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Anemia in early pregnancy among Canadian women presenting for abortion
International Journal of Gynecology and Obstetrics (2006) 94, 60 — 61
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Anemia in early pregnancy among Canadian women presenting for abortion E.R. Wiebe *, K.J. Trouton, A. Eftekhari Department of Family Practice, University of British Columbia, Canada Received 20 October 2005; received in revised form 12 March 2006; accepted 15 March 2006
KEYWORDS Anemia; Pregnancy; Ethnicity; Abortion
In an urban clinic providing abortions, it was noted that many women presenting for abortion were anemic. The U.S. National Health and Nutrition Examination Survey III established prevalence of anemia, defined as a hemoglobin lower than 120 g/ L, at 5.1% of the non-pregnant women in the population [1]. There are observational studies that associate anemia diagnosed prior to midpregnancy with increased risk of pre-term delivery, low birth weight, and fetal mortality [2,3]. A metaanalysis of trials of iron supplementation in pregnancy showed no detectable effect on any substantive functional measures of either maternal or fetal outcome [4]. The purpose of this study was to determine the prevalence of anemia in this population, identify
* Corresponding author. 1013-750 West Broadway, Vancouver BC V5Z 1H9, Canada. Tel.: +1 604 873 8303; fax: +1 604 873 8304. E-mail address: [email protected] (E.R. Wiebe).
likely causes in order to develop appropriate educational material for patients. A series of retrospective chart surveys of 641 charts was done in women presenting for medical abortion at less than 7 weeks of gestation. Routine tests included a complete blood count with indices, and this information was recorded, as well as demographic information from the clinical chart. Women with anemia were investigated with serum ferritin, hemoglobin electrophoresis, serum B12, and RBC folate as appropriate.
Table 1 Characteristics of anemic and non-anemic women presenting for medical abortion in 2000—2004 (N = 641)
Mean age in years (S.D.) Mean gestational age (days) Mean parity Caucasian [n (%)] East Asian [n (%)] South Asian [n (%)] Other [n (%)] Total [n (%)]
Hgb b 120 g/L
Hgb z 120 g/L
29.2 (6.8)
28.0 (7.3)
0.028
40.9 (5.0)
40.6 (5.1)
0.50
0.9 68 74 48 12 202
(1.0) (24.2) (31.4) (47.1) (57.1) (31.6)
0.69 213 162 54 9 438
(1.0) (75.8) (68.6) (52.9) (42.9) (68.4)
p-value
0.032 b0.001
0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2006.03.018
Anemia in early pregnancy among Canadian women presenting for abortion Of these women, 31.6% were anemic (Hgb b 120 g/L). South Asians had the highest rate (47.1%), followed by East Asians (31.4%) and Caucasians (24.4%). Most of the anemia was associated with iron deficiency and was likely nutritional; among 177 anemic women, the MCV was b82 fL in 53 (29.9%), RBC was b4.0 Tg/L 117 (66.1%) and ferritin was b10 Ag/L in 25/81 (30.9%). The mean ferritin was 29.9 Ag/L, with a range of 2—121 Ag/L. There were five cases of thalassemia but no cases of B12 or folate deficiency (Table 1). It was concluded that the rate of iron deficiency anemia is much higher in these women presenting for abortion than in the general population. The most striking characteristic related to the rate of anemia was ethnicity, with the highest rate of anemia in the South Asians. Diet is likely an important factor, considering that the South Asian diet tends to be predominantly vegetarian. Prior to this study, it had been recommended that anemic women in the clinic increase their
61
dietary sources of iron. Based on the findings in this study, there is no need to change these recommendations. Iron deficiency is not the only cause of anemia in this group, but there were no women with high ferritin levels in which iron supplementation would be a danger.
References [1] Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997;277:973 – 6. [2] Beaton GH. Iron needs during pregnancy: do we need to rethink our targets? Am J Clin Nutr 2000;72:265s – 71s [suppl]. [3] Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci 2000;900:125 – 36. [4] Mahomed K. Iron supplementation in pregnancy. Cochrane Database Syst Rev 2000;2:CD000117.
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Anemia in early pregnancy among Canadian women presenting for abortion E.R. Wiebe *, K.J. Trouton, A. Eftekhari Department of Family Practice, University of British Columbia, Canada Received 20 October 2005; received in revised form 12 March 2006; accepted 15 March 2006
KEYWORDS Anemia; Pregnancy; Ethnicity; Abortion
In an urban clinic providing abortions, it was noted that many women presenting for abortion were anemic. The U.S. National Health and Nutrition Examination Survey III established prevalence of anemia, defined as a hemoglobin lower than 120 g/ L, at 5.1% of the non-pregnant women in the population [1]. There are observational studies that associate anemia diagnosed prior to midpregnancy with increased risk of pre-term delivery, low birth weight, and fetal mortality [2,3]. A metaanalysis of trials of iron supplementation in pregnancy showed no detectable effect on any substantive functional measures of either maternal or fetal outcome [4]. The purpose of this study was to determine the prevalence of anemia in this population, identify
* Corresponding author. 1013-750 West Broadway, Vancouver BC V5Z 1H9, Canada. Tel.: +1 604 873 8303; fax: +1 604 873 8304. E-mail address: [email protected] (E.R. Wiebe).
likely causes in order to develop appropriate educational material for patients. A series of retrospective chart surveys of 641 charts was done in women presenting for medical abortion at less than 7 weeks of gestation. Routine tests included a complete blood count with indices, and this information was recorded, as well as demographic information from the clinical chart. Women with anemia were investigated with serum ferritin, hemoglobin electrophoresis, serum B12, and RBC folate as appropriate.
Table 1 Characteristics of anemic and non-anemic women presenting for medical abortion in 2000—2004 (N = 641)
Mean age in years (S.D.) Mean gestational age (days) Mean parity Caucasian [n (%)] East Asian [n (%)] South Asian [n (%)] Other [n (%)] Total [n (%)]
Hgb b 120 g/L
Hgb z 120 g/L
29.2 (6.8)
28.0 (7.3)
0.028
40.9 (5.0)
40.6 (5.1)
0.50
0.9 68 74 48 12 202
(1.0) (24.2) (31.4) (47.1) (57.1) (31.6)
0.69 213 162 54 9 438
(1.0) (75.8) (68.6) (52.9) (42.9) (68.4)
p-value
0.032 b0.001
0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2006.03.018
Anemia in early pregnancy among Canadian women presenting for abortion Of these women, 31.6% were anemic (Hgb b 120 g/L). South Asians had the highest rate (47.1%), followed by East Asians (31.4%) and Caucasians (24.4%). Most of the anemia was associated with iron deficiency and was likely nutritional; among 177 anemic women, the MCV was b82 fL in 53 (29.9%), RBC was b4.0 Tg/L 117 (66.1%) and ferritin was b10 Ag/L in 25/81 (30.9%). The mean ferritin was 29.9 Ag/L, with a range of 2—121 Ag/L. There were five cases of thalassemia but no cases of B12 or folate deficiency (Table 1). It was concluded that the rate of iron deficiency anemia is much higher in these women presenting for abortion than in the general population. The most striking characteristic related to the rate of anemia was ethnicity, with the highest rate of anemia in the South Asians. Diet is likely an important factor, considering that the South Asian diet tends to be predominantly vegetarian. Prior to this study, it had been recommended that anemic women in the clinic increase their
61
dietary sources of iron. Based on the findings in this study, there is no need to change these recommendations. Iron deficiency is not the only cause of anemia in this group, but there were no women with high ferritin levels in which iron supplementation would be a danger.
References [1] Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997;277:973 – 6. [2] Beaton GH. Iron needs during pregnancy: do we need to rethink our targets? Am J Clin Nutr 2000;72:265s – 71s [suppl]. [3] Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci 2000;900:125 – 36. [4] Mahomed K. Iron supplementation in pregnancy. Cochrane Database Syst Rev 2000;2:CD000117.