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Risk for death double for pregnant women with anemia
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Pregnant women with anemia appeared twice as likely to die during or shortly after pregnancy compared with women without anemia, according to an international study.
“As many as half of all pregnant women in low-income and middle-income countries are diagnosed with anemia, which affects 32 million pregnant women worldwide,” Jahnavi Daru, MBBS, clinical research fellow at Queen Mary University of London, and colleagues wrote. “Women in low-income and middle-income countries are at increased risk of anemia because of the higher frequency of dietary iron deficiency, hemoglobinopathies, macronutrient deficiencies, and infections such as malaria, HIV and hookworm infestation in those countries than in high-income countries. Anemia has been associated with increased prevalence of antepartum and postpartum hemorrhage.”
Daru and colleagues studied data from 312,281 pregnancies in 29 countries across Latin America, Africa, Western Pacific, Eastern Mediterranean and South East Asia. Of those studied, 4,189 women had severe anemia, whom researchers then propensity-score matched with 8,281 women without the condition.
Researchers defined severe anemia as antenatal or postnatal hemoglobin concentrations of less than 70 g/L in a blood sample. Maternal death included any death from admission to 7 days postpartum or discharge.
Researchers adjusted for postpartum hemorrhage, general anesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots and severe acidosis.
After adjustment, pregnant women with severe anemia had a two times greater risk for maternal death (OR = 2.36; 95% CI, 1.6-3.48) than pregnant women without anemia. In a propensity score analysis, pregnant women with severe anemia had an OR of 1.86 (95% CI, 1.39-2.49) for maternal death compared with controls.
Limitations of the study included its observational nature, lack of actual hemoglobin concentrations and missing data on timing of severe anemia.
In an accompanying editorial, Melissa F. Young, PhD, assistant professor at Rollins School of Public Health at Emory University, wrote Daru and colleagues’ estimate “is probably an underestimation.”
“The authors potentially overcontrolled for factors in the causal pathway and compared women with severe anemia with all other women, including those with mild or moderate anemia and high hemoglobin concentrations,” Young wrote.
Additionally, this study is a call for action, according to Young.
“Efficacious interventions, such as iron and folic acid supplementation, are available, but they do not seem to be working at scale as evidenced by insufficient progress in reducing maternal anemia,” she added. “The implementation of existing programs needs to improve, and other approaches that reach women before conception and during pregnancy, such as mass fortification and home fortification, and that tackle nonnutritional causes of anemia need to be developed. This study is a call to develop comprehensive strategies that address the diverse causes of anemia across contexts to improve maternal and child health.”– by Cassie Homer
Disclosures: Daru reports no relevant financial disclosures. One author reports financial support from Astellas and Novartis. Young reports no relevant financial disclosures.
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