Anemia in reproductive-aged women: diagnosis and correction of iron deficiency

DOI

https://dx.doi.org/10.18565/aig.2019.6.140-145

Vinogradova M.A.
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia, Moscow

Anemia is very common all over the world: more than one quarter of the population suffers from different types of anemia. Women of reproductive age, particularly ones during pregnancy and the postpartum period, are at a higher risk of anemia. The prevention of developing iron deficiency and its timely correction are of critical importance for such women due to the fact that anemia negatively affects the quality of life, pregnancy outcomes and newborns health. Despite comprehensive long-term studies of this condition, iron deficiency remains the most frequent cause of anemia. Subsequent pregnancies, excessive menstrual blood loss, low iron diet can gradually result in anemia. Differential diagnosis of iron deficiency and other types of anemia is of key importance. The diagnosed problem can be promptly eliminated without any further complications using up-to-date preventive and therapeutic approaches.

anemia

iron deficiency

ferritin

pregnancy

reproductive age

ferric hydroxide polymaltose complex

Full text (in Russian)

Kassebaum N.J. The global burden of anemia. Hematol. Oncol. Clin. North Am. 2016; 30(2): 247-308.
FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Iron deficiency anemia in pregnancy. Int. J.Gynaecol. Obstet. 2019; 144(3): 322-4. https://dx.doi.org/10.1002/ijgo.12740.
Cappellini M.D., Comin-Colet J., de Francisco A., Dignass A., Doehner W., Lam C.S. et al. Iron deficiency across chronic inflammatory conditions: international expert opinion on definition, diagnosis, and management. Am. J. Hematol. 2017; 92(10): 1068-78.
Costa M.M., Belo S., Souteiro P., Neves J.S., Magalhães D., Silva R.B. et al. Pregnancy after bariatric surgery: Maternal and fetal outcomes of 39 pregnancies and a literature review. J. Obstet. Gynaecol. Res. 2018; 44(4): 681-90. https://dx.doi.org/10.1111/jog.13574.
Evstatiev R., Gasche C. Iron sensing and signalling. Gut. 2012; 61(6): 933-52. https://dx.doi.org/10.1136/gut.2010.214312.
Huch R., Schaefer R. Iron deficiency and iron deficiency anemia. Pocket atlas special. Stuttgart, New York: Georg Thieme Verlag; 2006.
Hare D.J. Hepcidin: a real-time biomarker of iron need. Metallomics. 2017; 9(6): 606-18.
Koenig M.D., Tussing-Humphreys L., Day J., Cadwell B., Nemeth E. Hepcidin and iron homeostasis during pregnancy. Nutrients. 2014; 6(8):3062-83.
Bothwell T.H. Iron requirements in pregnancy and strategies to meet them. Am. J. Clin. Nutr. 2000; 72(1, Suppl.): 257S-64S.
National Institutes of Health. Iron. Dietary supplement fact sheet. Updated 2016. Available at: https://ods.od.nih.gov/factsheets/ IronHealthProfessional.
Davies J., Kadir R.A. Heavy menstrual bleeding: An update on management. Thromb. Res. 2017; 151(Suppl. 1): S70-7.
Mirza F.G., Abdul-Kadir R., Breymann C., Fraser I.S., Taher A. Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert Rev. Hematol. 2018; 11(9): 727-36. https://dx.doi.org/10.1080/17474086.2018.1502081.
Виноградова М.А., Федорова Т.А., Рогачевский О.В. Анемия при беременности: алгоритмы диагностики и лечения железодефицита. Акушерство и гинекология. 2014; 8: 138-43.[Vinogradova M. A., Fedorova T. A., Rogachevsky O. V. Anemia in pregnancy: diagnostic algorithms and treatment of iron deficiency. Obstetrics and gynecology. 2014; 8: 138-43. (in Russian)]
Серов В.Н., Бурлев В.А., Коноводова Е.Н., Кан Н.Е., Тютюнник В.Л. Диагностика, профилактика и лечение железодефицитных состояний у беременных и родильниц (клинический протокол). Акушерство и гинекология. 2014; 3(Приложение): 11-7. 7.[Serov V. N., Burlev V. A., Konovodova E. N., Kang N. E. Tyutyunnik V. L. Diagnosis, prevention and treatment of iron deficiency in pregnant and puerperal women (A clinical protocol). Obstetrics and gynecology. 2014; 3(Annex): 11-7 (in Russian)]
Breymann C., Auerbach M. Iron deficiency in gynecology and obstetrics: clinical implications and management. Hematology Am. Soc. Hematol. Educ. Program. 2017; 2017(1): 152-9.
Briley A., Seed P.T., Tydeman G., Ballard H., Waterstone M., Sandall J. et al. Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study. BJOG. 2014; 121(7): 876-88.
Tort J., Rozenberg P., Traoré M., Fournier P., Dumont A. Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth. 2015; 15: 235.
Ren A., Wang J., Ye R.W., Li S., Liu J.M., Li Z. Low first-trimester hemoglobin and low birthweight, preterm birth and small for gestational age newborns. Int. J. Gynaecol. Obstet. 2007; 98(2): 124-8.
Тютюнник В.Л., Кан Н.Е., Михайлова О.И. Коррекция железодефицитной анемии у беременных. Акушерство и гинекология. 2018; 8:106-10. 0.[Tyutyunnik V. L., Kang N. E. Mikhailova O. I. Correction of iron deficiency anemia in pregnant women. Obstetrics and gynecology. 2018; 8: 106-10. (in Russian)]
Lozoff B., Beard J., Connor J., Barbara F., Georgieff M., Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr. Rev. 2006; 64(5, Pt 2): S34-43.
Milman N. Postpartum anemia II: prevention and treatment. Ann. Hematol. 2012; 91(2): 143-54.
Wassef A., Nguyen Q.D., St-André M. Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review. J. Psychosom. Obstet. Gynaecol. 2019; 40(1): 19-28. https://dx.doi.org/10.1080/0167482X.2018.1427725.
De Franceschi L., Iolascon A., Taher A., Cappellini M.D. Clinical management of iron deficiency anemia in adults: Systemic review on advances in diagnosis and treatment. Eur. J. Intern. Med. 2017; 42: 16-23.
World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Geneva; 2011. Available at: http://www.who.int/vmnis/indicators/serum_ferritin.pdf.
Daru J., Allotey J., Peña-Rosas J.P., Khan K.S. Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review. Transfus. Med. 2017; 27(3): 167-74.
Breymann C., Honegger C., Hösli I., Surbek D. Diagnosis and treatment of iron-deficiency anaemia in pregnancy and postpartum. Arch. Gynecol. Obstet. 2017; 296(6): 1229-34.
Pavord S., Myers B., Robinson S., Allard S., Strong J., Oppenheimer C.; British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy. Br. J. Haematol. 2012; 156(5): 588-600.
Muñoz M., Peña-Rosas J.P., Robinson S., Milman N., Holzgreve W., Breymann C. et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus. Med. 2018; 28(1): 22-39. https://dx.doi.org/10.1111/tme.12443.
de Benoist B., McLean E., Egli I., Cogswell M., eds. Worldwide prevalence of anaemia 1993-2005. WHO global database on anaemia. Geneva: WHO; 2008. Available at: http://whqlibdoc.who.int/ publications/ 2008/9789241596657_eng.pdf]
Centers for Disease Control and Prevention (CDC). Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm. Rep. 1998; 47(RR-3): 1-29.
Ortiz R., Toblli J.E., Romero J.D., Monterrosa B., Frer C., Macagno E., Breymann C. Efficacy and safety of oral iron (III) polymaltose complex versus ferrous sulfate in pregnant women with iron-deficiency anemia: a multicenter, randomized, controlled study. J. Matern. Fetal Neonatal Med. 2011; 24(11): 1347-52. https://dx.doi.org/10.3109/14767058.2011.599080.
Wolf M., Chertow G.M., Macdougall I.C., Kaper R., Krop J., Strauss W. Randomized trial of intravenous iron-induced hypophosphatemia. JCI Insight. 2018; 3 (23). pii: 124486. https://dx.doi.org/10.1172/jci.insight.124486.
Шевелева Г.А., Федорова Т.А., Дубровина Н.В., Сокур Т.Н., Бакуридзе Э.М. Нарушение вегетативной регуляции у беременных с железодефицитной анемией и способы ее коррекции. Акушерство и гинекология. 2017; 6: 35-40.[Sheveleva G. A., Fedorova T. A., Dubrovina N. In. Sokur T. N., Bakuridze E. M. Violation of vegetative regulation in pregnant women with iron deficiency anemia and methods of its correction. Obstetrics and gynecology. 2017; 6: 35-40 (in Russian)]

Received 30.05.2019

Accepted 21.06.2019

Maria A. Vinogradova, PhD, head of Department of Reproductive Hematology and Clinical Hemostasiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel: +7495 4381406. Е-mail: Mary-grape@yandex.ru

For citation: M.A. Vinogradova Anemia in reproductive-aged women: diagnosis and correction of iron deficiency. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2019; (6):140-145 (in Russian)
https://dx.doi.org/10.18565/aig.2019.6.140-145

Anemia in reproductive-aged women: diagnosis and correction of iron deficiency

Vinogradova M.A.

Keywords

References

About the Authors

Similar Articles