Perinatal Outcomes in Pregnant Women with Anemia of Various Geneses

ORIGINAL ARTICLE
Victor E. Radzinsky, Bakhtykei M. Gasanova, Miroslava L. Polina, Natalya I. Douglas, Irina S. Bulshiy, Fatima I. Chotchayeva, Tatyana V. Dedy

 
International Journal of Biomedicine. 2020;10(3):241-246.
DOI: 10.21103/Article10(3)_OA8
Originally published September 10, 2020

Abstract: 

Modern methods for diagnosing disorders of iron metabolism (ferritin, C-reactive protein) in iron deficiency anemia (IDA) and anemia of chronic diseases (ACD) contribute to the identification of metabolic characteristics that negatively affect the mother-placenta-fetus system.
The biological response to hypoxia varies in anemia of different geneses: depletion of iron depot on the background of chronic infectious and inflammatory processes is accompanied by more obvious homeostasis disorders. Excessive activity of the peroxidase system (increase in prooxidant factors – malondialdehyde, catalase of blood serum and red blood cells, sulfhydryl groups) explains the large frequency of gestational complications and perinatal diseases in ACD women, such as morphofunctional immaturity, hypoxic-ischemic lesion of the central nervous system of newborns, and infectious and inflammatory diseases.
The degree of ante- and perinatal well-being in conditions of ID, accompanied by a violation of the molecular mechanisms of protein synthesis, depends on the activity of adaptive homeostatic mechanisms of the mother-placenta-fetus system. The strategy to reduce adverse perinatal outcomes includes identification of abnormal metabolism predictors with the expansion of the scope of examination in groups with high infectious risk, further monitoring of risk cases, and pathogenetic therapy.

Keywords: 
iron deficiency anemia • anemia of chronic diseases • outcomes • oxidative stress
References: 
  1. Auerbach M, Georgieff MK. Guidelines for iron deficiency in pregnancy: hope abounds: Commentary to accompany: UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):814‐816. doi:10.1111/bjh.16220
  2. Vásquez-Velásquez C, Gonzales GF. Situación mundial de la anemia en gestantes [Global situation of anemia in pregnant women]. Nutr Hosp. 2019;36(4):996‐997. doi:10.20960/nh.02712. [Article in Spanish].
  3. Sun D, McLeod A, Gandhi S, Malinowski AK, Shehata N. Anemia in Pregnancy: A Pragmatic Approach. Obstet Gynecol Surv. 2017;72(12):730‐737. doi:10.1097/OGX.0000000000000510
  4. Pavord S, Daru J, Prasannan N, et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020;188(6):819‐830. doi:10.1111/bjh.16221
  5. Apresyan SV. Pregnancy and childbirth in extragenital diseases. In Radzinsky VE editor. M.: GEOTAR-Media; 2015, 536 pp.
  6. Rukavitsyn OA. [Anemia of chronic diseases: actual aspects of diagnosis and treatment]. Clinical Oncohematology. 2012;5(4):296–304.[Article in Russian].
  7. Rahman MM, Abe SK, Rahman MS, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr. 2016;103(2):495‐504. doi:10.3945/ajcn.115.107896
  8. Parks S, Hoffman MK, Goudar SS, et al. Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan. BJOG. 2019;126(6):737‐743. doi:10.1111/1471-0528.15585
  9. Achebe MM, Gafter-Gvili A. How I treat anemia in pregnancy: iron, cobalamin, and folate. Blood. 2017;129(8):940‐949. doi:10.1182/blood-2016-08-672246
  10. Rabindrakumar MSK, Pujitha Wickramasinghe V, Gooneratne L, Arambepola C, Senanayake H, Thoradeniya T. The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka. BMC Hematol. 2018;18:37. Published 2018 Dec 22. doi:10.1186/s12878-018-0131-2
  11. Tayupova IM. [Medical and social aspects of iron deficiency anemia during pregnancy]. Vestnik Bashkirsk Universiteta. 2015;(3). URL: https://cyberleninka.ru/article/n/mediko-sotsialnye-aspekty-zhelezodefit... [Article in Russian].
  12. Kæstel P, Aaby P, Ritz C, Friis H. Markers of iron status are associated with stage of pregnancy and acute-phase response, but not with parity among pregnant women in Guinea-Bissau. Br J Nutr. 2015;114(7):1072‐1079. doi:10.1017/S0007114515001993
  13.  Otto JM, Plumb JOM, Clissold E, et al. Hemoglobin concentration, total hemoglobin mass and plasma volume in patients: implications for anemia. Haematologica.2017;102(9):1477‐1485. doi:10.3324/haematol.2017.169680
  14. Al-Gubory KH, Fowler PA, Garrel C. The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. Int J Biochem Cell Biol. 2010;42(10):1634‐1650. doi:10.1016/j.biocel.2010.06.001
  15. Harris C, Hansen JM. Oxidative stress, thiols, and redox profiles. Methods Mol Biol. 2012;889:325‐346. doi:10.1007/978-1-61779-867-2_21
  16. Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol. 2011;25(3):287‐299. doi:10.1016/j.bpobgyn.2010.10.016
  17. Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol. 2005;3:28. Published 2005 Jul 14. doi:10.1186/1477-7827-3-28
  18. Devrim E, Tarhan I, Ergüder IB, Durak I. Oxidant/antioxidant status of placenta, blood, and cord blood samples from pregnant women supplemented with iron. J Soc Gynecol Investig. 2006;13(7):502‐505. doi:10.1016/j.jsgi.2006.07.004
  19. Choudhury N, Aimone A, Hyder SM, Zlotkin SH. Relative efficacy of micronutrient powders versus iron-folic acid tablets in controlling anemia in women in the second trimester of pregnancy. Food Nutr Bull. 2012;33(2):142‐149. doi:10.1177/156482651203300208
  20. Okhotnikova EN, Poonochnaya EV. [Anemia in chronic diseases]. Klin Immunol Allergol Infektolog. 2012;(5/6):22-24.[Article in Russian].
  21. Garcia AC, Roschel H, Ramos S, Benatti FB. Iron supplementation and its association with the incidence of gestational diabetes mellitus. J Braz Soc Food Nutr. 2012;37:215–226.
  22. Ruckavitsyn OA. Topical issues of diagnosis and treatment of anemia in chronic diseases. Clinical Oncohematology. 2012;5(4):296-304.[Article in Russian].
  23. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907‐916. doi:10.1016/S0140-6736(15)60865-0
  24. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Family Med Prim Care. 2017;6(4):739‐743. doi:10.4103/jfmpc.jfmpc_33_17
  25. Mburu AS, Thurnham DI, Mwaniki DL, Muniu EM, Alumasa F, de Wagt A. The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently healthy, HIV+ Kenyan adults. J Nutr. 2008;138(3):613‐619. doi:10.1093/jn/138.3.613
  26. Karlsson T. Evaluation of a competitive hepcidin ELISA assay in the differential diagnosis of iron deficiency anaemia with concurrent inflammation and anaemia of inflammation in elderly patients. J Inflamm (Lond). 2017;14:21. Published 2017 Sep 18. doi:10.1186/s12950-017-0166-3
  27. Figueiredo ACMG, Gomes-Filho IS, Silva RB, et al. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(5):601. Published 2018 May 12. doi:10.3390/nu10050601
  28. Radzinsky VE, Orazmuradov AA. Pregnancy of early terms. From pregravid preparation to healthy gestation, 3rd ed. M., Status Praesens; 2018, 800 pp.
  29. Lelic M, Bogdanovic G, Ramic S, Brkicevic E. Influence of maternal anemia during pregnancy on placenta and newborns. Med Arch. 2014;68(3):184‐187. doi:10.5455/medarh.2014.68.184-187
  30. Stangret A, Wnuk A, Szewczyk G, Pyzlak M, Szukiewicz D. Maternal hemoglobin concentration and hematocrit values may affect fetus development by influencing placental angiogenesis. J Matern Fetal Neonatal Med. 2017;30(2):199‐204. doi:10.3109/14767058.2016.1168395
  31. Leal CA, Schetinger MR, Leal DB, Morsch VM , da Silva AS ,  Rezer JF,  et al. Oxidative stress and antioxidant defenses in pregnant women. Redox Rep. 2011;16(6):230‐236. doi:10.1179/1351000211Y.0000000013
  32. Haider BA, Olofin I, Wang M, et al. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013;346:f3443. Published 2013 Jun 21. doi:10.1136/bmj.f3443

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Received May 7, 2020.
Accepted May 31, 2020.
©2020 International Medical Research and Development Corporation.