RESUMO
Rates of postpartum hemorrhage have been increasing in Canada over the last 10 years, with postpartum iron deficiency anemia as the most common consequence. Postpartum anemia is treated with oral iron supplementation and/or blood transfusion. Recent studies have evaluated the use of parenteral iron as a better tolerated treatment modality. Compared with oral iron supplements, parenteral iron is associated with a more rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period. It may also decrease rates of blood transfusion. Parenteral iron may be considered in select clinical situations for the treatment of postpartum anemia.
Les taux d'hémorragie postpartum ont connu une hausse au Canada depuis les 10 dernières années, la manifestation d'une anémie ferriprive postpartum en étant la conséquence la plus courante. L'anémie postpartum est prise en charge au moyen d'une supplémentation orale en fer et/ou d'une transfusion sanguine. De récentes études ayant évalué l'utilisation de fer parentéral ont indiqué qu'il s'agissait d'une modalité de traitement mieux tolérée. Par comparaison avec les suppléments oraux de fer, le fer parentéral est associé à une hausse plus rapide des taux sériques de ferritine et d'hémoglobine, en plus de mener à une amélioration des scores de fatigue maternelle au cours de la période postpartum. Le fer parentéral pourrait également mener à une diminution des taux de transfusion sanguine. Son utilisation pourrait être envisagée dans certaines situations cliniques particulières, aux fins de la prise en charge de l'anémie postpartum.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/administração & dosagem , Hematínicos/administração & dosagem , Transtornos Puerperais/tratamento farmacológico , Feminino , Óxido de Ferro Sacarado , Ácido Glucárico/administração & dosagem , Humanos , Infusões Parenterais , Complexo Ferro-Dextran/administração & dosagemRESUMO
Consumption of ethanol during human pregnancy can produce a wide spectrum of teratogenic effects, including neurobehavioral dysfunction. This study, in the guinea pig, tested the hypothesis that chronic maternal administration of antioxidant vitamins C plus E, together with ethanol, mitigates ethanol neurobehavioral teratogenicity. Pregnant guinea pigs received one of the following four chronic oral regimens: ethanol and vitamins C plus E; ethanol and vitamin vehicle; isocaloric-sucrose/pair-feeding and vitamins C plus E; or isocaloric-sucrose/pair-feeding and vehicle. Vitamins C (250 mg) plus E (100mg) or vehicle were given daily, and ethanol (4 g/kg maternal body weight/day) (E) or isocaloric-sucrose/pair-feeding was given for 5 consecutive days followed by 2 days of no treatment each week throughout gestation. One neonate from selected litters was studied on postnatal day (PD) 0. Neurobehavioral function was determined by measuring task acquisition and task retention using an 8-day moving-platform version of the Morris water-maze task, starting on PD 45. Thereafter, in vivo electrophysiologic assessment of changes in hippocampal synaptic plasticity was conducted. There was an ethanol-induced decrease in neonatal brain weight compared with sucrose. The vitamins C plus E regimen protected hippocampal weight relative to brain weight in ethanol offspring, and mitigated the ethanol-induced deficit in the task-retention component of the water-maze task. However, in the sucrose group, this Vit regimen produced deficits in both task acquisition and task retention. The vitamins C plus E regimen did not mitigate the ethanol-induced impairment of hippocampal long-term potentiation. These results indicate that maternal administration of this high-dose vitamins C plus E regimen throughout gestation has limited efficacy and potential adverse effects as a therapeutic intervention for E neurobehavioral teratogenicity.