An evidence-based definition of anemia for singleton, uncomplicated pregnancies

Abstract

Background The definition for anemia in pregnancy is outdated, derived from Scandinavian studies in the 1970’s to 1980’s. To identity women at risk of blood transfusion, a common cause of Severe Maternal Morbidity, a standard definition of anemia in pregnancy in a modern, healthy United States cohort is needed. Objective To define anemia in pregnancy in a United States population including a large county vs. private hospital population using uncomplicated patients. Materials and methods Inclusion criteria were healthy women with the first prenatal visit before 20 weeks. Exclusion criteria included preterm birth, preeclampsia, hypertension, diabetes, short interval pregnancy (<18 months), multiple gestation, abruption, and fetal demise. All women had iron fortification (Ferrous sulfate 325 mg daily) recommended. The presentation to care and pre-delivery hematocrits were obtained, and the percentiles determined. A total of 2000 patients were included, 1000 from the public county hospital and 1000 from the private hospital. Each cohort had 250 patients in each 2011, 2013, 2015, and 2018. The cohorts were compared for differences in the fifth percentile for each antepartum epoch. Student’s t-test and chi-squared statistical tests were used for analysis, p-value of ≤0.05 was considered significant. Results In the public and private populations, 777 and 785 women presented in the first trimester while 223 and 215 presented in the second. The women at the private hospital were more likely to be older, Caucasian race, nulliparous, and present earlier to care. The fifth percentile was compared between the women in the private and public hospitals and were clinically indistinguishable. When combining the cohorts, the fifth percentile for hemoglobin/hematocrit was 11 g/dL/32.8% in the first trimester, 10.3 g/dL/30.6% in the second trimester, and 10.0 g/dL/30.2% pre-delivery. Conclusions Fifth percentile determinations were made from a combined cohort of normal, uncomplicated pregnancies to define anemia in pregnancy. Comparison of two different cohorts confirms that the same definition for anemia is appropriate regardless of demographics or patient mix.

Direct Dispensation of Prenatal Supplements With Iron and Anemia Among Pregnant People

“…Postpartum hemorrhage was defined as estimated blood loss greater than 500 cc in a vaginal delivery or greater than 1000 cc in a cesarean delivery consistent with institutional protocol. Maternal anemia was defined as a hematocrit less than 30% 11 based on data from our patient population supporting this is less than the fifth percentile, and is consistent with national guidelines. 11 Transfusion data included time from delivery to blood administration and number of units transfused.…”

“…Maternal anemia was defined as a hematocrit less than 30% 11 based on data from our patient population supporting this is less than the fifth percentile, and is consistent with national guidelines. 11 Transfusion data included time from delivery to blood administration and number of units transfused.…”

“…In the current study, we observed a change in prevalence of anemia from 18% to 11% on admission for delivery. Our study defined maternal anemia as hematocrit levels lower than 30% (as defined in our population) 11 and measured hematocrit levels on admission. A 2018 study by Siekmans and colleagues 12 surveyed patients across 7 different countries in Asia and Africa to identify barriers to prenatal iron and folic acid supplementation.…”

“…First, the measure of hematocrit was used to determine if rate of anemia in the population, defined as proportion of patients with a hematocrit level lower than 30% per previous studies at our institution, changed with universal iron supplementation. 11 Second, we compared incidence of transfusion for symptomatic blood loss anemia in the immediate postpartum period not related to obstetric catastrophe between the 2 cohorts.…”

Formulation and Analysis of Millennia Nutrition Content (Anti-Anemia Jelly Drink) to Increase Hemoglobin Levels in Young Girls

“…Based on Riskesdas data in 2013, the prevalence of anemia in young women was 23% and it had increased in 2018 by 32%, meaning that 3-4 out of 10 adolescents suffer from anemia. The government's program to administer Blood Supplement Tablets (TTD) to young women aims to reduce the prevalence of anemia which is still high in young women (Zhu et al, 2020;Zofkie et al, 2022). This activity is in the form of giving blood-supplemented tablets for 4 months to young women which must be consumed according to the rules so that young women do not experience iron nutritional anemia.…”