The impact of response to iron therapy on maternal and neonatal outcomes among pregnant women with anemia

Detlefs, Sarah; Jochum, Michael D.; Salmanian, Bahram; McKinney, Jennifer; Aagaard, Kjersti M.

doi:10.1016/j.ajogmf.2022.100569

Cited by 18 publications

(15 citation statements)

References 29 publications

(43 reference statements)

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“…Despite the small sample size of our study, a recent study reported that patients exposed to iron supplementation(ferrous sulfate, ferrous gluconate, ferrous fumarate, and ferrous glycinate) experienced reduced odds of preeclampsia and/or PTB. [30] In contrast to sertraline and ferrous sulfate, the signal we observed for acyclovir was misleading. According to CDC treatment guidelines, [25] acyclovir is recommended for administration at 36 weeks of gestation for patients with genital herpes.…”

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

“…We identified 365,074 patients with singleton pregnancies and continuity of care as our analytic population. This population was enriched with people who were aged 30 S2). The mean gestational age at delivery was 275.0 days.…”

Section: Descriptive Statisticsmentioning

confidence: 99%

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Detection of Drug Effect Signals Associated with Adverse Pregnancy Outcomes Using Propensity Score Matching at Scale

Hwang,

Piekos,

Wei

et al. 2024

Preprint

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ObjectiveWe applied propensity score matching method at scale on patient records to confirm signals of known drug effects on preterm birth and detect previously unidentified potential drug effects.Materials and MethodsThis was a retrospective study on women who had continuity of care at Providence St. Joseph Health (PSJH) both before and after pregnancy and delivered live births between 2013/01/01 and 2022/12/31 (n=365,075). Our exposures of interest were all outpatient medications prescribed during pregnancy. We limited our analyses to medication that met the minimal sample size (n=600). The primary outcome of interest was preterm birth. Secondary outcomes of interest were small for gestational age and low birth weight. We used propensity score matching at scale to evaluate the risk of these adverse pregnancy outcomes associated with drug exposure after adjusting for demographics, pregnancy characteristics, and comorbidities.ResultsThe total medication prescription rate increased from 58.5% to 75.3% (P<0.0001) from 2013 to 2022. The prevalence rate of preterm birth was 7.7%. 175 out of 1329 prenatally prescribed outpatient medications met the minimum sample size. We identified 58 medications statistically significantly associated with the risk of preterm birth (P≤0.1; decreased: 12, increased: 46).DiscussionWe narrowed down from 1329 medications to 58 medications that showed statistically significant association with the risk of preterm birth even after addressing numerous covariates through propensity score matching.ConclusionThis data-driven approach demonstrated that multiple testable hypotheses in pregnancy pharmacology can be prioritized at scale, laying the foundation for application in other pregnancy outcomes.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Detection of Drug Effect Signals Associated with Adverse Pregnancy Outcomes Using Propensity Score Matching at Scale

Hwang,

Piekos,

Wei

et al. 2024

Preprint

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“…9 Despite American College of Obstetricians and Gynecologists' recommendations for routine complete blood cell count screening, there are screening inconsistencies in clinical settings. 13,41 Many believe that national guidelines reflect outdated evidence on anemia in pregnancy and promulgate inequalities by race and ethnicity. 9,34,42 Our data support a strong correlation between antepartum anemia and SMM; antepartum anemia drives SMM more than nontransfusion SMM for every racial and ethnic group.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity

Igbinosa,

Leonard,

Noelette

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. METHODS: We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. RESULTS: In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian–Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42–1.53 to approximated RR 1.27, 95% CI 1.22–1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5–25.0%), followed by Black (20.9%, 95% CI 18.1–23.4%) and Hispanic (20.9%, 95% CI 19.9–22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. CONCLUSION: Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian–Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.

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“…Iron deficiency is the most common cause of anemia and is the most widespread nutritional disorder in the world [3,4]. Anemia had the potential risk of increasing preterm birth in addition to many other maternal diseases during and after pregnancy [5]. Since anemia is the most common diagnosis among pregnant women [6], it could be significantly associated with preterm labor as well as other comorbidities [7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of haemoglobin and serum ferritin level in preterm labour and preterm prelabour rupture of membrane (PPROM): a case-control study

Mohammed¹,

Haseeb²

2023

It Journ Gyn Obs

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Objective. Evaluate the level of maternal hemoglobin and ferritin in preterm labor and PPROM among Iraqi women. Materials and methods.The case-control study conducted at Azadi Teaching Hospital-Kirkuk included 225 pregnant women equally distributed into three groups, preterm, PPROM, and control group. A maternal blood sample (5 ml) was collected at the time of presentation, hemoglobin and ferritin measurements were performed for all participants.Results. Hemoglobin showed a significantly low level among the preterm and PPROM groups compared to control group (p=0.0001). While ferritin showed a significantly low level among the preterm group compared to other groups (p=0.0001). Comparing preterm with control, a hemoglobin level of ≥ 10 was associated with 89% sensitivity and 44% specificity, and a ferritin level of ≥32 was associated with 84% sensitivity and 61% specificity. Comparing PPROM with control, a hemoglobin level of ≥10 was associated with 80% sensitivity and 46% specificity, and a ferritin level of ≥74 was associated with 80% sensitivity and 46% specificity. In logistic regression analysis for preterm and control groups, only Hb was found to be a significant independent risk factor for preterm. And for PPROM control groups, both Hb and ferritin level were found to be significant independent risk factors for PPROM. M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o nConclusions. Pregnant women with anemia and a lower ferritin level are at risk of preterm labour, while those with anemia and high level of ferritin are at risk of PPROM among pregnant women.

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The impact of response to iron therapy on maternal and neonatal outcomes among pregnant women with anemia

Cited by 18 publications

References 29 publications

Detection of Drug Effect Signals Associated with Adverse Pregnancy Outcomes Using Propensity Score Matching at Scale

Detection of Drug Effect Signals Associated with Adverse Pregnancy Outcomes Using Propensity Score Matching at Scale

Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity

Evaluation of haemoglobin and serum ferritin level in preterm labour and preterm prelabour rupture of membrane (PPROM): a case-control study

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