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- W2029114632 abstract "New & Wirth, in their paper in BJOG 122:2 2014, have focused attention on anaemia as a key global maternal health issue. The authors emphasise that despite being flagged up as a common problem affecting ~30 million women worldwide, there has been surprisingly little reduction in the prevalence of maternal anaemia reported over the last three decades. The results of the WHO Multicountry Survey on Maternal and Newborn Health have highlighted anaemia as the most common indirect cause of adverse maternal outcomes including maternal death (Lumbiganon P et al. BJOG 2014;121 Suppl 1:32–9). Severe anaemia in mothers also increases the risk of perinatal mortality (Vogel et al. BJOG 2014;121 Suppl 1:76–88). While the association between anaemia and maternal morbidity and mortality clearly merits more detailed scrutiny, New & Wirth have questioned the actual definitions for anaemia in pregnancy and the recommendations for the haemoglobin cut-offs used. Is there now a need to look beyond the conventional and well established contributory factors, such as physiological changes in pregnancy related to gestational age, at more poorly understood variables that may also have an impact? Although adolescents are recognised to be at greater risk of anaemia, the scope for considering age-specific cut-offs for haemoglobin in pregnancy certainly raises an interesting question for further study. However, it is the lack of comparative data on ethnic differences on haemoglobin in pregnancy in particular that has been flagged up by the authors. Should we now move away from attempts at simplified definitions of maternal anaemia and the concept that ‘one size fits all’ and acknowledge that other factors may contribute to differences? This will require significant efforts to obtain a better understanding of geographical and ethnic variations in haemoglobin levels in pregnancy, taking into account other endemic diseases contributing to anaemia. Such initiatives can potentially better inform and underpin targeted attempts towards more effective therapeutic interventions. However, the application of more complex algorithms for defining anaemia incorporating multiple variables in day-to-day clinical practice poses considerable challenges that should not be underestimated. There are already significant concerns about the sub-optimal management of maternal anaemia even in high-resource countries (Parker et al. BMC Pregnancy Childbirth 2012;12:56), likely due in part to a lack of consistent good quality evidence. There is now an urgent need for us to respond collectively to this timely ‘call for action’ by the authors of this paper as we focus on the Millennium Development Goals (MDG) 5A to reduce maternal mortality that will not be addressed by 2015. Research priorities should tackle the current evidence gaps in the understanding and definition of anaemia in pregnancy and also aim at the development of more standardised approaches to reporting outcomes of maternal anemia together with the impact of therapy. I have no conflicts of interest." @default.
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- W2029114632 date "2014-12-26" @default.
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- W2029114632 title "Anaemia in pregnancy-a renewed focus needed" @default.
- W2029114632 doi "https://doi.org/10.1111/1471-0528.13226" @default.
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