Anemia and birth weight gestational age and infant mortality

Most reviewers of the scientific literature will agree that there is a U-shaped curve relationship between the maternal hemoglobin concentration and the proportion of LBW infants [2]. The cause of the elevation in prevalence of LBW infants at the upper end of the distribution of Hb is believed to be improper expansion of the maternal plasma volume [26], while insufficient erythropoiesis and poor volume expansion may be

Table 16.3

Common Iron Supplement Prescribed during Pregnancy

Chemical form

Trade names

Oral forms

Ferrous sulfate

Feosol, Feratab, Fer-gen-sol, Ferospace, Ferralyn, Lanacaps Ferra-TD, Slow Fe Fergon, Ferralet, Simron

Capsules, extended release, oral liquid, syrup, tablets

Ferrous gluconate

Capsules, tablets, extended release tablets

Ferrous fumarate Femiron, Feostat, Ferretts,

Fumasorb, Fumerin, Hemocyte, Ircon, Nephro-Fer, Span-FF Iron-polysaccharide Hytinic, Niferex, Nu-Iron

Extended release, oral solution, oral suspension, tablets, chewable tablets

Capsules, oral solution, tablets associated with the low Hb concentrations at the other end of the distribution curve. The optimal maternal Hb for minimal incidence of LBW in the published literature varies (Table 16.3). The hemoglobin concentration and the definition of anemia are trimester dependent, with a clear nadir of concentration in mid-gestation. Since many of these studies did not use finite times of sampling, the variations may well reflect the timing of sampling and not true discrepancies in the relationship of data to outcomes [27].

Severity of anemia is an additional factor associated with an increased risk of LBW and prematurity with severe anemia (Hb < 80 g/l) [27]. There is a median relative risk (RR) of 4.9 for severe anemia with moderate anemia having a median risk of approximately 2. The causes of anemia were not known in most studies; thus, the contribution of iron deficiency anemia cannot be evaluated. In a study of pregnancy outcome where malaria is endemic, Verhoeff et al. [28] reported a RR of 1.6 for intrauterine growth retardation if maternal Hb was <80 g/l at the first clinic visit compared to a RR of 1.4 (not significant) if moderate anemia was present at delivery. Interestingly, the prevalence of anemia decreased from 23.6 to 11.4% between the first trimester and delivery. In this study of 1,423 live-born singleton births in rural Malawi, there was no benefit to intrauterine growth retardation of iron-folate administration during pregnancy. The authors did observe, however, a significant reduction in the prevalence of prematurity with micronutrient supplementation. In contrast, malaria intervention, even in mid gestation was effective in promoting fetal growth.

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