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Archives of the Balkan Medical Union vol. 51, no. 1, pp.

Copyright © 2016 CELSIUS March 2016



King Salman Hospital, Riyadh, Saudi Arabia
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Aim: An analytical retrospective and prospective study to compare Relation entre l'anémie et la prématurité spontanée
the effect of lower hemoglobin (iron anemia, lower ferritin) in the But: Une étude analytique rétrospective et prospective afin de com-
blood serum of pregnant women during pregnancy in the parer l'effet du niveau baissée d'hémoglobine (anémie ferriprive,
incidence of preterm labor when patients treatment with iron and niveau réduit de ferritine) dans le sérum sanguin des femmes
comparison with pregnant women with normal ratios of iron and enceintes pendant la grossesse sur l’incidence de l’accouchement
ferritin. prématuré des patients traités avec du fer et la comparaison avec des
Methods: Pregnant women with single fetus under surveillance femmes enceintes aux taux normaux de fer et de ferritine.
before and during research period form 3/5/2012 to 5/6/2014 and Méthodes: Les femmes enceintes avec un seul fœtus sous surveil-
cases included 586 cases in King Salman Hospital. Cases were lance et pendant la période de la recherche de 3/5/2012 à 5/6/2014
distributed as follows: pregnant women with iron deficiency et la casuistique incluant 586 de cas à l'Hôpital le Roi Salman. Les
anemia and without treatment, pregnant women with iron cas étaient répartis comme suit: les femmes enceintes avec de
deficiency anemia and with iron treatment before week 30th, l'anémie ferriprive sans traitement, les femmes enceintes avec
pregnant women having normal blood. anémie ferriprive et traitement avec du fer avant la 30 ème
Results: It was observed that the lower the hemoglobin in semaine, les femmes enceintes aux valeurs du sang normales.
pregnant women the greater percentage of preterm labor, where Résultats: On a observé que tant la valeur de l'hémoglobine chez
the incidence of early labor 9% when the hemoglobin blood is la femme enceinte etait plus réduite tant le pourcent du travail
9-7 mg/dl. While early labor ratio rose to 15 % when the hemo- prematuré était plus grand, donc l'incidence représentait 9%
globin blood is 7-4 mg /dl. This percentage dropped when pregnant lorsque l'hémoglobine dans le sang était de 9-7 mg / dl. Ouand le
women taked iron. taux du travail prématuré a augmente de 15%, l'hémoglobine dans
Conclusions: Should be given preventive doses of iron for le sang était de 7-4 mg/dl. Le pourcentage s’est abaissé lorsque la
pregnant women to avoid iron anemia, and prompt treatment for femme enceinte a pris du fer.
any anemia to reduce complications to a minimum. Conclusions: Des doses préventives de fer doivent être données
Key words: anemia, preterm labor, IDA aux femmes enceintes pour éviter l'anémie ferriprive et un
traitement prompte pour toute forme d'anémie afin de réduire au
minimum les complications.
Mots clés: anémie, accouchement prématuré, IDA

I NTRODUCTION diagnosed and undertreated. Anemia is one of the most

prevalent public health problems in most of the developing
nemia affects millions of the people world- countries and has serious consequences on national

A wide. The National center for health statistics

estimated that 3.4 millions are living with
Anemia. (1) Nevertheless the actual greater as anemic
Incidence and prevalence
individuals may be even greater as anemia is often under- Iron deficiency is the common form of anemia seen in

Correspondence address: Raghad Aboushamat MD

Bucharest, Romania e-mail: dr.raghadaboushamat@gmail.com

pediatric, general medical and clinical hematology prac- deficiency and normal pregnant women in their
tices in the US. ability to respond to inhibitors of labor and in occur-
Prevalence: rence of early birth and the results on newborn.
• Adult men 5,000/100,000 • Comparison between pregnant women iron deficiency
• Adult women 14,000/100,000 anemia treatments with non-treatment pregnant
Frequency: women in terms of response to stop the labor and the
• Prevalence in low income pregnant women in the results.
US is 9% to 14% and 37% in first second and third • Compare results with the results of similar studies.
trimesters respectively
Classification of cases
• Most common in infant particularly those with diets 1. Groups of patients who suffer from anemia of iron
based on cow’s milk that is not fortified. This is less deficiency and who did not take their treatment
common now, the introduction of iron fortified with iron, about 423 patients.
• Common in toddlers with picky diets 2. Groups of patients who suffer from anemia of iron
• Common in women during reproductive years, due deficiency and who take treatment with iron before
to menses and pregnancy 7 week 30th, about 785 patients.
• Slightly greater incidence in afro-american women 3. Groups of women who did not complain of anemia,
• No race prediction in children 937 patients.
Iron Deficiency Anemia is the most common nutri- That excludes pregnant women who suffer from one of
tional deficiency and is one of the leading risk factors of the following conditions:
disability and death worldwide affecting an estimated two • Problems of uterus and cervix abnormalities.
billion people. (2) • Embryonic reasons for preterm labor.
Anemia is usually a consequence of many diseases • Excessive stretching of the uterus.
including chronic inflammatory infections or neoplastic Each patient of the three groups is evaluated; the detailed
disorders. It may also occur from the treatment of the disease story includes personal identity and story of pregnancy
itself. Anemia may affect school children adolescents, (Where the three groups will be distributed under groups of
elderly and reproductive age women. Anemia has serious primiparous and parous women. In order to distinguish prece-
negative consequences including: dents for early natural births or because of the possibility of
• Increased mortality in women and children specially increased anemia in parous women.) story of the current
in pregnant woman pregnancy (gestational age by date of last menstrual cycle,
• Reduced capacity to learn studies data of ultrasound, complications associated with
• Decreased productivity in all individuals pregnancy monthly schedule for analysis of hemoglobin and
Anemia in the elderly is linked to an increased morbidity ferritin.)
and mortality. (3) Pregnant women often show iron Early labor is being evaluated as follows:
deficiency anemia as a consequence of increased plasma • Do women with high risks patients for preterm labor.
volume during pregnancy, and in many cases causes preterm • Are the patients improving the symptoms of early
labor. Gynecological anemia is often caused by hyper- labor.
menorrhea (increased menstrual bleeding). (4) • Patients in inevitable preterm labor.
Treatment should be directed to the cause of the anemia • Are there other disorders when pregnant caused by
this will be discussed in detailed research. Regarding the iron anemia and having had an impact factor increasing
deficiency and its effects in causing preterm labor how a major the proportion of preterm labor:
healthcare problem throughout the globe constitutes 7 to 8%  Pre-eclampsia and eclampsia; many studies suggest
of the total births and contributes to 85% of deaths among that they are one of the complications of anemia;
premature infants. (5)  Early abruption of placenta;
Despite the current use of material, money effort in  Aggravation of heart disease among pregnant
perinatal medical technology. Neonatal mortality rates for women;
newborns born in the US (5 per 1 000 babies) may rank as  IUGR;
low as 32 industrialized nations superior only to Latvia  Increased risk of infection of the amniotic fluid.
successful reduction of neonatal morbidity and mortality. • Determine the degree of anemia.
Associated with prematurity it may require implementa- • Determine the cause of anemia with iron deficiency
tion of effective identification and behavioral modification and ferritin:
programs for the prevention of the preterm labor.  Insufficient iron diet accredited U.S;
 Insufficient iron stores in most of the women at
M ETHODS the reproductive age;
 Not enough natural absorption of iron intake;
• Identify the various causes of low hemoglobin iron  Iron loss excess from the body of the pregnant.
deficiency in increase of preterm labor. • Determine the adopted methods to compensate
• Comparison of pregnant women with anemia of iron the iron and the degree of response:
Archives of the Balkan Medical Union March 2016, 39

Table 1 that the impact of anemia increases the percentage of

preterm labor.
Category Hemoglobin level On the other side, we found that the percentage of
Light 11-9 preterm labor in untreated anemic primary pregnant (9.26%)
Average 9-7 is greater than the percentage of preterm labor in treated
Intense 7-4 anemic fertile pregnant (9.1 %). And we noticed the per-
Ferocious <4 centage of preterm labor in treated anemic pregnant (7.64 %)
is almost equal to the percentage of preterm labor in preg-
nant without anemia (7.57 %) which shows the importance
 Type of iron; of immediate treatment and preventive treatment for anemic
 Dose; pregnant women.
 Way taken;
 Blood transfusion. C ONCLUSIONS
• Determine the methods adopted to discourage
preterm labor and degree of response compared to Anemia is one of the common and serious diseases
patients with no anemia, preventive treatment for during pregnancy that causes wide range of side effects.
high risk pregnant women. Therefore, early diagnosis and preventive treatment are
necessary for all cases even for the light ones. Since the rate
R ESULTS of anemia and preterm labor are high in primary pregnant
especially at very young age, pre-pregnancy laboratory is
We found that from 423 pregnant (156 primaries, 267 necessary for early treatment. If the treatment with iron for
fertile) who suffer from untreated iron deficiency anemia, anemic pregnant is sufficient the side effects of anemia will
about 35 pregnant women had preterm labors, 8.27 % in be reduced remarkably. Pregnant women who take iron
percentage. From previous 156 primary pregnant, about 15 preventive therapy will make the rate of preterm labor
had preterm labors, 9.61% in percentage. While in 267 become less.
fertile pregnancies about 25 pregnant had a preterm labor, I conclude that the response of the treatment of
9.36% in percentage. pre-term labor in anemic pregnancy is less than the
And we found out that from 785 pregnant (205 primary, response of pre-term labor in patient who did not suffer
580 fertile) with treated iron deficiency anemia about 60 from anemia.
pregnancies had preterm labor which is about 7.64%. From
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