Research topic
This paper highlights the efficacy of diet and medication interventions in improving the outcomes among anemic pregnant women. It comprises patients who are pregnant and with anemia from four ethnic groups. It will highlight intervention strategies intended to lessen the anemia among pregnant women with special emphasis on the dependant and independent variables
Research Problem
The development of the maternal environment is a complicated process that involves a cascade of events. These may include hormonal, genetic, biochemical, immunological, or environmental factors. However, nutrition also plays an important role. Especially, a diet regimen needs a perfect balance between the two essential components, nutrients and therapy or medication. With this in hand, the expectation of a successful pregnancy is no more a difficult task. In certain instances, conditions like anemia may complicate the pregnancy outcome which could occur through Iron deficiency. The frequent iron abnormalities are iron deficiency anemia (IDA) and Iron deficiency (ID) which are problematic health concerns globally (Paesano et al., 2010). In the third trimester, the frequency of prepartum anemia is nearly 14-52% in placebo-controlled women and 0-25% in women who are taking iron, which in turn relies on iron dosage (Milman, 2008). Similarly for those who are on ferritin administration, the proportion of IDA is nearly 12- 17% in placebo-controlled women and 0-% in women on ferritin (Milman, 2008). The iron-deficient condition leads to compromised neonatal hygiene, decreased weight of newborns, fetal growth retardation, and over trouble for preterm delivery (Paesano et al., 2010). Elevated iron need during pregnancy may contribute to the above-mentioned aberrations (Paesano et al., 2010). On the other hand, chemotherapeutic approaches involving folic acid and ferrous sulfate have some benefits in the improvement of anemia during pregnancy. However, there is limited information on the efficiency of diet and therapy in lessening anemia among pregnant women. Most pregnant women still need effective obstetric and pediatric supervision. A defect in this particular juncture could result in insufficient clinically relevant care for anemic pregnant women. This needs to be overcome by an efficient strategy.
Research Purpose
The main purpose of the study is to identify the interventions that may improve outcomes among pregnant women with Anemia. Anemia is a severe health problem worldwide. It causes depleted levels of hemoglobin due to various reasons like malnutrition or poor diet, pregnancy, blood loss due to menstruation, vitamin B12, or folic acid deficiency. Most importantly, in pregnant women anemia occurs due to iron deficiency. It is essential for pregnant women to meet the growing needs of iron to nurture the developing baby. This could be accomplished through proper diet and medication management.
However, there is little information on the intervention strategies being exploited for the improvement of anemia among pregnant women. Especially, the role of nurses is considered important in providing care to anemic patients through the knowledge gained from the practice, theories or models, and education. They still need some assistance from the literature so that they could modify nursing skills in an evidence-based manner for the better improvement of anemia among pregnant women. The central component of this research is to identify and highlight the intervention strategies that may influence the improvement outcomes among anemic pregnant women. Further, this proposal attempts to connect the problem of anemia among pregnant women with nurse care.
Research question
What are the risk factors for pregnant women with anemia?
Review of literature
Pregnancy-associated conditions often rely on the optimum levels of certain required nutrients. One such condition is Anemia which is an important health issue among the women of reproductive age. In the developing countries, anemia is reported to be more common in preschool children (Leenstra et al., 2004). This was revealed when two risk population involving pregnant women and preschool children were assessed for Ferritin levels, iron deficiency in a multistage random study (Leenstra et al., 2004). The frequency of anemia and iron deficiency in school attending girls may indicate that these aberrations get induced since the beginning of childhood, right at the school age. This may further complicate the pregnancy success at a later stage. There is need to identify the anemic women population right at the initial stages of life.
The possible factors contributing to iron deficiency and anemia in this population may be low awareness of standardized diet or nutritional imbalance. In certain instances, overweight and obese conditions may interfere with the iron requirement (Eckhardt, Torheim, Monterrubio Barquera & Ruel, 2008). In a study, it was described that the iron needs are not thoroughly met in overweight and obese women in developing countries (Eckhardt et al., 2008). In addition, the supplementation of micronutrients other than iron seems to be inadequate (Eckhardt et al., 2008). Hence, the diet standard is a vital concern among women who are albeit on adequate energy consumption. In developed nations, pregnant women surviving on low economic conditions have increased vulnerability to Iron deficiency anemia (IDA) (Leblanc & Rioux, 2007).
Nutritionists have played key role in the selection process of pregnant women and at 36 +/- 2 weeks of gestation parameters like mean corpuscular volume, Hb,serum ferritin, and at six months of age transferrin saturation (TS), total iron binding capacity (TIBC),SF (Leblanc & Rioux, 2007).The pregnant women surviving on low income have similar frequency of IDA as that observed in high income groups. Most of these participants had abnormal Hb and SF levels (Leblanc & Rioux, 2007). Pregnant women had their abnormal anemic levels in the multipara and late stages of gestation (Kagu, Kawuwa, & Gadzama, 2007). In addition, the influence of malaria parasitaemia was also high in multipara and primigravidae (Kagu et al., 2007). This has indicated that the infestation of parasitic potozoans like malaria and Shistosoma and, educational awareness, decreased birth gap period were identified as risk contributing factors for anemia among pregnant women (Kagu et al., 2007).
Therefore, the risk factors necessary for the incidence or prevalence of anemia among pregnant women would also need to be considered from the infectious disease context. This could be because of the possibility that these parasites ay interfere with the normal homeostatic or metabolic machinery and accelerate the chances of acquiring anemia. Pregnant women need to be weary of cautionary measures about the living environment. Next, treatment strategies involving iron have certain side effects that need to be considered (Zhou,Gibson, Crowther,& Makrides, 2009).Dosage levels of iron in high and small amounts may induce problems related gastrointestinal tract (Zhou et al., 2009). Experiments conducted after the supplementation of iron at various doses have demonstrated that hemoglobin levels have shown a good response to iron (Zhou et al., 2009). This was apparent with 20mg, 40mg and 80 mg per day. One hundred and seventy-nine (99%) women completed the trial (Zhou et al., 2009).
Gastric abnormalities like vomiting, nausea, and stomach pain were however in decreased proportion for the group that received lower doses of iron compared to that received a higher dose (Zhou et al., 2009).Supplementation of iron may need to be cautiously recommended for the treatment of anemia especially with regard to the dosage (Zhang et al., 2009).This could minimize the unnecessary complications related to gastrointestinal tract. Epidemiology of anemia during is still unresolved with regard to the risk contributing factors. Initiative programs focusing on pregnancy-monitoring has shed light on anemia (Zhang, et al., 2009). Hemoglobin levels tested in each trimester of pregnancy has shown the proportion of 32.6% prevalence of anemia. There is also marked difference in each trimester (Zhang et al., 2009).
With this data in hand, researchers have noted that hypertension, which is in the form of mild and severely induced in pregnancy, job, education at pre high school level, and age are risk factors for anemia(Zhang et al., 2009). In addition, the supplementation of folic acid before the conception was shown to lessen the risk of anemia in the first trimester (Zhang et al., 2009). Whereas, in the 2nd and 3rd trimesters parental care implemented following the 1st trimester has enhanced risk contributing effect on anemia (Zhang et al., 2009). The magnitude of hypertensive disorders is closely associated with risk of anemia and 1st trimester anemia has low risk corresponding to the folic acid intake at the time of pre conception (Zhang et al., 2009). School girls at the teenage level may be susceptible candidates for the risk of anemia and in some circumstances anemia may also affect the physical work performance in nonpregnant adolescents and teenage pregnancies (Leenstra et al., 2009).
Hence, when adolescent schoolgirls were evaluated for iron levels and effect of vitamin A on hemoglobin concentration, hemoglobin levels were high with regard to the placebo group receiving iron for a prolonged period (Leenstra et al., 2009).
This observation was confined to iron deficient adolescent girls in contrast to those with sufficient iron levels (Leenstra et al., 2009). In addition, the same treatment strategy when applied for nonmenstruating and menstruating girls, the results did not show any variation (Leenstra et al., 2009). However, vitamin A did not exert any effect on iron levels (Leenstra et al., 2009).This has strengthened the connection between elevated hemoglobin levels and iron intake provided weekly among adolescent girls (Leenstra et al., 2009). It is important to note that this approach has profound significant impact on the effects caused by malaria in anemic pregnant women. Hence, iron supplementation could serve as the good diet resource among menstruating iron deficient teenage girls and also for the subsequent years of their pregnancy stage (Leenstra et al., 2009). Thus could also indirectly mitigate that parasitic influence on the anemic pregnant women (Leenstra et al., 2009).
Treatment strategies employing ferrous sulfate for anemic pregnant women have been initiated in clinical trials. Pregnant women having a gestation age of 16 to 20 weeks have been largely recruited (Souza et al., 2009). Ferrous sulphate in the form of elemental iron at a supplemented dose of 60 mg is the preferred choice. This has been accomplished in three regimens like daily dose of one tablet, one tablet two times per 7 days, and one table per 7 days (Souza et al., 2009). Hence, educational programs targeted in this area could result in awareness among nurses.
This is with respect to acquisition of knowledge, intervention confidence skills of nursing students variations in attitude and influence of particular demographic variables. Since morbidity and mortality rates are prominent with anemia, nurses could be readily prepared to respond to the intervention strategies handle the anemic patients effectively. Nurses could better streamline the modulation of diet with the required needs of iron and appropriate management. Pregnant women could receive timely encouragement from the nursing professionals. Next, through an evidence based practice framework student interest and engagement will be improved. From the significant results obtained on anemic conditions nurses could learn to systematically locate, asses and could utilize the available research skills to address the clinical problem. Hence, nurses could establish better relationship with the anemic pregnant women as efficient care providers which help patients to get relieved of any psychosocial problems. The anemic risk factors identified by the nursing professionals will thus be regulated before they become detrimental and affect the quality of life of pregnant women. Correspondingly, the bLf induced high hematological indices have contributed to low IL-6 levels and high serum hepcidin ,found as as prohepcidin and ferrous sulfate induced high IL-6 levels and has no effect on prohepcidin and hematological parameters(Paesano et al., 2010). Anemia prevalence data obtained from the girls aged between 12 and 13 years was not considered to be significant due to the different in the age and sex match centiles of haematocrit and hemoglobin (Mackerras & Singh, 2007). This study when conducted on boys at the same age level yielded high significant values compared to girls (Mackerras & Singh, 2007). There seems to be discrepancy in the age- sex relationship that might influence the haematocrit and hemoglobin levels (Mackerras & Singh, 2007).
This could indicate that anemic pregnant women at a very young age need proper management with regard to the cutoffs and incidence which could help in better assessing the risk. To this end, some strategies may be explored to determine the anemia at a very young age among pregnant who may likely acquire serious complications at a later stage (Day, 2004).
Objectives
The main objective of the study is to identify high risk anemic pregnant women and devise a standardized strategy for creating awareness about standardized diet and medication regimen.
Hypothesis
The hypothesis is that
- It is unknown whether by educating anemic pregnant women about the risk factors and assisting them in self-care management behaviors and
- developing a standardized frame work about diet and medication regimen, would serve to improve the anemia among pregnant women.
Methodology; Design
The study is a quasi experimental one. Here pregnant women randomly selected will be used to evaluate the efficacy of diet regimen and management approaches in improving the anemia among pregnant women. Participants who are pregnant women seeking antenatal care will be recruited from obstetrical department of Government General Hospital. To be eligible for enrollment, the participants had to
- have a confirmed pregnancy
- Primary diagnosis of anemia
- be 16 years or older, and
- understand and speak English (Yuan Xing et al., 2009).
Interviewed will be organized by professionals who are interview experts. A 5 ml of blood will e collected from the participants after seeking an informed written consent about their willingness to participate. From all the participants, a subgroup will be randomly selected to perform laboratory tests for the levels of Hb,serum iron and serum ferritin. The subgroup selection procedure will be done as follows. Initially, all the study participants on the day of election will be categorized into ethnic groups like African Americans, whites, Latinos, and Asians.
This is a stratified random sample method where the data will be collected equivalently from the all the selected ethnic groups.
Data collection
Doctors will be called to gather information on the list of individuals with anemia from different ethnic groups. The sample size is 400. From each group 100 participants will be selected. The inclusion criteria will be pregnant women with anemia, have abnormal Hb indices and iron levels. The exclusion criteria will be pregnant women without anemia.
Data Collection Methods
During the data collection characteristics like Education, smoking, weight, family history, diet, decrease exercise will be selected as independent variables. On the other hand: Anemia, hemoglobin level, hematocrit level, blood pressure, with history of atleast one Hypertension medication will be selected as dependant variables.
The selected independent variables may influence the study purpose in devising a framework to improve the outcome through modulation of life style where these variables interfere and affect the outcome. For example proper nutrition regimen or diet therapy rich in iron, good exercise, cessation of smoking etc may be incorporated in the interventions. It also helps in assessing the current awareness on anemia and its management and keeping that in mind, individuals can be better imparted awareness or knowledge on the risk factors, hemoglobin levels, blood pressure etc. This enables the outcome parameters reduced to normal levels through balanced iron needs and controlled management strategies. This strategy can be implemented by selecting a pre teaching session group where all the levels of the dependant variables are measured along with the information sought on the independent variables. A teaching session group followed up by 36 weeks where all the measures will be checked to determine the outcome. These are measured statistically by a‘t’ test. A value of p<0.001 will be expected and considered significant.
Implications for practice
There is a need for funding anemic pregnant women. This is due to the fact that Anemia in pregnancy is a severe health problem characterized by high demands of iron supplementation. A defect in the timely intake of iron and care delivery could lead to significant maternal morbidity and mortality, loss of baby and low birth weight. Large number of pregnant women especially, living in low socioeconomic conditions is still in need of proper care by the health care professionals. It is unknown whether these women constitute a high risk category. They need rapid identification by the policy makers at the earliest. This would necessitate screening various geographical regions. Initially, staffing should be given paramount importance. The members may include health care professionals, nurses, and data entry operators Travel and other costs likely to be incurred since the inception of project operation till the stage of completion have to be met. Hence funds need to be raised from an authorized grant agency to enable better quality of life among pregnant women who are unaware of potential risks induced by anemic conditions. The results obtained from the study would give nurses, advanced practice nurse (APN) information with regard to causes of anemia and prevalence in elderly nursing home (NH) residents(Sabol et al., 2010). This would facilitate reliable diagnostic and management strategies that could enhance mobility and overall physical functions. This could be because with the old age the prevalence of anemia may increase (Sabol et al., 2010). The symptoms that occur in anemic elderly women may also likely to predispose the pregnant women with the early teenage till the menopause. Hence, the study would impact nurse practice in ensuring fine awareness on anemia which would direct evidence-based care in the near future (Polit & Beck, 2010). The strategy implemented in the study highlights the quantitative research starting from the research problem and purpose to research outcomes (Burns and Grove, 2003)
This also enables the APN a chance to adapt and modulate the interventions of medical and restorative care (Sabol et al., 2010). Since the conditions of anemia are seriously modifiable nursing interventions may store, confine or alter outcome impairments an enable optimum functional activity independently (Sabol et al., 2010). Further implications are prevention of adverse health consequences of anemia as per the recommendations of World Health Organization. Pregnant women may be supplemented with sufficient amounts of iron who are located in highly prevalent iron-deficient regions. Here additional advantage is that pregnant women infected with HIV may also be covered with this strategy. This could be because it is widely believe that large number of pregnant women become susceptible for HIV and other infections.
Hence, implications will be focused on iron supplementation in pregnant women who are infected with HIV and other parasitic agents. This ensures a foundation for carrying out more number of studies like placebo controlled randomized clinical trials. This would help in predicting the harmful or beneficial outcome of iron supplementation in HIV and other parasite induced infections on pregnant women. It may also enhance the modulation of anti-anemia interventions in this specific category of pregnant women. The other implications may be differences among the ethnic populations with regard to hemoglobin levels. This could be due to the fact that pregnant women of certain ethnic descendants may show increased predisposition to anemia compared to other groups. For instance in a study it was described that non-Northern European pregnant women constitute the risk group for decreased hemoglobin levels cut-off values indicating that they possess increased opportunity to become anemic (Jans, Daemers, de Vos & Lagro-Jansen, 2009). In contrast, pregnant women of Northern European descent did not show the effects as observed in the high risk non-Northern European pregnant women.
Thus, the high risk pregnant women of Northern European descent were considered as risk factor for anemia in pregnancy (Jans et al., 2009).Hence the propose study that will be carried out in four ethnic populations will influence the primary care midwifery practices in this context(Jans et al., 2009). They could gain better insights on the demographic information with regard to the anemia among pregnant women. More number of studies on various ethnic populations that are suspected for high risk zones for pregnancy anemia could become feasible and easily funded. On the whole, nurse-midwifery education programs will gain momentum that will be focused with an objective of complete understanding of adverse effects anemia during pregnancy.
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