Anders Ole Agger

Iron status markers and serum erythropoietin in 120 mothers and newborn infants: Effect of iron supplementation in normal pregnancy

In a randomized, double‐blind, placebo controlled study of the effect of iron supplementation during pregnancy, iron status (hemoglobin (Hb), serum (S‐)transferrin saturation, S‐ferritin) and S‐erythropoietin (EPO) were assessed in 120 healthy pregnant women at 14–16 weeks of gestation, and just before delivery; 63 women were treated with 66 mg iron daily, and 57 with placebo. There were no differences in baseline values in the two groups. At term, the iron treated group had significantly higher Hb, transferrin saturation, S‐ferritin (median 22 μg/1 vs. 14 μg/1, (p<0.0001) and lower S‐EPO compared to the placebo treated group. In the iron group, 30.2% had exhausted iron stores (i.e. S‐ferritin <20 μg/1), 6.3% latent iron deficiency (S‐ferritin <20 μg/1 and transferrin saturation < 15%), and no patients had iron deficiency anemia (S‐ferritin <20 μg/1 and transferrin saturation < 15% and Hb < 110 g/1). In the placebo group, 93.0% had exhausted iron stores, 54.4% latent iron deficiency, and 17.5% iron deficiency anemia; S‐EPO was inversely correlated to iron status markers: Hb, rs = −0.51,p<0.001; transferrin saturation, rs= −0.65,p<0.0001; S‐ferritin, rs= − 0.31, R<0.01, suggesting that the elevation in S‐EPO was secondary to iron deficient erythropoiesis. Newborns to iron treated mothers had higher cord S‐ferritin, median 155 μg/1, than newborns to placebo treated mothers, median 118 ug/1 (p<0.02); there were no differences in birth weight, transferrin saturation, or S‐EPO. Supplemental iron in a dose of 65 mg/day from the second trimester is sufficient to prevent iron deficiency in pregnant Danish women.

Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation

Background. The aim was to define reference values for hemoglobin, hematocrit and erythrocyte indices, i.e. erythrocyte count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), in normal pregnancy and after a normal delivery in non‐iron‐supplemented and iron supplemented women.

The influence of prepregnancy body mass index on labor complications.

BACKGROUND To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

Variations in serum relaxin (hRLX-2) concentrations during human pregnancy

Study objective. To study variations in serum relaxin concentrations during normal and abnormal human pregnancy and parturition and in umbilical cord blood.

Obesity as a predictor of postpartum urinary symptoms

Background. To investigate the relationship between pre‐pregnancy obesity, and urinary symptoms, especially urinary incontinence, before, during, and 6–18 months after delivery.

Serum Ferritin is a Reliable, Non-invasive Test for Iron Status in Pregnancy: Comparison of Ferritin with Other Iron Status Markers in a Longitudinal Study on Healthy Pregnant Women; Erythropoiesis.

Background and Aims: To assess the true positive and false positive rates of the iron status markers (serum iron, serum transferrin, transferrin saturation, haemoglobin, haematocrit, mean corpuscular volume (MCV), mean cell haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), erythrocyte count) in the diagnosis of depleted iron stores (iron depletion) during normal pregnancy and postpartum. Methods: Among 120 pregnant women, 58 were randomised to placebo-treatment and 62 to iron treatment (66 mg ferrous iron daily from 14 weeks of gestation). Iron status markers were measured every 4th week during pregnancy and 8 weeks postpartum. Iron depletion was defined by a serum ferritin concentration <16μg/L. The 5th percentiles for the other iron status markers in the group of iron-treated women were used as cut-off values. Calculations were made in the 2nd and 3rd trimester, praepartum and postpartum. Results: In general, the true positive rates of other iron status markers in the diagnosis of iron depletion (serum ferritin < 16 μg/L) were low ranging from 0% to 52% during pregnancy and from 9% to 64% postpartum. Transferrin saturation and MCH displayed the highest true positive rates. The false positive rates ranged from 0% to 13% during pregnancy and from 4% to 17% postpartum. Haemoglobin and MCH displayed the highest false positive rates. Conclusions: The sensitivities of the other iron status markers were too low and the false positive rates too high to be of clinical value in the diagnosis of iron depletion. Despite physiologic variations due to haemodilution, the serum ferritin concentration is currently the most reliable non-invasive marker of iron status in pregnancy and postpartum.

Correlations Between Iron Status Markers During Normal Pregnancy in Women with and without Iron Supplementation

UNLABELLED The aim was to evaluate relationships between iron status markers (haemoglobin, erythrocyte indices, serum iron, serum transferrin, serum transferrin saturation, serum ferritin) in normal pregnancy. Iron status markers were measured at 4-week-intervals during pregnancy and postpartum in 120 healthy women; 62 had daily treatment with tablets containing 66 mg ferrous iron, 58 were treated with placebo. Placebo-treated: Ferritin displayed positive correlations with transferrin saturation during 2nd and 3rd trimester. There were positive correlations between ferritin, erythrocyte MCV and MCH during 2nd and 3rd trimester and postpartum. Prior to delivery and postpartum, ferritin demonstrated positive correlations with haemoglobin. Transferrin saturation showed positive correlations with MCV, MCH and MCHC during 2nd and 3rd trimester and postpartum. Transferrin saturation displayed positive correlations with haemoglobin prior to delivery and postpartum. Iron-treated: In general, there were no correlations between iron status markers. Positive correlations appeared postpartum between ferritin, transferrin saturation and MCHC but not with haemoglobin. Transferrin saturation showed a positive correlation with MCH postpartum, but not with haemoglobin. CONCLUSION The patterns of relationships in placebo-treated women were consistent with iron deficient erythropoiesis.

Prepregnancy body mass index in non-diabetic women with and without shoulder dystocia.

OBJECTIVE To investigate the distribution of prepregnancy body mass index (BMI) in non-diabetic women with and without shoulder dystocia. STUDY DESIGN Cases were 142 non-diabetic women experiencing shoulder dystocia during the period from 1 January 1993 to 31 December 1999. Shoulder dystocia was defined as the impossibility of delivering the fetal shoulders by standard procedures. Controls were 142 women vaginally delivering during the same period without experiencing shoulder dystocia. Cases and controls were matched for parity (primi-/multipara) and birthweight (+/-250 g). Women with diabetes mellitus, gestational diabetes or a history of shoulder dystocia in a previous birth were excluded. The BMI and selected obstetric data were extracted from an internal database in the department. RESULTS Delivery was performed using McRoberts maneuvre (42%), Woods screw (50%) or by primary delivery of the posterior arm (8%). Women experiencing shoulder dystocia had significantly more labor augmentation and more instrumental deliveries. No differences were shown in the prevalence of low Apgarscores. The proportion of children with Erbs palsy and clavicular fracture was very close to be significantly different in cases or controls. However, these data does not allow any conclusion. The distribution of BMI was equal in cases and controls. CONCLUSION Non-diabetic women experiencing shoulder dystocia do not have a higher BMI than non-diabetic women delivering without this experience, given a fixed fetal weight.

Morbidity after cesarean section in obese women

C Acta Obstet Gynecol Scand 77 (1998) weight woman (19.9∞BMI∞25.0) matching for age (π/a2 years), parity (primi-/multipara), gestational age (∞37 gestational weeks/±Ω37 gestational weeks), duration of ruptured membranes before delivery (more/less than 12 hours) and type of cesarean section (emergency/elective), was selected as control for each case patient. Information about peror postoperative complications was extracted directly from the database, while information about the incision and preoperative antibiotics were found by record review. Peroperative blood loss was registered as estimated by the surgeon. Puerperal fever was defined as a rectal temperature of 38.5æC or more during at least 8 hours or a clinical picture with fever necessitating antibiotic treatment, without an extragenital focus. Wound infection was defined as redness or swelling requiring antibiotics. Cystitis was defined as a positive culture or subjective symptoms and presence of leucocytes or nitrite in the urine. The results were compared using chi-square test and, when appropriate, Fischer’s exact test.