Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis

Daru, Jahnavi; Zamora, Javier; Fernández-Félix, Borja M.; Vogel, Joshua P.; Oladapo, Olufemi T.; Morisaki, Naho; Tuncalp, Oezge; Torloni, Maria Regina; Mittal, Suneeta; Jayaratne, Kapila; Lumbiganon, Pisake; Ganchimeg, Togoobaatar; Thangaratinam, Shakila; Khan, Khalid S.

doi:10.1016/s2214-109x(18)30078-0

Cited by 286 publications

(237 citation statements)

References 30 publications

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“…Despite established interventions to treat and prevent postpartum haemorrhage, haemorrhage was the primary cause of death in our study, in keeping with global data . EmOC training emphasises the timely management of haemorrhage; however, this data emphasises the need to continue to strengthen this training.…”

Section: Discussionsupporting

confidence: 78%

Maternal mortality at the National Referral Hospital in Honiara, Solomon Islands over a five‐year period

Silva

Panisi²,

Maepioh³

et al. 2019

Aust NZ J Obst Gynaeco

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Background The Solomon Islands is a developing country facing significant barriers to the provision of quality antenatal and obstetric care. The maternal mortality rate is 114/100 000 live births, ranking the Solomon Islands 113th globally. Investigating maternal mortality may yield valuable insight into improving these numbers. Aim The objective of this study was to review all cases of maternal mortality at the National Referral Hospital, Solomon Islands over a five‐year period. Materials and methods This was a retrospective review of maternal deaths occurring at the National Referral Hospital, Solomon Islands from 2013 to 2017. Data on maternal demographics, characteristics and cause of death were collected. Results There were 39 maternal deaths at the National Referral Hospital from 2013 to 2017. The maternal mortality rate of the National Referral Hospital (139/100 000) is higher than the national rate (114/100 000). Most deaths were direct, with 28% attributed to haemorrhage. Overall, 79% of the total maternal deaths had elements that may be considered preventable, with laboratory delays present in 54% and medication shortages present in 29% of cases. Conclusion Maternal mortality is high in the Solomon Islands, with many potentially preventable deaths occurring at the National Referral Hospital. Continued focus on improving data collection, access to resources, and training is vital to reduce maternal mortality in the Solomon Islands.

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Section: Discussionsupporting

confidence: 78%

Maternal mortality at the National Referral Hospital in Honiara, Solomon Islands over a five‐year period

Silva

Panisi²,

Maepioh³

et al. 2019

Aust NZ J Obst Gynaeco

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“…Maternal health is impacted by anemia during pregnancy. A recent analysis describes a 2.36 fold higher risk of maternal death in women with severe anemia (hemoglobin < 70 g/L) [8]. The risk of postpartum depression is also higher in women with iron deficiency anemia (IDA) [9].…”

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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“…While iron deficiency (ID) is not the only cause of anemia, it is the most common contributor. Strategies to reduce anemia among pregnant women often prove ineffective, and a recent publication utilizing data from a WHO survey reported that severe anemia can substantially increase the risk of maternal mortality [2]. Thus, we believe current recommendations for screening and treatment of ID anemia (IDA) in gravidas and neonates require revision, and we further believe failure to address the use of intravenous iron in both populations represents an unmet clinical need.…”

Section: Introductionmentioning

confidence: 99%

Perinatal Iron Deficiency: Implications for Mothers and Infants

Juul¹,

Derman²,

Auerbach³

2019

Neonatology

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Iron deficiency, with or without anemia, is common in pregnant women. In fact, nearly 30% of reproductive-age women are anemic worldwide, and anemia in pregnancy has an estimated global prevalence of 38%. Severe anemia can substantially increase the risk of maternal mortality, and can adversely affect fetal development. In this review, we examine the available data regarding epidemiology and consequences of iron deficiency in mothers and infants, current treatment strategies, and make recommendations for screening and treatment of iron deficiency anemia in gravidas and neonates.

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Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis

Abstract: Barts and the London Charity.

Cited by 286 publications

References 30 publications

Maternal mortality at the National Referral Hospital in Honiara, Solomon Islands over a five‐year period

Maternal mortality at the National Referral Hospital in Honiara, Solomon Islands over a five‐year period

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

Perinatal Iron Deficiency: Implications for Mothers and Infants

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