Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2021

Open Access 01-12-2021 | Sectio Ceasarea | Research

Incidence and predictors of iron deficiency anaemia in parturients undergoing elective caesarean section at a tertiary hospital in New Zealand: a retrospective, observational cohort study

Authors: Pablo L. de Vena Franks, Andrew Y. Pan, Manpreet K. Gill, Angela M. K. Cross, Katy L. Konrad, Nicholas J. Lightfoot

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Login to get access

Abstract

Background

Worldwide, iron deficiency anaemia in pregnancy is a significant problem which can be especially problematic when delivery is by caesarean section, a procedure associated with significant blood loss. Optimising iron stores pre-delivery remains an overarching goal. We aim to measure the incidence of iron deficiency anaemia in patients undergoing elective caesarean section at our institution and determine any associated predictors, as well as adverse outcomes.

Methods

A retrospective, observational cohort study of patients presenting for elective caesarean section over a two-year period. Patient data was collected from hospital electronic records. Iron deficiency anaemia was defined a haemoglobin < 110 g/L and a ferritin < 30 μg/L in the three-month period prior to delivery. The primary aim was to establish the incidence of iron deficiency anaemia at the time of delivery and any associated predictors. Secondary outcomes included any association between the primary outcome and complications defined by the hospital discharge complication coding system, as well as an evaluation of the number of blood tests carried out antenatally per trimester.

Results

One thousand and ninety-three women underwent caesarean section over the study period and 16.2% had iron deficiency anaemia. Patients with iron deficiency anaemia were more likely to be of Māori and Pacific Island ethnicity, have a greater booking body mass index, be younger and have a greater parity. Pre-operative anaemia was associated with a greater likelihood of post-operative blood transfusion.

Conclusions

There remains potential for optimisation of iron deficiency anaemia in our local population undergoing elective caesarean section.
Appendix
Available only for authorised users
Literature
1.
go back to reference Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1:e16–25.CrossRef Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1:e16–25.CrossRef
2.
go back to reference Sutherland S, O'Sullivan D, Mullins J. An association between anemia and postpartum depression. Obstet Gynecol. 2018;131:39S.CrossRef Sutherland S, O'Sullivan D, Mullins J. An association between anemia and postpartum depression. Obstet Gynecol. 2018;131:39S.CrossRef
3.
go back to reference 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;103:495–504.CrossRef 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;103:495–504.CrossRef
4.
go back to reference Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–44.CrossRef Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–44.CrossRef
5.
go back to reference Ferguson MT, Dennis AT. Defining peri-operative anaemia in pregnant women – challenging the status quo. Anaesthesia. 2019;74:237–45.CrossRef Ferguson MT, Dennis AT. Defining peri-operative anaemia in pregnant women – challenging the status quo. Anaesthesia. 2019;74:237–45.CrossRef
6.
go back to reference Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72:233–47.CrossRef Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72:233–47.CrossRef
7.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.CrossRef
9.
go back to reference Myles PS, Grocott MPW, Boney O, et al. Standardizing end points in perioperative trials: towards a core and extended outcome set. Br J Anaesth. 2016;116:586–9.CrossRef Myles PS, Grocott MPW, Boney O, et al. Standardizing end points in perioperative trials: towards a core and extended outcome set. Br J Anaesth. 2016;116:586–9.CrossRef
10.
go back to reference Horowitz KM, Ingardia CJ, Borgida AF. Anemia in pregnancy. Clin Lab Med. 2013;33:281–91.CrossRef Horowitz KM, Ingardia CJ, Borgida AF. Anemia in pregnancy. Clin Lab Med. 2013;33:281–91.CrossRef
13.
go back to reference Figueiredo ACMG, Gomes-Filho IS, Silva RB, et al. Maternal anemia and low birth weight: a systematic review and meta-analysis. Nutrients. 2018;10:601.CrossRef Figueiredo ACMG, Gomes-Filho IS, Silva RB, et al. Maternal anemia and low birth weight: a systematic review and meta-analysis. Nutrients. 2018;10:601.CrossRef
14.
go back to reference Moore MP, Lunt H. Diabetes in New Zealand. Diabetes Res Clin Pract. 2000;50:65–71.CrossRef Moore MP, Lunt H. Diabetes in New Zealand. Diabetes Res Clin Pract. 2000;50:65–71.CrossRef
15.
go back to reference Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol. 2015;52:339–47.CrossRef Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol. 2015;52:339–47.CrossRef
16.
go back to reference Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRef Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907–16.CrossRef
17.
go back to reference Juul SE, Derman RJ, Auerbach M. Perinatal iron deficiency: implications for mothers and infants. Neonatology. 2019;115:269–74.CrossRef Juul SE, Derman RJ, Auerbach M. Perinatal iron deficiency: implications for mothers and infants. Neonatology. 2019;115:269–74.CrossRef
18.
go back to reference Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Womens Health (Lond). 2015;11:891–900.CrossRef Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Womens Health (Lond). 2015;11:891–900.CrossRef
19.
go back to reference Morton LJ, Konrad KL, Xu TJ, Lightfoot NJ. The interaction between pre-operative anaemia and peri-operative blood transfusion on patient outcomes following general surgical procedure: a retrospective review. N Z Med J. 2019;132:13–24.PubMed Morton LJ, Konrad KL, Xu TJ, Lightfoot NJ. The interaction between pre-operative anaemia and peri-operative blood transfusion on patient outcomes following general surgical procedure: a retrospective review. N Z Med J. 2019;132:13–24.PubMed
20.
go back to reference Pivina L, Semenova Y, Doşa MD, Dauletyarova M, Bjørklund G. Iron deficiency, cognitive functions, and neurobehavioral disorders in children. J Mol Neurosci. 2019;68:1–10.CrossRef Pivina L, Semenova Y, Doşa MD, Dauletyarova M, Bjørklund G. Iron deficiency, cognitive functions, and neurobehavioral disorders in children. J Mol Neurosci. 2019;68:1–10.CrossRef
21.
go back to reference Dziembowska I, Kwapisz J, Izdebski P, Żekanowska E. Mild iron deficiency may affect female endurance and behavior. Physiol Behav. 2019;205:44–50.CrossRef Dziembowska I, Kwapisz J, Izdebski P, Żekanowska E. Mild iron deficiency may affect female endurance and behavior. Physiol Behav. 2019;205:44–50.CrossRef
22.
go back to reference Beard JL, Hendricks MK, Perez EM, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.CrossRef Beard JL, Hendricks MK, Perez EM, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.CrossRef
23.
go back to reference Dama M, Van Lieshout RJ, Mattina G, Steiner M. Iron deficiency and risk of maternal depression in pregnancy: an observational study. J Obstet Gynaecol Can. 2018;40:698–703.CrossRef Dama M, Van Lieshout RJ, Mattina G, Steiner M. Iron deficiency and risk of maternal depression in pregnancy: an observational study. J Obstet Gynaecol Can. 2018;40:698–703.CrossRef
24.
go back to reference Hidese S, Saito K, Asano S, Kunugi H. Association between iron-deficiency anemia and depression: a web-based japanese investigation. Psychiatry Clin Neurosci. 2018;72:513–21.CrossRef Hidese S, Saito K, Asano S, Kunugi H. Association between iron-deficiency anemia and depression: a web-based japanese investigation. Psychiatry Clin Neurosci. 2018;72:513–21.CrossRef
25.
go back to reference Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139–42.CrossRef Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139–42.CrossRef
26.
go back to reference DeLoughery TG. Safety of oral and intravenous iron. Acta Haematol. 2019;142:8–12.CrossRef DeLoughery TG. Safety of oral and intravenous iron. Acta Haematol. 2019;142:8–12.CrossRef
27.
go back to reference Blunden RW, Lloyd JV, Rudzki Z, Kimber RJ. Changes in serum ferritin levels after intravenous iron. Ann Clin Biochem. 1981;18:215–7.CrossRef Blunden RW, Lloyd JV, Rudzki Z, Kimber RJ. Changes in serum ferritin levels after intravenous iron. Ann Clin Biochem. 1981;18:215–7.CrossRef
28.
go back to reference Baird-Gunning J, Bromley J. Correcting iron deficiency. Aust Prescr. 2016;39:193–9.CrossRef Baird-Gunning J, Bromley J. Correcting iron deficiency. Aust Prescr. 2016;39:193–9.CrossRef
30.
go back to reference Peng YY, Uprichard J. Ferritin and iron studies in anaemia and chronic disease. Ann Clin Biochem. 2017;54:43–8.CrossRef Peng YY, Uprichard J. Ferritin and iron studies in anaemia and chronic disease. Ann Clin Biochem. 2017;54:43–8.CrossRef
31.
go back to reference Fraenkel PG. Understanding anemia of chronic disease. Hematol Am Soc Hematol Educ Program. 2015;2015:14–8.CrossRef Fraenkel PG. Understanding anemia of chronic disease. Hematol Am Soc Hematol Educ Program. 2015;2015:14–8.CrossRef
32.
go back to reference Ueda N, Takasawa K. Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease. Nutrients. 2018;10:1173.CrossRef Ueda N, Takasawa K. Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease. Nutrients. 2018;10:1173.CrossRef
Metadata
Title
Incidence and predictors of iron deficiency anaemia in parturients undergoing elective caesarean section at a tertiary hospital in New Zealand: a retrospective, observational cohort study
Authors
Pablo L. de Vena Franks
Andrew Y. Pan
Manpreet K. Gill
Angela M. K. Cross
Katy L. Konrad
Nicholas J. Lightfoot
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-021-04121-9

Other articles of this Issue 1/2021

BMC Pregnancy and Childbirth 1/2021 Go to the issue