Health status and fatigue of postpartum anemic women: a prospective cohort study.

OBJECTIVE: The incidence of postpartum anemia is high. Current therapy consists of iron supplementation or blood transfusions, based on the assumption that these treatments improve health status (HS) and reduce fatigue. The aim of this study was to compare HS and fatigue in postpartum women with and without anemia. STUDY DESIGN: This prospective cohort study was performed in The Netherlands between April 2008 and August 2010 and involved 112 anemic (hemoglobin [Hb]<10.5g/dL) and 108 non-anemic (Hb≥10.5g/dL) women. The anemic women received oral iron supplementation. Within 48h and 5 weeks after delivery, HS was measured using the 36 item Short-Form Health Survey (SF-36) and fatigue was measured using the Checklist Individual Strength (CIS). ANOVA for repeated measures was used to compare HS and fatigue scores among groups and across time. RESULTS: After adjustment for confounding variables, there were no differences in any of the HS and fatigue scores. HS and fatigue seem to be more influenced by a complicated delivery than by anemia. HS and fatigue scores significantly improved over time in all women. CONCLUSION: HS and fatigue were not different among women with and without postpartum anemia.

A randomized controlled trial examining the addition of folic acid to iron supplementation in the treatment of postpartum anemia.

OBJECTIVE: To evaluate the efficacy of adding folic acid to oral iron supplementation in postpartum women with anemia. METHODS: A randomized controlled trial was conducted in the Netherlands between April 8, 2008, and August 31, 2010. A total of 112 postpartum women with anemia (hemoglobin <10.5 g/dL) were randomly allocated to receive 600 mg/day ferrous fumarate plus 1mg/day folic acid (FFFA group) or 600/day ferrous fumarate alone (FF group) for 4 weeks. Primary outcome measures were hemoglobin and health status. Secondary outcome measures were fatigue, compliance, and adverse reactions. RESULTS: No between-group differences were observed in hemoglobin and health status after treatment, and no differences were found in fatigue scores. Approximately 75% of all women reported having at least one symptom resulting from ferrous fumarate use. Constipation caused by ferrous fumarate was significantly associated with non-compliance (P=0.014). CONCLUSION: The addition of folic acid to iron supplementation is not beneficial in women with postpartum anemia, as it has no effect on hematologic or health status parameters. CLINICAL TRIAL REGISTRATION: CCMO website NL21797.028.08 and Netherlands Trial Register NTR2232.