Anemia In Pregnancy: Examining Missed Diagnoses and Racial Disparities in the Upper Midwest.

Anemia in pregnancy (AIP) is associated with poor maternal/fetal outcomes. The prevalence of AIP globally ranges from 44-53% and varies drastically depending on maternal race/ethnicity and other factors. Screening and treatment of AIP is disputed. This study is a retrospective review of electronic medical records (EMR) of pregnant adults over three years (2018-2020, inclusive) of Sanford Health, a large healthcare system in the upper Midwest. AIP was determined by either diagnosis or lab values (hemoglobin, hematocrit, and ferritin) overlapping with pregnancy. A missed diagnosis was characterized by confirmed anemia through lab values but lacking a diagnosis of anemia within EMR. A total of 35,498 patients were included in this study, 42.9% were determined to have AIP. Of AI/AN (American Indian/Alaska Native) patients, 58.3% were anemic and 55.1% of Black/African American patients were anemic compared to 40.0% of anemic white patients. Of anemic patients, 81.1% did not have an anemia diagnosis listed in EMR. This study identifies racial and ethnic disparities of AIP among patients in the upper Midwest. In addition, this study highlights the need for improved data integrity within EMR.

"Anemia and Response to Neoadjuvant Chemotherapy in Breast Cancer Patients".

We analyzed the effect of anemia on tumor response of patients with primary invasive breast cancer (BC) receiving neoadjuvant chemotherapy (NACT). The patient collective was very homogenous; finally, 74 BC patients with identical medication and duration of NACT were enrolled. After completion of NACT, 49 patients (66.2%) had a post-NACT Hb level <12 g/dl. In the anemic group, we found a tendency of lower median tumor response compared to nonanemic patients at this time (15 versus 17 mm, retrospectively, p = 0.18). Age at diagnosis significantly correlated with the difference of Hb [before initiation - after completion of NACT] (correlation coefficient = 0.40, p < 0.001).

HIV infection and anaemia do not affect HbA1c for the detection of diabetes in black South Africans: Evidence from the Durban Diabetes Study.

OBJECTIVE: South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA1c to over- or underestimate glycaemia; however, this has not been comprehensively investigated in African populations. We assessed the association of anaemia, HIV infection and antiretroviral therapy (ART) with HbA1c , and implications for the detection and diagnosis of diabetes, in a black South African population. RESEARCH DESIGN AND METHODS: In this population-based cross-sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA1c and conducted oral glucose tolerance tests (OGTTs), HIV diagnostic tests and full blood count measurements among 1067 participants without a history of diabetes diagnosis. Linear regression was used to examine differences in HbA1c by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA1c -based diabetes prevalence was compared with OGTT-based prevalence among individuals with anaemia and with untreated and ART-treated HIV. RESULTS: In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA1c compared with no anaemia, whereas macrocytic anaemia and ART-treated HIV were associated with lower HbA1c compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range: ß  = -3.4 mmol/mol or -0.31%, p < 0.001 [macrocytic anaemia] to ß = 2.1 mmol/mol or 0.19%, p < 0.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA1c or OGTT among individuals with anaemia (2.9% vs. 3.3%, p = 0.69), untreated HIV (1.6% vs. 1.6% p = 1.00) or ART-treated HIV (2.9% vs. 1.2%, p = 0.08). CONCLUSIONS: Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA1c for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub-Saharan African populations.

Age, Ethnicity, Glucose-6-Phosphate Dehydrogenase Deficiency, Micronutrient Powder Intake, and Biomarkers of Micronutrient Status, Infection, and Inflammation Are Associated with Anemia Among Children 6-59 Months in Nepal.

BACKGROUND: Anemia is a major concern for children in Nepal; however, little is known about context-specific causes of anemia. OBJECTIVE: We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6-59 mo (n = 1367). METHODS: Hemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models. RESULTS: Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (µg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (µmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6-23 mo compared with 24-59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase deficiency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia. CONCLUSION: Both nonmodifiable and potentially modifiable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control.

Prospective payment system and racial/ethnic disparities: a national retrospective observational study in anaemia complication among end-stage renal disease patients in the US.

BACKGROUND: A series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008-2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes. METHODS: The International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge. RESULTS: The percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15-1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat. CONCLUSIONS: Our findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.

Maternal Anaemia in Pregnancy: A Significantly Greater Risk Factor for Anaemia in Australian Aboriginal Children than Low Birth Weight or Prematurity.

OBJECTIVES: To identify maternal and perinatal risk factors associated with childhood anaemia. METHODS: A retrospective cohort study was conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004-2014 in Community A and 2010-2014 in Community B and C, and their respective mothers were recruited into the study. Maternal and child data were linked to provide a longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was the prevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6 months. RESULTS: Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6 months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08-9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21-5.70) were associated with an increased risk of childhood anaemia at 6 months of age. CONCLUSIONS FOR PRACTICE: This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

Hemoglobin Concentration Reference Interval Revisited: a Nationwide Study from Korea.

BACKGROUND: Anemia is a common cause among the elderly for increased mortality. Hemoglobin concentration can be affected by many factors, but the reference interval defined by the World Health Organization has not been adjusted for the previous half century. METHODS: Through using the dataset generated by the National Health Insurance (NHI) health screening program of Republic of Korea, here we attempt to present a close to actual hemoglobin concentration of the Korean population. Between January 2009 and December 2013, a total of 57,409,872 health screening events were registered in the NHI database. Following the exclusion criteria, 6,759,566 participants were enrolled for analyses. RESULTS: Significant portion of the study population was considered 'anemic', while the mean value (2.5% ~ 97.5%) of hemoglobin concentration from the study was 14.8 (12.5 ~ 16.8) g/dL in men and 12.8 (10.6 ~ 14.7) g/ dL in women. Concordant results of hemoglobin concentration declining with age were observed as previous studies have described, supporting the need for separate, possibly lower cutoff in the elderly. CONCLUSIONS: A considerable portion of the participants being categorized as anemia contests the accuracy of the current lower cutoff for anemia. From a large representative dataset, the need for adjustment to the lower cutoff for anemia is suggested.

Evaluation of haemoglobin cut-off for mild anaemia in Asians - analysis of multiple rounds of two national nutrition surveys.

Background & objectives: The haemoglobin (Hb) cut-off is a single value for all populations. It is possible that different populations might have slightly different cut-off values; but, this needs to be evaluated in healthy populations with low possibility of inadequate dietary intakes of haematopoietic nutrients. This study was conducted to assess the existence of race-specific Hb cut-offs for mild anaemia in healthy populations and their potential implications. Methods: In this study the Hb distributions of healthy White, Black, Mexican and Hispanic and Asian non-pregnant women obtained from nine rounds of the National Health and Nutrition Examination Survey (NHANES) and two rounds of National Diet and Nutrition Survey (NDNS), was examined to check the existence of race-specific Hb cut-off for mild anaemia, by standard statistical methods. Results: The mean Hb of Blacks, Mexicans and Hispanics and Asians were lower than Whites, consistent with previous literature. The Hb cut-off for mild anaemia in Asians was lower at 11.22 g/dl. Interpretation & conclusions: Using the Hb cut-off derived in this study in place of the World Health Organization, cut-off of 12 g/dl would result in a 17.9 per cent decrease in the prevalence of anaemia in India. This points to the need for re-examining race-specific cut-off for mild anaemia and points to the need for alternative methods, perhaps linked to risk of unhealthy outcomes.

Prevalence of anemia and associated risk factors among pregnant women in Lahore, Pakistan.

Maternal anemia is a frequent problem during pregnancy, especially in developing countries, such as Pakistan. In this context, the present study was conducted to determine factors associated with maternal anemia prevalent among women of different age groups visiting different hospitals in Lahore from February to April 2017. The current study used a cross-sectional design involving 390 pregnant women. Data related to demographic area, maternal age, gestational age/period, educational and income level, as well as socioeconomic status of all the participants were collected. Also, hemoglobin levels of the participants were obtained for assessment of maternal anemia. A total of 57.7% of participants were anemic (34.4 % mild and 23.3% moderate anemia). Bivariate analysis showed that less education (p = 0.01), occupation as housewife (p = 0.03), lower income (p = 0.001), rural residence (p = 0.028), and greater number of house members (p = 0.04) were significantly associated with maternal anemia. Results of multivariable logistic regression showed that low income was the only significant factor independently associated with maternal anemia. These results suggest that interventions, such as the Nutrition Support Program, to improve nutritional status of pregnant women by providing free food supplements with focus on the poor and marginalized communities are recommended to prevent anemia.

Caution is Needed in Interpreting Hemoglobin A1c Levels in the Muslim Bedouin Population of Southern Israel.

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.

[A study on the association between the infant anemia and the utilization of maternal and child health services in ethnic minorities gathering in poverty-stricken rural areas of two provinces in Western China].

In this study, 1 065 infants and young children aged 24 months below in ethnic minorities gathering in poor rural areas in poor rural areas of Liangshan Yi Autonomous Prefecture of Sichuan Province and Gannan Tibetan Autonomous Prefecture of Gansu Province were investigated for their anemia status from October to November 2014, and the association between anemia and the utilization of maternal and child health services was analyzed. The prevalence of anemia in this area was 52.68%(561/1 065). After the adjustment of socio-demographic characteristics of mothers and infants, compared with infants aged 2-5 months, Han ethnic group, and infants whose mother was not anemic, the OR(95%CI) values of infant anemia for infants aged 6-12 months, 13-8 months, 19-24 months, ethnic minorities group, and infants whose mother was anemic were 11.65 (7.09-19.14), 9.91 (5.99-16.38), 5.87 (3.39-10.16), 1.55 (1.10-2.18) and 1.52 (1.14-2.04), respectively; Compared with infants whose child examination times not up to standard, and who were not only non-hospital delivered but also received inadequate number of inoculation, the OR (95%CI) values of infant anemia for infants whose child examination times up to standard, and who were not only hospital delivered but also received adequate number of inoculation were 0.60 (0.38-0.94) and 0.71 (0.52-0.98), respectively. The infants anemia is associated with the utilization of maternal and child health services.

Molecular diagnosis of α-thalassemia in a multiethnic population.

OBJECTIVE: α-Thalassemia, one of the most common genetic diseases, is caused by deletions or point mutations affecting one to four α-globin genes. Molecular diagnosis is important to prevent the most severe forms of the disease. However, the diagnosis of α-thalassemia is complex due to a high variability of the genetic defects involved, with over 250 described mutations. We summarize herein the findings of genetic analyses of DNA samples referred to our laboratory for the molecular diagnosis of α-thalassemia, along with a detailed clinical description. METHODS: We utilized a diagnostic algorithm including Gap-PCR, to detect known deletions, followed by sequencing of the α-globin gene, to identify known and novel point mutations, and multiplex ligation-dependent probe amplification (MLPA) for the diagnosis of rare or novel deletions. RESULTS: α-Thalassemia was diagnosed in 662 of 975 samples referred to our laboratory. Most commonly found were deletions (75.3%, including two novel deletions previously described by us); point mutations comprised 25.4% of the cases, including five novel mutations. Our population included mostly Jews (of Ashkenazi and Sephardic origin) and Muslim Arabs, who presented with a higher rate of point mutations and hemoglobin H disease. Overall, we detected 53 different genotype combinations causing a spectrum of clinical phenotypes, from asymptomatic to severe anemia. CONCLUSION: Our work constitutes the largest group of patients with α-thalassemia originating in the Mediterranean whose clinical characteristics and molecular basis have been determined. We suggest a diagnostic algorithm that leads to an accurate molecular diagnosis in multiethnic populations.

[Changing trend of children's malnutrition and anemia rate from 2009 to 2015 in Taicang City, Jiangsu Province].

OBJECTIVE: To analyze the changing trend of children's malnutrition and anemia rate in Taicang City, Jiangsu Province from 2009 to 2015. METHODS: Data of medical examination on children under 3 was retrived from Electronic Health Care Records in Taicang, Jiangsu, and children's malnutrition and anemia rates were assessed based on WHO children's growth standard in 2006 and anemia diagnosis standard in 2001. The differences of children's malnutrition and anemia rates from 2009 to 2015 were analyzed based on the data. The Mantel-Haenszel Estimation Method was used to standardize themalnutrition rate and the anemia rate. Mantel-Haenszel Chi-square test was used to compare the differences of count data. RESULTS: The average WAZ, HAZ and WHZ scores were 0. 51, 0. 23 and 0. 56, and the average rates of low weight, stunting, wasting, overweight and obesity were 0. 65%, 1. 54%, 0. 56%, 6. 37% and 1. 03%, respectively. The rates of low weight, wasting, overweight and obesity remained stable from 2009 to 2015. The overweight rate increased from 5. 84% in 2009 to 6. 99% in2012, and dropped to 6. 12% in 2015( MH χ~2= 5. 41, P < 0. 05). The boys had a higher malnutrition rate than the girls, and the migrant children had worse conditions in stunting, overweight and obesity than local children. The anemia rate in children under 3 declined from 24. 02% in 2009 to 9. 25% in 2015( Cochran-Armitage Z = 29. 41, P < 0. 05). The boys had a higher anemia rate than the girls, and the local children had a higher anemia rate than the migrant children. CONCLUSION: The growth status of children under 3 in Taicang from 2009 to 2015 is better than the WHO reference standards. The overweight rates increase from 2009 to 2012 and decline from 2012 to 2015. The anemia rate in children decline from 2009 to 2015. This study indicates that controlling the high overweight rate and high anemia rate in young children under 3 are two predominating working directions in Taicang, Jiangsu.

[The anemia and vitamin A, vitamin D nutritional status of Chinese rural pregnant women in 2010-2012].

OBJECTIVE: By analyzing the levels of hemoglobin, vitamin A and vitamin D in Chinese rural pregnant women during 2010-2012, the changes of the prevalence of anemia were evaluated, and the nutritional status of vitamin A and vitamin D were evaluated. METHODS: All the data in this study came from the China Nutrition and Health Survey in 2010-2012. By using multi-stage stratified sampling and population proportional stratified random sampling method, pregnant women from 45 ordinary ruralareas and 30 poor rural areas were included in this study. 1 763 cases of blood hemoglobin concentration were determined by cyanmethemoglobin method. 601 cases of retinol level were determined by high performance liquid chromatography method. 979 cases of 25-hydroxy vitamin D level were determined by enzyme linked immunosorbent assay. The level of blood hemoglobin and the prevalence of anemia, the level of vitamin A and the prevalence of VAD, the level of vitamin D and the prevalence of vitamin D deficiency were analyzed. RESULTS: In 2010-2012, the level of blood hemoglobin of Chinese city pregnant women was 123. 60( 113. 80-133. 50) g/L, 123. 10( 114. 00-132. 20) g/L for ordinary rural area and 125. 40( 113. 30-136. 80) g/L for poor rural area. The level of blood hemoglobin of ordinary rural area was statistically higher than that of poor rural area( P = 0. 020). The anemia prevalence of Chinese rural pregnant women was 17. 58%, 16. 10% for ordinary rural area and 20. 19% for poor rural area. Statistically difference was found between different areas( P = 0. 029). The level of vitamin A of Chinese rural pregnant women was 1. 53( 1. 18-1. 98) µmol/L. The prevalence of VAD of Chinese county pregnant women was 3. 49%, the marginal deficiency rate was 12. 81%. The level of vitamin D of Chinese city pregnant women was 15. 55( 11. 94-19. 90) ng/m L. The prevalence of vitamin D deficiency of Chinese rural pregnant women was up to 75. 38%, 65. 36% for ordinary rural area and 87. 42% for poor rural area. Significant difference was observed in the prevalence of vitamin D deficiency between ordinary and poor rural areas( P < 0. 001). CONCLUSION: The prevalence of anemia in Chinese rural pregnant women improve from 2002 to 2012, but still higher than other populations. The prevalence of vitamin D deficiency in pregnant women is generally more serious, while there is a certain percentage of vitamin A marginal deficiency.

Anemia among indigenous women in Brazil: findings from the First National Survey of Indigenous People's Health and Nutrition.

BACKGROUND: Anemia is recognized as a major public health problem that disproportionately affects vulnerable populations. Indigenous women of reproductive age in Brazil are thought to be at high risk, but lack of nationwide data limits knowledge about the burden of disease and its main determinants. This study aimed to assess the prevalence of anemia and associated factors in this population using data from The First National Survey of Indigenous People's Health and Nutrition in Brazil. METHODS: Data were collected from Indigenous women between 15 and 49 years old based on a nationwide sample of villages. The outcomes of interest were hemoglobin levels (g/dL) and anemia (< 12 g/dL for nonpregnant and < 11 g/dL for pregnant women). Multilevel models were used to explore associations with contextual (village) and individual (household/woman) level variables. RESULTS: Based on data for 6692 Indigenous women, the nationwide mean hemoglobin level was 12.39 g/dL (95% CI: 12.29-12.50). Anemia prevalence was high (33.0%; 95% CI: 30.40-35.61%) and showed pronounced regional disparities. No village-level characteristics were associated with anemia or hemoglobin levels in the multilevel model. Even after controlling for upper level variables, socioeconomic status, parity, body mass index, and having been treated for malaria were associated with anemia and hemoglobin levels. CONCLUSION: The prevalence of anemia in Brazilian Indigenous women was 12% greater than the national estimates for women of reproductive age. Anemia prevalence and mean hemoglobin levels among Indigenous women appear to be partly explained by some previously recognized risk factors, such as socioeconomic status, body mass index, and malaria; however, part of the variability in these outcomes remains unexplained. Knowledge of health status and its potential determinants is essential to guide public policies aimed at controlling anemia burden in Indigenous communities.

Sociodemographic factors associated with anaemia in pregnancy at booking for antenatal care.

Late patronage of antenatal care by women in low-resource areas makes timely intervention at correcting anaemia difficult. This study aimed to identify modifiable sociodemographic factors that predict anaemia before commencing antenatal care and make appropriate recommendation. A survey of sociodemographic features and haemoglobin concentrations of 232 women booking for antenatal care was conducted. Anaemia was diagnosed in 119 (51.3%), of which 87 (37.5%) had mild anaemia and 32 (13.8%) were moderately anaemic. There was no severe anaemia. Anaemia was highest among respondents who were 35 years of age, Muslims, of Igbo ethnicity (64.3%), single (55.0%), student/unemployed (58.8%), nulliparous (57.3%) and those who registered at 21 weeks' gestation (54.2%). Only occupation of the woman showed association with anaemia before antenatal care (p 0.007). A personal source of income may reduce anaemia in pregnancy; and it is advisable to have a social welfare package for unemployed pregnant women.

[Study on the relationship between anemia and dietary factors of rural residents in the suburb of Chengdu].

OBJECTIVE: To investigate the relationship between anemia and dietary factors of rural residents in the suburb of Chengdu. METHODS: 467 rural residents were randomly selected in the survey, using 24-hour dietary recall questionnaire and food frequency questionnaire to obtain dietary information of surveyed residents and to detect the hemoglobin content and calculate dietary diversity scores. RESULTS: (1)The prevalence of anemia in surveyed residents was 20. 13%, with a percentage of 19. 30% in female and20. 92% in male. (2)The average intake of cereals, vegetables, livestock and poultry meat, protein, carbohydrate, fibre, folic acid, magnesium, iron and copper were lower in anemic male than that in non-anemic male( P < 0. 05, P < 0. 01). The average intake of cereals, energy, protein, carbohydrate, fibre, vitamin B6, vitamin B12, folic acid, vitamin C, magnesium and iron were lower in anemic female than that in non-anemic female( P <0. 05, P < 0. 01). (3) The prevalence of anemia in group with dietary diversity scored between 1 and 3 was the highest, the risk of which was 6. 109 times of group with dietarydiversity scored between 7 and 9( P < 0. 05). CONCLUSION: Nutrients intake and the level of dietary diversity are associated with anemia of the rural residents in the suburb of Chengdu.

Anemia among Muslim Bedouin and Jewish women of childbearing age in Southern Israel.

There are inequalities in health indicators among different ethnic groups living in the same region and receiving the same medical services. Anemia is a global problem. Although the prevalence of anemia is not high in Israel, differences among ethnic groups have not been studied. Our objective was to assess anemia among Bedouin and Jewish women of childbearing age in southern Israel. A retrospective observational study was conducted based on data from computerized medical records. Seven thousand eight hundred seventy-one women in the study clinics underwent complete blood counts and had blood hemoglobin levels of 11 g/dl or below. The Jewish patients were older (31.7 vs. 29.7 years, P < 0.001), practiced birth control more (24.2 vs. 9.9 %, P < 0.001), and adhered to it more (81.1 vs. 61.9 %, P < 0.001). Bedouin women had more children (3.7 vs. 1.9, P < 0.001), and more Bedouin women were pregnant during the study period (49.3 vs. 35.0 %, P < 0.001). The most prevalent types of anemia were iron deficiency and anemia of chronic disease. Two types of anemia were proportionally higher among Jewish women, anemia of chronic disease (18.1 vs. 9.7 %, P < 0.001) and folic acid deficiency (3.3 vs. 2.2 %, P > 0.001). The adherence rates for treatment were very low. Three factors associated with severe anemia (hemoglobin below 8 g/dl) were being Bedouin (odds ratio (OR) = 1.295, P < 0.001), use of birth control (OR = 0.419, P < 0.001), and pregnancy (OR = 0.447, P < 0.001). Being a Bedouin woman is a risk factor for severe anemia, and adherence to treatment for anemia is very low in both groups. These findings should be addressed in a national program to reduce health inequalities.

Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study.

BACKGROUND: One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD: Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS: Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS: There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.

Placental inflammation is associated with rural and remote residence in the Northern Territory, Australia: a cross-sectional study.

BACKGROUND: The Northern Territory has the highest rates of perinatal morbidity and mortality in Australia. Placental histopathology has not been studied in this high-risk group of women. METHODS: This is the first study to detail the placental pathology in Indigenous women and to compare the findings with non-Indigenous women in the Northern Territory. There were a total of 269 deliveries during a three-month period from the 27(th) of June to the 27(th) of August 2009. Seventy-one (71%) percent of all placentas were examined macroscopically, sectioned then reviewed by a Perinatal Pathologist, blinded to the maternal history and outcomes. RESULTS: Indigenous women were found to have higher rates of histologically confirmed chorioamnionitis and or a fetal inflammatory response compared with non-Indigenous women (46% versus 26%; OR 2.4, 95% CI 1.3-4.5). In contrast, non-Indigenous women were twice as likely to show vascular related pathology (31% versus 14%; OR 2.77, 95% CI 1.3-5.9). Indigenous women had significantly higher rates of potentially modifiable risk factors for placental inflammation including genitourinary infections, anaemia and smoking. After adjusting for confounders, histological chorioamnionitis and fetal inflammatory response was significantly associated with rural or remote residence (Adjusted OR 2.5, 95% CI 1.08 - 5.8). CONCLUSION: This study has revealed a complex aetiology underlying a high prevalence of placental inflammation in the Northern Territory. Placental inflammation is associated with rural and remote residence, which may represent greater impact of systemic disadvantage, particularly affecting Indigenous women in the Northern Territory.