Iron stores in pregnant women with sickle cell disease: a systematic review

Abstract

Background Gradual improvements in the management of sickle cell disease (SCD), have led to an increase in the number of women with SCD who reach the age of procreation. However, evidence on the iron status of pregnant women with sickle cell disease (PWSCD) remains inconclusive. We conducted the first systematic review on the prevalence, determinants and maternal/foetal outcomes of iron deficiency anaemia among PWSCD. Methods We searched MEDLINE, EMBASE, Global Health, Africa Index Medicus, the Cochrane library databases and reference lists of retrieved publications for studies describing the iron status of PWSCD. The literature search was done over a period of 1 month, with no language or date restrictions applied. Data were extracted on a Microsoft excel sheet. Two authors assessed all included studies for methodological quality and risk of bias. Results A total of 710 reports were identified for title and article screening. Five retained studies were conducted before or during the 90s and included 67 participants. After quality assessment, the observational studies were designated to have a “fair” quality assessment while the randomised control trial had an “unclear” quality assessment. The prevalence of iron deficiency anaemia among PWSCD varied by study design and diagnostic method. The overall prevalence ranged from 6.67–83.33%. None of the studies provided evidence on factors associated with iron deficiency anaemia and the randomized trial reported no difference in outcomes between PWSCD who had iron supplementation and those who did not. Conclusion Evidence on factors associated with iron deficiency anaemia among PWSCD and maternal/foetal outcomes in PWSCD who have iron deficiency anaemia is poor. The studies included in this review suggests that iron deficiency anaemia may be highly prevalent in PWSCD but due to the very small sample sizes and varied study designs, this evidence is inconclusive. The review shows that there is a need for more studies with robust designs and adequate sample sizes to assess the disease burden of iron deficiency anaemia in PWSCD.

Iron Metabolism in Normal and Pathological Pregnancies and Fetal Consequences

“…Aroke et al reported an extremely variable prevalence of iron-deficiency anemia during pregnancy among SCD patients, ranging from 6.7% to 83.3%, using multiple diagnostic tools (bone-marrow iron staining, serum iron levels, and/or ferritin levels) [132]. As SCD is responsible for intravascular hemolysis, SCD patients have lower concentrations of haptoglobin (0.09 versus 1.18 g/L, p < 0.0001) and hemopexin (0.42 versus 1.05 g/L, p = 0.0001) than unaffected controls [AG Cordier and K Peoc'h, Personal communication].…”

Meta-Analysis Effects of Antenatal Care Visit and Knowledge on the Adherence of Iron Tablet and Folic Acid Consumption

“…women, and children aged 6-24 months are usually the group most affected by iron deficiency (Agegnehu et al, 2019). Iron deficiency anemia in pregnant women is known to reach 38.2% on a global scale (Aroke et al, 2020). The number of cases of anemia has been increasing lately from 37.10% (2013) to 48.…”