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      Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis

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          Abstract

          Maternal anemia is a well‐recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta‐analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta‐analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small‐for‐gestational‐age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long‐term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high‐quality individual‐level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.

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          Most cited references123

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis.

            Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries.
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              Iron requirements in pregnancy and strategies to meet them.

              T BOTHWELL (2000)
              Iron requirements are greater in pregnancy than in the nonpregnant state. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter; the total requirement of a 55-kg woman is approximately 1000 mg. Translated into daily needs, the requirement is approximately 0.8 mg Fe in the first trimester, between 4 and 5 mg in the second trimester, and >6 mg in the third trimester. Absorptive behavior changes accordingly: a reduction in iron absorption in the first trimester is followed by a progressive rise in absorption throughout the remainder of pregnancy. The amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy and a woman must enter pregnancy with iron stores of >/=300 mg if she is to meet her requirements fully. This is more than most women possess, especially in developing countries. Results of controlled studies indicate that the deficit can be met by supplementation, but inadequacies in health care delivery systems have limited the effectiveness of larger-scale interventions. Attempts to improve compliance include the use of a supplement of ferrous sulfate in a hydrocolloid matrix (gastric delivery system, or GDS) and the use of intermittent supplementation. Another approach is intermittent, preventive supplementation aimed at improving the iron status of all women of childbearing age. Like all supplementation strategies, however, this approach has the drawback of depending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective option for the future.
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                Author and article information

                Contributors
                melissa.young@emory.edu
                Journal
                Ann N Y Acad Sci
                Ann. N. Y. Acad. Sci
                10.1111/(ISSN)1749-6632
                NYAS
                Annals of the New York Academy of Sciences
                John Wiley and Sons Inc. (Hoboken )
                0077-8923
                1749-6632
                17 April 2019
                August 2019
                : 1450
                : 1 , Hemoglobin Concentration for Assessing Anemia ( doiID: 10.1111/nyas.v1450.1 )
                : 47-68
                Affiliations
                [ 1 ] Hubert Department of Global Health Emory University Atlanta Georgia
                [ 2 ] Department of Nutrition and Food Sciences University of Rhode Island Kingston Rhode Island
                [ 3 ] Department of Nutrition University of California, Davis Davis California
                [ 4 ] Heidelberg Institute of Global Health University of Heidelberg Heidelberg Germany
                Author notes
                [*] [* ]Address for correspondence: Melissa F. Young, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 5009, Atlanta, GA 30322. melissa.young@ 123456emory.edu
                Article
                NYAS14093
                10.1111/nyas.14093
                6767572
                30994929
                603257e1-4d13-4732-a856-a39d3883b0b4
                © 2019 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 December 2018
                : 05 March 2019
                : 19 March 2019
                Page count
                Figures: 4, Tables: 5, Pages: 22, Words: 13277
                Funding
                Funded by: World Health Organization
                Categories
                Nutrition
                Public Health
                Review
                Reviews
                Custom metadata
                2.0
                nyas14093
                August 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:30.09.2019

                Uncategorized
                hemoglobin,anemia,pregnancy,review,birth outcomes
                Uncategorized
                hemoglobin, anemia, pregnancy, review, birth outcomes

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