality?

1. Abstract

Iron-deficiency anemia is a health problem that often goes untreated, especially in developing countries, where it can be most dangerous. Many severe health complications of iron-deficiency anemia are evident in pregnancy. The World Health Organization (WHO) estimates that an average of 56% of pregnant women in developing countries is anemic. This percentage ranges from 35% to 75% in specific areas, and is much higher than the 18% of anemic pregnant women in developed countries. Iron deficiency during pregnancy is known to be caused by combination of factors such as previously decreased iron supply, the iron requirements of the growing fetus, and expansion of maternal plasma volume. While plasma volume and red cell mass are both known to expand during pregnancy, plasma volume swells to a greater extent, therefore diluting the maternal hemoglobin concentration (Hb). It is necessary to take this into consideration when diagnosing anemia in pregnant women. Effective diagnosis has been achieved by accurate laboratory tests of hemoglobin and hematocrit levels.

1.2 Key Words

• Hemoglobin. • Iron deficiency anemia. • Pregnancy. • Perinatal mortality.

• Birth weight. • Preterm delivery. • Low birth weight.

1.3 Introduction

Iron-deficiency anemia is a common and easily treated condition that occurs when there is not enough iron in the body. It is the most common type of anemia. A lack of iron in the body can come from; bleeding, not eating enough foods that contain iron, or not absorbing enough iron from food that is eaten. Iron deficiency (ID) is one of the risks to pregnant women. Causes of ID include extra iron required by the growing fetus and the placenta and the increased maternal red cell mass.

As part of a critical review process to examine the importance of iron-deficiency anemia, this review was undertaken to determine whether these conditions in pregnant women cause low birth weight (LBW) or prenatal mortality and other birth outcome. Because LBW (80 mL/mo). Contraceptive practice also plays a part—the intrauterine devices increases menstrual blood loss by 30%–50% while oral contraceptives have the opposite effect. Pregnancy is another factor. During pregnancy there is a significant increase in the amount of iron required to increase the red cell mass, expand the plasma volume and to allow for the growth of the fetal-placental unit. Finally, there is diet. Women in their reproductive years often have a dietary iron intake that is too low to offset losses from menstruation and the increased iron requirement for reproduction (Institute of Medicine, 1990). Consequently, the overall prevalence of iron deficiency in non-pregnant women of reproductive age in the United States, 9%–11%, is higher than at other ages apart from infancy. The prevalence of IDA in the same age group is 2%–5%. Prevalence of iron deficiency and IDA is increased 2-fold or more for those women who are minorities, below the poverty level or with < 12 y of education. Risk is also increased with parity—nearly 3-fold higher for women with 2–3 children and nearly 4-fold greater for women with 4 or more children, thus implicating pregnancy (Rasmussen, K, 2001).

It is estimated that < 50% of women do not have adequate iron stores for pregnancy (Institute of Medicine, 1990. Gambling.L, et al, 2003). Because the iron required for pregnancy (3–4 mg/d) is substantial, risk of iron deficiency and IDA should increase with gestation. However, the prevalence of anemia and IDA in pregnant women from the United States is not well defined but must be substantial, particularly among the poor. During pregnancy, anemia increases > 4-fold from the 1st to the 3rd trimester in the low-income women monitored as part of pregnancy nutritional surveillance by the CDC (47). In the Camden Study where the cohort is mostly minority, current data (2000–2004) suggest that the prevalence of anemia increases > 6-fold from 6.7% (1st trimester) to 27.3% (2nd trimester) to 45.6% in the 3rd trimester. Only a fraction of anemic women in Camden have iron deficiency anemia. Based on low hemoglobin for gestation by CDC criteria plus low ferritin ( ................
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