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Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study
T O Scholl1, M L Hediger, R L Fischer
1Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Camden 08103-1505.
Insights
Iron-deficiency anemia in pregnant women significantly increases risks for low birth weight and preterm delivery. Other anemias did not show these adverse outcomes, highlighting the importance of iron status during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Public Health
Background:
- Anemia is common in pregnancy, particularly in inner-city populations.
- Iron deficiency is often presumed to be the primary cause of anemia in these groups.
Purpose of the Study:
- To assess the prevalence of anemia and iron-deficiency anemia in inner-city pregnant women.
- To determine the association of iron deficiency with pregnancy outcomes and compare it to other causes of anemia.
Main Methods:
- Utilized Centers for Disease Control criteria to evaluate anemia and iron-deficiency anemia (serum ferritin < 12 µg/L).
- Assessed over 800 inner-city gravidas at prenatal care entry.
- Analyzed associations with energy/iron intake, mean corpuscular volume, birth weight, preterm delivery, vaginal bleeding, and pregnancy weight gain.
Main Results:
- Iron-deficiency anemia correlated with lower energy/iron intake and reduced mean corpuscular volume.
- Iron deficiency tripled the odds of low birth weight and more than doubled preterm delivery odds.
- Anemia from other causes did not increase these risks.
- Vaginal bleeding amplified preterm delivery risks for both iron-deficiency anemia and other anemias.
- Inadequate pregnancy weight gain was more common in women with iron-deficiency anemia and other anemias.
Conclusions:
- Iron-deficiency anemia, not anemia from other causes, is linked to adverse pregnancy outcomes like low birth weight and preterm delivery.
- The prevalence of iron-deficiency anemia (3.5%) was lower than expected in this population.
- Clinical assumptions about anemia etiology in inner-city pregnant women may require re-evaluation.
Abstract:
Using criteria from the Centers for Disease Control, anemia and iron-deficiency anemia (anemia with serum ferritin concentrations less than 12 micrograms/L) were assessed in greater than 800 inner-city gravidas at entry to prenatal care. Iron-deficiency anemia was associated with significantly lower energy and iron intakes early in pregnancy and a lower mean corpuscular volume. The odds of low birth weight were tripled and of preterm delivery more than doubled with iron deficiency, but were not increased with anemia from other causes. When vaginal bleeding at or before entry to care accompanied anemia, the odds of a preterm delivery were increased fivefold for iron-deficiency anemia and doubled for other anemias. Inadequate pregnancy weight gain was more prevalent among those with iron-deficiency anemia and in those with anemias of other etiologies. The prevalence of iron-deficiency anemia (3.5%), however, was lower than anticipated for an inner-city, minority population in whom most anemias had been attributed clinically to iron deficiency.