Redefining normal hemoglobin and anemia in singleton and twin pregnancies

Shinar, Shiri; Shapira, Udi; Maslovitz, Sharon

doi:10.1002/ijgo.12506

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…Overall, pregnancy has a net iron loss of approximately 740 mg [2]. In Canada, 23% of pregnant women are anemic (Hb < 110 g/L in 1st and 3rd trimesters, < 105 g/L in 2nd trimester) [3,4] and an estimated 85% of these cases are attributable to iron deficiency [5]. In its early stages, iron deficiency can occur without anemia.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

VanderMeulen

Strauss

Lin

et al. 2020

BMC Pregnancy Childbirth

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Background: Iron deficiency in pregnancy is associated with inferior maternal and fetal outcomes. Postpartum depression, prematurity, intrauterine growth restriction, impaired childhood cognition and transfusion are all sequelae of maternal iron deficiency anemia. Transfusion to women of childbearing age has important consequences including increasing the risk of hemolytic disease of the fetus and newborn with future pregnancies. The relative contribution of iron deficiency to transfusion rates in the peripartum period is unknown. This study aimed to identify the prevalence of iron deficiency and anemia in pregnant women that received peripartum transfusions relative to age-matched non-transfused controls. Methods:We performed a retrospective case-control study of all women that were transfused in the peripartum period from January, 2014 to July, 2018. Cases were compared to the next age matched control to deliver at our institution. The primary objective was to determine the proportion of patients with iron deficiency in pregnancy or anemia in pregnancy in cases and controls. Charts were reviewed for predisposing risk factors for iron deficiency, laboratory measures of iron deficiency and anemia, iron supplementation history and maternal and fetal outcomes. Factors associated with peripartum transfusion were analyzed using a multivariate logistic regression.Results: 169 of 18, 294 (0.9%) women were transfused in the peripartum period and 64 (44%) of those transfused received 1 unit. Iron deficiency or anemia were present in 103 (71%) transfused women and 74 (51%) control women in pregnancy (OR 2.34, 95% CI: 3.7-18.0). Multivariate analysis identified social work involvement (adjusted OR 4.1, 95% CI: 1.8-10.1), intravenous iron supplementation in pregnancy (adjusted OR 3.8, 95% CI: 1.2-17.4) and delivery by unscheduled cesarean section (adjusted OR 2.8, 95% CI: 1.3-6.2) as significant predictors of peripartum transfusion.(Continued on next page)

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Section: (Continued From Previous Page)mentioning

confidence: 99%

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

VanderMeulen

Strauss

Lin

et al. 2020

BMC Pregnancy Childbirth

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“…Anemia in pregnancy is generally defined as a hemoglobin concentration below 11.0 g/dL in the first and third trimester of pregnancy and ≤10.5 g/dL in the second trimester [ 3 ], although according to some experts, the limit hemoglobin concentration in the third trimester is 10.5 g/dL [ 87 , 90 ]. Publications usually do not touch upon the issues of separate criteria for anemia in women pregnant with twins [ 91 , 92 ], but Shinar et al, suggest that in the second trimester, the cut-off point for hemoglobin concentration should be 9.7 g/dL because it is the best prognostic indicator for anemia [ 93 ].…”

Section: Resultsmentioning

confidence: 99%

Review of Dietary Recommendations for Twin Pregnancy: Does Nutrition Science Keep Up with the Growing Incidence of Multiple Gestations?

Wierzejska

2022

Nutrients

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Recommendations for nutrition and the use of dietary supplements for pregnant women are updated on regular basis but it remains to be seen to what extent they may be applicable in twin pregnancies. The aim of this narrative review is to present the current state of knowledge about the energy and nutrient demand in twin pregnancy. There is general consensus in literature that the energy demand is higher than in a singleton pregnancy, but there is a lack of position statements from scientific societies on specific energy intake that is required. In turn, recommended maternal weight gain, which favors the normal weight of the neonate, has been determined. There is even a larger knowledge gap when it comes to vitamins and minerals, the body stores of which are theoretically used up faster. The greatest number of studies so far focused on vitamin D, and most of them concluded that its concentration in maternal blood is lower in twin as compared to singleton pregnancy. Few randomized studies focus on iron supplementation and there are no other studies that would assess dietary interventions. In light of a growing incidence of multiple pregnancies, more studies are necessary to establish the nutritional demands of the mother and the course of action for adequate supplementation.

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“…The mean ferritin concentration was 16.0 µg/L (95% CI 11.6-17.5) and 42% of women had positive anemia workup results, including 34% with iron deficiency anemia (defined in the study as hemoglobin below 105 g/L with the coexistence of ferritin <15 µg/L). The hemoglobin value that was the best predictor of positive anemia workup results was 9.7 g/dL (sensitivity 80%, specificity 70%; AUC 0.809 ± 0.260) [56]. In a study by Delaney et al, one out of three women with multiple pregnancies for whom data on serum ferritin were available had a level below 12 µg/L [42].…”

Section: Ironmentioning

confidence: 98%

“…The systematic literature search retrieved 12 articles and 1 series of publications (four articles) [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. They included 830 participants from eight countries, predominantly with twin pregnancies (96%).…”

Section: Characteristics Of the Retrieved Studiesmentioning

confidence: 99%

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Micronutrients in Multiple Pregnancies—The Knowns and Unknowns: A Systematic Review

Zgliczyńska

Kosińska-Kaczyńska

2021

Nutrients

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Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.

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Redefining normal hemoglobin and anemia in singleton and twin pregnancies

Abstract: Anemia evaluation could be unnecessary in pregnant women with a hemoglobin value of 100-105 g/L. Consideration should be given to redefining anemia in singleton and twin pregnancies.

Cited by 15 publications

References 19 publications

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

Review of Dietary Recommendations for Twin Pregnancy: Does Nutrition Science Keep Up with the Growing Incidence of Multiple Gestations?

Micronutrients in Multiple Pregnancies—The Knowns and Unknowns: A Systematic Review

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