ÖZET

Amaç:

Bu çalışmanın amacı, gebeliğin üçüncü trimesterinde demir eksikliği anemisi ve şiddeti ile serebroplasental oran (CPR) ilişkisini değerlendirmektir.

Yöntemler:

Araştırma prospektif olarak planlanmıştır. Dünya Sağlık Örgütü (DSÖ), hamilelik sırasında hemoglobin (Hb) düzeylerinin 11,0 g/dL’nin üzerinde kalmasını önermektedir. DSÖ kılavuzları, 10 ila 10,9 g/dL arasındaki Hb değerlerini hafif anemi, 7 ila 9,9 g/dL arasındaki değerleri orta derecede anemi olarak tanımlar. CPR, orta serebral arter pulsatilite indeksinin (MCA PI) umbilikal arter (UA) PI’ya bölünmesi ile hesaplandı.

Bulgular:

Bu çalışmadaki 108 gebenin 40’ı orta derecede anemik, 34’ü hafif anemik ve 34’ü sağlıklı olarak gruplandı. Demografik özellikler gruplar arasında benzerdi. Orta dereceli anemi grubunda MCA PI 1,89±0,34, hafif anemi grubunda 1,63±0,32, kontrol grubunda 1,57±0,39 idi ve gruplar arasında anlamlı fark vardı (p<0,001). UA PI değerleri orta dereceli anemi grubunda 0,92±0,18, hafif anemi grubunda 1,01±0,15 ve kontrol grubunda 1,01±0,14 idi (p=0,013). Gruplar arasında MCA direnç indeksi (RI) değerleri benzer iken (p=0,836) UA RI’da gruplar arasında anlamlı fark vardı (p=0,042). CPR PI değerleri orta dereceli anemi grubunda 2,11±0,43, hafif anemi grubunda 1,62±0,22 ve kontrol grubunda 1,56±0,4 idi (p<0,001).

Sonuç:

Sonuçlarımız, gebeliğin üçüncü trimesterinde demir eksikliği anemisi varlığında MCA PI, UA PI, UA RI ve CPR PI’nın değiştiğini göstermektedir.

References

Şahin ME, Madendağ İÇ. The role of intravenous iron sucrose treatment in patients with iron deficiency anemia in pregnancy: a prospective controlled cohort study. Journal of Surgery and Medicine 2019;3:78-81.

World Health Organization. Prevention and management of severe anemia in pregnancy. Report of a Technical Working Group, Geneva, 20–22 May 1991. Maternal Health and SafMotherhood Programme. Geneva: World Health Organization; 1993. https://apps.who.int/iris/bitstream/handle/10665/62087/WHO_FHE_MSM_93.5.pdf?sequence=1

World Health Organization. Assessing the iron status of populations: second edition including literature reviews—report of a joint World Health Organization/centers for disease control and prevention technical consultation on the assessment of iron status at the population level. World Health Organization, Geneva, Switzerland; 2004. http://apps.who.int/iris/bitstream/10665/75368/1/9789241596107_eng.pdf?ua=1&ua=1

Cogswell ME, Parvanta I, Ickes L, Yip R, Brittenham GM. Iron supplementation during pregnancy, anemia, and birth weight: a randomized controlled trial. Am J Clin Nutr 2003;78:773-81.

Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol 2008;87:949-59.

Col Madendag I, Eraslan Sahin M, Madendag Y, Sahin E, Demir MB, Acmaz B, et al. The Effect of Iron Deficiency Anemia Early in the Third Trimester on Small for Gestational Age and Birth Weight: A Retrospective Cohort Study on Iron Deficiency Anemia and Fetal Weight. Biomed Res Int 2019;2019:7613868.

Abdel-Megeed AMI, Riad AAM, Elsherif SMMM. Effect of Maternal Anemia on Fetal Doppler Indices during the Last Trimester of Pregnancy. Egypt J Hosp Med 2018;73:6082-9.

Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol 2019;53:465-72.

Morales-Roselló J, Khalil A, Fornés-Ferrer V, Perales-Marín A. Accuracy of the fetal cerebroplacental ratio for the detection of intrapartum compromise in nonsmall fetuses. J Matern Fetal Neonatal Med 2019;32:2842-52.

Fiolna M, Kostiv V, Anthoulakis C, Akolekar R, Nicolaides KH. Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor. Ultrasound Obstet Gynecol 2019;53:473-80.

World Health Organization, “Assessing the iron status of populations: second edition including literature reviews-report of a joint World Health Organization/centers for disease control and prevention technical consultation on the assessment of iron status at the population level,” Tech. Rep., pp. 6-8, World Health Organization, Geneva, Switzerland, 2004, http://apps.who.int/iris/bitstream/10665/75368/1/9789241596107_eng.pdf?ua=1&ua=1.

World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. World Health Organization, Geneva, Switzerland; 2011. https://apps.who.int/iris/handle/10665/85839

Swarray-Deen A, Nkyekyer K, Seffah JD, Mumuni K, Mensah-Brown SA, Tuuli MG, et al. Cerebro-placental ratio as a prognostic factor of fetal outcome in pregnancy complicated by maternal sickle cell disease. Int J Gynaecol Obstet 2020;150:248-53.

WHO. Guideline: Daily Iron and Folic Acid Supplementation in Pregnant Women. Geneva, World Health Organization; 2014. http://apps.who.int/iris/bitstream/handle/10665/77770/9789241501996_eng.pdf?sequence=1

Cahill LS, Hoggarth J, Lerch JP, Seed M, Macgowan CK, Sled JG. Fetal brain sparing in a mouse model of chronic maternal hypoxia. J Cereb Blood Flow Metab 2019;39:1172-84.

Tang J, Li N, Chen X, Gao Q, Zhou X, Zhang Y, et al. Prenatal Hypoxia Induced Dysfunction in Cerebral Arteries of Offspring Rats. J Am Heart Assoc 2017;6:e006630.

Ali E, Kumar M, Naqvi SE, Trivedi SS, Singh A. Fetal vascular adaptation before and after treatment of severe maternal anemia in pregnancy. Int J Gynaecol Obstet 2016;133:284-6.

Abdelsamie ASAM, Bosilah AMH, Farouk RAM. Adverse effect of Maternal Anemia on Fetal Doppler Indices and estimated fetal weight during the Last trimester of pregnancy in rural and suburban area. FYMJ 2021;4:1-10.

Charles CV. Iron Deficiency Anemia: A Public Health Problem of Global Proportions, Public Health - Methodology, Environmental and Systems Issues, Maddock J, editors. 2012.

Gebeliğin Üçüncü Trimesterinde Maternal Demir Eksikliği Anemisi ve Şiddetinin Serebroplasental Oran ile İlişkisi

ÖZET

References