Literature Review
Iron deficiency is a world health challenge both in developed and developing nations. Iron deficiency among pregnant women contributes to preterm births and impaired development of the fetus (Bagchi 758). Iron deficiency during pregnancy leads to the birth of iron-deficient babies (Liu et al. 278).
Taha et al. (342) conducted a study to establish the effect of iron supplementation on women attending gynecology and obstetrics outpatient clinics in Saudi Arabia. The study included reproductive women aged 25.97±7.17 years of which 15 were pregnant, and 16 were not pregnant. Clinical tests found that 17 women were anemic. Hemoglobin deficiency was deficient among 58.8% of the 17 women while Hematocrit (HCT) was low in 77.4% of the anemic women. Saturation of transferring was abnormal in 87.1% of the study participants (Taha et al. 339). The findings indicated that iron deficiency leads to iron anemia deficiency (IDM) among pregnant women and consequently affects the development of vital fetus organs such as the placenta. For example, the low levels of HCT and hemoglobin among the pregnant mothers implied that the fetuses were likely to be iron deficient (Taha et al. 341). Bagchi (759) states that iron deficiency during pregnancy leads to preterm births and affects leads to high mortality rate of children born to the iron deficient mothers (Bagchi 759).
West et al. (27) carried a study to establish the effect of iron supplementation on birth outcomes and infant mortality in rural Bangladesh. The study included 44,567 pregnant women, 22, 405 were placed on multiple micronutrients while 22,162 were on iron folic supplementation. The study recorded 28,516 live births (West et al. 26). A follow up for the women was made from conception to delivery and six months after childbirth. In the micronutrient group, there were 14,374 live births while the iron-folic group reported 14,142 (West et al. 27). The study by West et al. pointed that lack of iron in the multiple micronutrient group did not result in preterm births. According to West et al. (31), there is no evidence relationship between iron deficiency and infant mortality rate and preterm births. For example, a follow-up for six months after delivery reported 764 and 741 deaths respectively. The study established that there were no significant reductions in preterm births for both the multiple micronutrient and iron folic supplementations (West et al. 30).
Strengths and Weaknesses
The study by Taha et al. applied a cross-sectional study design that ensured that the study participants were monitored over time hence accurate indication of effects of iron deficiency. However, the study was limited by relatively small sample size and time. On the other hand, the study conducted by West et al. was comprehensive and had a significant study sample. The follow-up criteria ensured that the crucial status of iron intake and dietary habits of the women was established before they got pregnant and after childbirth. However, the studies did not establish a direct link between the preterm births and iron deficiency. The multiple micronutrient supplements could have influenced the control group outcomes.
Relevance of the Question
The question answers the concerns that affect pregnant women in relation their healthy and that of the unborn. The two studies pointed that iron plays a significant role in pregnancy and development of the fetus. However, due to the lack of direct correlation between iron deficiency and the fetal development in the two studies, further research is necessary to determine how the iron deficiency affects the developmental stages of the pregnancy, fetal development and the implication to the newborns.
Article #1
Taha, Asia et al. ‘Iron deficiency anemia in reproductive age women attending obstetrics and gynecology outpatient of university health centre in Al-Ahsa, Saudi Arabia’. African Journal of Traditional, Complementary and Alternative medicine, 11.2 (2014): 339–342. Web.
Abstract
Background
Iron deficiency is the most common nutritional disorder in the world. The aim of this questionnaire based survey study was to determine the prevalence of iron deficiency anemia in reproductive age women, and their relation to variables such as age, marital status, education with those attending obstetrics and gynecology outpatient of King Faisal University Health Centre in Al-Ahsa in eastern region of Kingdom of Saudi Arabia.
Materials and Methods
This study was conducted for the period of 6 month staring from September 2012 to February 2013. The questionnaire had three sections on personal information: their educational indicators, gynecological clinical history, and hematological indices.
Results
The average age was 25.97±7.17 years. According to the gynecological clinical history of the respondents, 15 (48.4%) respondents were pregnant while 16 (51.6%) were not pregnant. There was significant effect of pregnancy status on Hb level. Majority of the anemic respondents 15/17 were married. Moreover 14/17 anemic women were experiencing severe menstrual bleeding, 11/17 respondents were pregnant. 54.8% of respondents were hemoglobin deficient while 77.4% were found to have low Hct. In 87.1 % of the respondents, transferrin saturation was found to be abnormal.
Conclusion
In this study iron deficiency anemia is quite prevalent in the university community especially among pregnant women. The fetus’s and newborn infant’s iron status depends on the iron status of the pregnant woman and therefore, iron deficiency in the mother-to-be means that growing fetus probably will be iron deficient as well. Thus iron deficiency anemia during pregnancy in well-educated set up needs more attention by the concerned authorities.
Keywords: Iron deficiency Anemia (IDA), Hemoglobin, Female, Reproductive Age
Article #2
West, Klemin et al. ‘Effects of maternal multiple micronutrient vs. iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial’. Journal of American Medical Association, 312.24. (2014): 24-31. Web.
Abstract
Importance
Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia.
Objective
To assess effects of antenatal multiple micronutrient vs. iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes.
Design, Setting, and Participants
Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12).
Interventions
Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum.
Main Outcomes and Measures
The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5).
Results
Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P < .001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95% CI, 0.85-0.91; P < .001).
Conclusions and Relevance
In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight.
Works Cited
Bagchi, Ketz. ‘Iron deficiency anemia an old enemy’. East Mediterranean Health Journal, 6.10 (2004):754–760. Print.
Liu, Ming et al. ‘Micronutrient supplementation and pregnancy outcomes: Double blind randomized controlled trial in China’. Journal of American Medical Association, 173.1 (2013):276–282. Print.
Taha, Asia et al. ‘Iron deficiency anemia in reproductive age women attending obstetrics and gynecology outpatient of university health centre in Al-Ahsa, Saudi Arabia’. African Journal of Traditional, Complementary and Alternative Medicine, 11.2 (2014):339–342. Print.
West, Klemin et al. ‘Effects of maternal multiple micronutrient vs. iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial’. Journal of American Medical Association, 2312.24. (2014):24- 31. Print.