'This is normal during pregnancy': a qualitative study of anaemia-related perceptions and practices among pregnant women in Mumbai, India.

OBJECTIVES: to explore anaemia-related perceptions and practices among pregnant women in Mumbai, India. DESIGN: descriptive qualitative study using in-depth interviews and focus group discussions. SETTING: three government-run maternity hospitals in Mumbai, India. PARTICIPANTS: 31 pregnant women aged 18-33 years; three women completed higher secondary school; 28 were homemakers. FINDINGS: respondents described anaemia as 'lack of blood in the body' because that was the term used by health providers; yet they did not seem worried about the consequence on their own health. Women perceived anaemia as 'normal during pregnancy' because their body had to simply share resources with the fetus and every female relative had suffered from it during pregnancy. Respondents did recognise weakness and dizziness as symptoms of anaemia. They attributed the cause to a poor diet, but did not know the specific link with iron-deficiency. They listed various negative effects of anaemia on the fetus, but very few stated ill-effects on the mother, and none stated maternal death as an outcome. Women saw their role primarily as child-bearers and prioritised newborn's health over their own. CONCLUSION AND IMPLICATIONS: anaemia stands at the intersection of health, nutrition, culture and gender. Interventions in the country have to go beyond distributing or monitoring compliance with iron-folic acid (IFA) supplements. Health education programmes for women and household members have to highlight the seriousness of anaemia and address socio-cultural norms and gendered behaviours in families with respect to nutrition and health. There is an urgent need in maternal and child health programmes to emphasise the importance of the mother's own health. Anaemia interventions have the potential to become proxies for women's health and empowerment programmes.

We've got it covered! Graduated compression stockings.

Hypercoagulability is a well documented feature of pregnancy and contributes to the increased incidences of venous thromboembolism (VTE) in pregnancy. Thromboembolism remains a leading cause of maternal death in the UK, though it's predicted that up to two thirds of these deaths could be prevented if appropriate thrombophylaxsis is adopted. This article aims to further midwives' knowledge in relation to thromboprophylaxsis, focusing in particular on graduated compression stockings (GCS). It aims to assist midwives in identifying those women at high risk of developing a VTE, explain the way in which compressio stockings can reduce thromboembolism and provide advice on their application and the clinical observations required.

Guidelines on anaemia: effect on primary-care midwives in The Netherlands.

OBJECTIVE: To assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. DESIGN: Cross-sectional survey study. SETTING: Primary-care midwifery in The Netherlands. PARTICIPANTS: 160 midwives (60% response rate). MEASUREMENTS: Questionnaire on the knowledge of, and attitudes and self-reported adherence to, 14 key recommendations in the guideline; attitudes to guidelines in general; and perceived barriers to implementation. FINDINGS: The number of midwives agreeing with and adhering to specific recommendations varied between 29 and 90%. Most midwives had a positive attitude to the guidelines. The most relevant general barriers were related to the behaviour of general practitioners and obstetricians (32% of the midwives reported this). Larger numbers of midwives mentioned barriers to specific aspects of the guideline, particularly alternative iron supplementation or dietary supplements (59%), and not prescribing iron supplementation if haemoglobin was low but mean corpuscular volume was normal (49%). KEY CONCLUSIONS: The guideline on anaemia was well received by primary-care midwives in The Netherlands, but implementation of specific recommendations needs further attention. IMPLICATIONS FOR PRACTICE: The study provides evidence for the national organisation of midwives to continue with the development and implementation of clinical guidelines.

Management of iron deficiency in pregnancy.

UNLABELLED: This article reviews a study, published in Clinical and Laboratory Haematology (2003), which looked at using iron-rich spa water (Spatone) as a prophylaxis against iron deficiency in pregnancy. Anaemia is a significant problem in pregnant women that can have a detrimental effect on the baby and mother. The problems of non-compliance with oral iron supplements in this population are well-documented. This was a prospective, randomised, double-blind, placebo-controlled trial, and 102 patients were recruited into the study. Inclusion criteria included singleton pregnancy, booking haemoglobin >10.4g/dl and gestational age confirmed by ultrasound at 20 weeks. Primary outcome measures were compliance with treatments during the trial period, ferritin levels at 22 and 28 weeks and dyspepsia scores at 22 and 26 weeks. RESULTS: Mean ferritin levels fell by 24% in the Spatone group compared with a mean fall of 51% in ferritin levels in the control group, p = 0.016. In the Spatone group, 31% of patients raised their ferritin levels during the trial period compared with 11% in the control group. The authors concluded that Spatone is effective in maintaining iron stores in non-anaemic patients and is well-tolerated. The study delivers a clear message to midwives--namely that Spatone has a place in the management of iron-deficient pregnant women, because it is well-tolerated and provides iron in a highly bioavailable form.

Thalassemia and pregnancy.

Thalassemia syndromes, hemoglobinopathies characterized by anemia secondary to genetic defects of hemoglobin, are the most common of the genetic blood disorders. The prevalence and severity of the thalassemia syndromes are population dependent, with the type of thalassemia seen dependent on racial background. The health care provider must recognize the woman at highest risk for thalassemia and initiate appropriate screening and diagnostic testing. The specific thalassemia dictates the potential maternal, fetal, and neonatal consequences of anemia, red blood cell dysfunction, and systemic oxygenation issues. This article discusses normal globin chain synthesis, diagnostic testing for thalassemia, plan of management, and implications for the woman and fetus.

A "conservative" approach to iron supplementation during pregnancy.

A review of current knowledge about iron metabolism during pregnancy and the evidence from various studies on the effects of iron supplementation in pregnancy on maternal, fetal, and infant outcomes suggest that the implicit goal of current recommendations regarding iron supplementation may be to achieve the highest hemoglobin concentration possible. This goal is only weakly related to improved maternal and infant outcomes in the current pregnancy or to improved maternal iron stores long-term. Indeed, the claim that iron supplementation is universally innocuous is shown to be controversial. For women in developed countries who are generally clinically healthy and have access to adequate nutrition, the benefits of iron supplementation are unclear, and there may be risks. Thus, a better "conservative" approach may be that such women do not require routine iron supplementation during pregnancy. The midwifery philosophy of individualizing care based on a woman's history and health status is one that should be taken in approaching the issue of iron supplementation in pregnancy.