| Objective1.To understand the status of iron deficiency anemia and iron deficiency in pregnant women with different body mass index (BMI) in pregnancy,and to provide basis for targeted education and management during pregnancy.2.By investigating serum ferritin (SF) and hemoglobin (Hb) levels of pregnant women of different BMI at 20 weeks of gestation,and analyzing the results of iron supplementation treatment based on SF and Hb levels,to evaluate the effect of iron supplementation in pregnant women with different BMI.Method1.A retrospective analysis was conducted on 1,770 pregnant women who had built a perinatal health care card and received regular prenatal examination in Drum Tower Hospital at the 20th week of pregnancy from May 2017 to October 2017.A total of 273 pregnant women with SF<30μg/l and Hb<110g/L at 20 weeks of gestation were selected as the research objects.They were divided into two groups according to their pre-pregnancy BMI:group A:18.5kg/m2<BMI<24kg/m2,222 patients.Group B:51 patients with BMI≥24 kg/m2.All pregnant women were given routine iron supplementation therapy in accordance with the "guidelines for diagnosis and treatment of iron deficiency and iron-deficiency anemia during pregnancy" issued by the perinatal medicine branch of the Chinese medical association in 2014(Supplement ferrous succinate 3 tablets/day (containing iron 105mg/d),treatment until Hb returns to normal,continue oral administration to postpartum,referred to as conventional treatment).Hb value and hematocrit (HCT) value of pregnant women were reviewed at 32 weeks and 38 weeks of pregnancy to evaluate the treatment effect and follow up the pregnancy outcome.2.To prospectively study the effect of iron supplementation on pregnant women with different BMI.There were a total of 3022 pregnant women who set up a perinatal health care card in Drum Tower Hospital and had regular birth examination at the 20th week of pregnancy from December 01,2017 to April 30,2018.Pregnant women with SF<30μg/l at 20 weeks of gestation were selected to be included in the analysis.A total of 1506 pregnant women who met the inclusion criteria met the inclusion criteria.Among them,63 patients were discontinued after adverse drug reactions occurred in the course of medication,29 patients refused to use medication,and 55 patients had poor compliance.The 1359 pregnant women all enrolled have SF<30μg/l were divided into four groups according to BMI,and Hb.The G1 group included 354 women,BMI ranging from 18.5kg/m2 to <24kg/m2,and Hb<110g/L.Group G2:88 patients with BMI≥24 kg/m2,Hb<110g/L.Group G3:752 persons,18.5kg/m2≤BMI<24kg/m2,Hb> 110g/L.Group G4:165 patients with BMI>24kg/m2,Hb>110g/L.All pregnant women were routinely treated with iron supplementation according to the "guidelines for diagnosis and treatment of iron deficiency and iron-deficiency anemia during pregnancy" issued by the perinatal medicine branch of the Chinese medical association in 2014.Hb value,SF value and HCT value of pregnant women were reviewed at 32 weeks and 38 weeks of pregnancy to evaluate the effect of iron supplementation treatment and follow up the pregnancy outcome.Results1.The relationship between BMI and anemia in pregnant women and the effect of routine iron supplementation in pregnant women with anemia with different BMI(1) IDA was found in 15.4% of pregnant women at 20 weeks of gestation in this study,including 16.8% of overweight and obese women and 15.1% of normal BMI women.(2) All pregnant women:Overweight and obese pregnant women had higher Hb levels at 20 weeks of gestation than those with normal BMI(t=4.388,P<0.05).With the increase of gestation week,the Hb level of the overweight and obese group gradually decreased,and the difference was statistically significant(t=10.372,P<0.05).People who are overweight or obese have an increased risk of developing anemia as the gestational age increases.(3)There was no statistically significant difference in Hb and HCT levels between groups A and B at 20 weeks of pregnancy (P>0.05).By 38 weeks of pregnancy,Hb and HCT levels in group B were lower than those in group A (P<0.05).Pregnant women with iron deficiency anemia with a normal BMI have a higher cure rate than those who are overweight or obese(P<0.05).(4)Pregnancy outcomes of group A and group B:Compared to group A,the gestational age of newborns in group B was small (P<0.05),the incidence of premature delivery and neonatal transfer to the intensive care unit was high (P<0.05),and there was no significant difference in neonatal Apgar score,body weight,body length and other aspects (P>0.05).2.Effect of iron supplementation on pregnant women with different BMI(1)The mean Hb level of all included pregnant women at 20 weeks of gestation was 118.86±8.49g/L,the mean SF level was 38.13±37.35ng/ml,the IDA prevalence was 15.37% (464/3022),and the ID prevalence was 31.89% (963/3022).At 32 weeks of gestation,the average Hb level was 118.12±9.18g/L, and the average SF level was 20.73.13±16.49ng/ml.At 38 weeks of gestation,the mean Hb level was 123.89±9.47g/L,the mean SF level was 26.26±17.72ng/ml,the IDA cure rate was 74.43% (345/464),and the ID cure rate was 75.57% (728/963).(2)Pregnant women with iron deficiency anemia with SF<30μg/l in G1 and G2 groups.The levels of Hb,HCT and SF in the two groups were significantly higher than those before treatment,while those in the G1 group were significantly higher than those in the G2 group,with statistically significant difference (P<0.05).(3) G3 and G4 groups were pregnant women with SF<30μg/l but normal Hb.At 20 weeks of gestation,Hb and HCT levels in G4 group were higher than those in G3 group,and the difference was statistically significant.After treatment,Hb and HCT levels in G3 group were gradually higher,while those in G4 group showed a decreasing trend.However,the Hb and HCT levels in G3 group were higher than those in G4 group at 38 weeks of gestation,and the difference was statistically significant (P<0.05).(4) There was no statistical difference in SF level between G3 group and G4 group at 20 weeks of gestation.With the increase of gestation week,SF level in G3 group gradually increased,while SF level in G4 group decreased.By 38 weeks,SF level in G3 group was significantly higher than that in G4 group,and the difference was statistically significant (P<0.05).(5)The cure rate of iron deficiency anemia in pregnant women in G1 group was 78.8%,and that of G2 group was 56.8% (50/88).The cure rate of G1 group was higher than that of G2 group (17.918,P<0.05).The cure rate of G3 group was 79.5%(598/752),and that of G4 group was 57.6% (95/165).The cure rate of G3 group was higher than that of G4 group,and the difference was statistically significant(χ2=35.301,P<0.05).(6)G1/G2 and G3/G4 group of pregnant women pregnancy outcomes comparison:G2 group of pregnant women delivery of newborns gestational age small in the G1 group (P<0.05),higher incidence of G2 group turn neonatal intensive care units (P<0.05),G2 group 24 hours postpartum haemorrhage amount more (P<0.05),and neonatal Apgar score,birth weight,body length of birth,incidence of preterm births,puerperal infection rates and cesarean delivery,the incidence of postpartum blood transfusion had no significant difference (P>0.05).There was no significant difference in neonatal Apgar score,neonatal weight,gestational age,length of birth,incidence of neonatal transfer to intensive care unit,incidence of premature infants,puerperal infection rate,cesarean section delivery rate,and incidence of postpartum blood transfusion (P>0.05).Conclusion1.Iron-deficient pregnant women with SF<30μg/l can be treated with iron supplements to improve pregnancy outcome.2.Overweight and obese pregnant women have a higher risk of ID and IDA in the third trimester of pregnancy,However,the recommended dose of iron supplementation according to the guidelines is not effective,suggesting that the treatment dose for this group is worth exploring. |
