Re: [ozmidwifery] measuring Hb during pregnancy
Hi Marilyn, The article arrived in the mail yesterday. Thanks so much. I plan to use it for an assignment I am doing for Uni this semester - Evidence Based Care. It really amazes me how much of obstetric care isn't actually evidence based. All the best, Leanne. From: Marilyn Kleidon [EMAIL PROTECTED] Reply-To: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] measuring Hb during pregnancy Date: Wed, 22 Sep 2004 12:34:54 -0700 Exactly Andrea. There is an article in the Journal of Nurse-Midwifery (now the Journal of Midwifery and Women's Health) Volume 39, No.2 (Supplement), March/April 1994, pp.133 - 148 Nurse-Midwifery Management of iron-deficiency anaemia during pregnancy by Janet L.Engstrom, CNM, Ph.D and Claudia P. Sittler, CNM, MS which discusses these issues and is excellent reading. It gives you an algorithm for a differential diagnosis and pathophysiology of the various anemias and the beneficial and normal haemodilution of the healthy second trimester (no pathophysiology here). I have a photocopy of this article and could send copies by snail mail to anyone who wants, though I am sure you can find this journal in some Uni library. marilyn - Original Message - From: Andrea Quanchi To: ozmidwifery Sent: Tuesday, September 21, 2004 6:30 PM Subject: [ozmidwifery] measuring Hb during pregnancy All this talk about haemaglobin reminded me about something I read recently and thought would make a good discussion. I have just finished reading Michel O'Dent's book 'The Casarean' ( available from Birth International) which was very interesting reading. In it he discusses measuring Hb during pregnancy and I will type the relevent section from pages 115-116 He states that '... there is a widespread belief that this test can effectively detect anaemia and iron deficiency. In fact this test cannot diagnose iron deficiency because the blood volume of pregnant women is supposed to increase dramatically, so the haemoglobin concentration indicates first the degree of blood dilution, an effect of placental activity. A large british study, involving more than 150,000 pregnancies found the highest average birth weight was in the group of women who had a haemaglobin concentration between 8.5 and 9.5. Furthermore when the haemaglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, pre term birth and pre-eclampsia. The regrettable consequence of routine evaluation of haemoglobin is that all over the world, millions of pregnant women are wrongly told that they are anaemic and are given iron supplements. there is a tendency both to overlook the side effects of iron (constipation, diarhhoea, heartburn etc) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is an oxidative substance that can exacerbate the production of free radicals and might even increase the risk of pre-eclampsia. ' of course he gives references Well I knew the first bit about blood dilution but was not aware of the study that showed the higher birth weight amongst the women with lower Hb or the tendancy to pre eclampsia to women with higher Hb. Makes sense though that if there is higher blood pressure then placental function/flow will be decreased and lead to lower foetal growth. Makes the whole thing a bit of a joke though doesnt it as Hb is the one thing I thought was worth knowing of the battery of tests that women are subjected to. Maybe we should be celebrating when there Hb comes back lower that 10.5 and 'worrying' when it doesn't. Cant you see it now new indication for keeping an eye on BP Hb above 10.5'. Food for thought though. As it will make any though of supplements virtually obsolete. Andrea Quanchi Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862l _ SEEK: Now with over 50,000 dream jobs! Click here: http://ninemsn.seek.com.au?hotmail -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] measuring Hb during pregnancy
Yes Please Marilyn,
55 Aldinga Rd
Willunga
SA 5172
Thank you,
Liz.
- Original Message -
From:
Marilyn
Kleidon
To: [EMAIL PROTECTED]
Sent: Thursday, September 23, 2004 5:04
AM
Subject: Re: [ozmidwifery] measuring Hb
during pregnancy
Exactly Andrea. There is an article in the
Journal of Nurse-Midwifery (now the Journal of Midwifery and Women's
Health) Volume 39, No.2 (Supplement), March/April 1994, pp.133 -
148 " Nurse-Midwifery Management of iron-deficiency anaemia during
pregnancy" by Janet L.Engstrom, CNM, Ph.D and Claudia P. Sittler,
CNM, MS which discusses these issues and is excellent reading. It gives you
an algorithm for a differential diagnosis and pathophysiology of the
various anemias and the beneficial and normal haemodilution of the healthy
second trimester (no pathophysiology here). I have a photocopy of this article
and could send copies by snail mail to anyone who wants, though I am sure you
can find this journal in some Uni library.
marilyn
- Original Message -
From:
Andrea Quanchi
To: ozmidwifery
Sent: Tuesday, September 21, 2004 6:30
PM
Subject: [ozmidwifery] measuring Hb
during pregnancy
All this talk about haemaglobin reminded me about something I
read recently and thought would make a good discussion.I have just
finished reading Michel O'Dent's book 'The Casarean' ( available from Birth
International) which was very interesting reading. In it he discusses
measuring Hb during pregnancy and I will type the relevent section from
pages 115-116 He states that'...
there is a widespread belief that this test can effectively detect anaemia
and iron deficiency. In fact this test cannot diagnose iron deficiency
because the blood volume of pregnant women is supposed to increase
dramatically, so the haemoglobin concentration indicates first the degree of
blood dilution, an effect of placental activity. A large british study,
involving more than 150,000 pregnancies found the highest average birth
weight was in the group of women who had a haemaglobin concentration between
8.5 and 9.5. Furthermore when the haemaglobin concentration fails to fall
below 10.5 there is an increased risk of low birth weight, pre term birth
and pre-eclampsia. The regrettable consequence of routine evaluation of
haemoglobin is that all over the world, millions of pregnant women are
wrongly told that they are anaemic and are given iron supplements. there is
a tendency both to overlook the side effects of iron (constipation,
diarhhoea, heartburn etc) and to forget that iron inhibits the absorption of
such an important growth factor as zinc. Furthermore, iron is an oxidative
substance that can exacerbate the production of free radicals and might even
increase the risk of pre-eclampsia. 'of course he gives
referencesWell I knew the first bit about blood dilution but was not
aware of the study that showed the higher birth weight amongst the women
with lower Hb or the tendancy to pre eclampsia to women with higher Hb.
Makes sense though that if there is higher blood pressure then placental
function/flow will be decreased and lead to lower foetal growth. Makes the
whole thing a bit of a joke though doesnt it as Hb is the one thing I
thought was worth knowing of the battery of tests that women are subjected
to. Maybe we should be celebrating when there Hb comes back lower that 10.5
and 'worrying' when it doesn't. Cant you see it now new indication for
keeping an eye on BP "Hb above 10.5'. Food for thought though. As it will
make any though of supplements virtually obsolete.Andrea
Quanchi
Re: [ozmidwifery] measuring Hb during pregnancy
Andrea wrote:"... there is a widespread belief that this test (hb)can effectively detect anaemia and iron deficiency." The latest measure seems to be Ferritin and according to www.ironpanel.com.au this measures the iron stores in the marrow.Ironpanel says that "ferritin 15 means that a person usually has no sustainable iron left in the bone marrow" My experience has been that pregnant women have reasonable Hbs (110) with ferritins of 5. They are usually well and energetic, but because of the low ferritin are being supplemented quite heavily. Comments please?
Re: [ozmidwifery] measuring Hb during pregnancy
I can only speak about my own pregnancy but I had consistently normal hb but low serum ferritin levels. The care I was given was to keep an eye on my dietary iron intake and monitor my hb to make sure it stayed up then to recheck sometime before my next pregnancy to see if I was always that way. Both levels remained consistent from the time this was first noticed, no more action was taken (than eating iron rich foods) and i did end up getting the retest a year or more post natally and my ferritin was normal so the low levels were presumably pregnancy related. I think supplements may have been suggested as an option if I felt like it but not pushed as necessary unless the situation changed... cheers Jo At 8:13 PM +0800 22/9/04, Mary Murphy wrote: Andrea wrote:... there is a widespread belief that this test (hb) can effectively detect anaemia and iron deficiency. The latest measure seems to be Ferritin and according to http://www.ironpanel.com.auwww.ironpanel.com.au this measures the iron stores in the marrow. Ironpanel says that ferritin 15 means that a person usually has no sustainable iron left in the bone marrow My experience has been that pregnant women have reasonable Hbs (110) with ferritins of 5. They are usually well and energetic, but because of the low ferritin are being supplemented quite heavily. Comments please? -- Jo Bourne Virtual Artists Pty Ltd -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] measuring Hb during pregnancy
Dear Marilyn, I would also appreciate a copy of this article. I did attempt to get a copy through the 'Journal of Midwifery and Women's Health' but it was going to be quite expensive - $30A per article. Thanks, Leanne. 3 Rodney Court Mildura Vic 3500 From: Liz Newnham [EMAIL PROTECTED] Reply-To: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] measuring Hb during pregnancy Date: Wed, 22 Sep 2004 20:39:28 +0930 Yes Please Marilyn, 55 Aldinga Rd Willunga SA 5172 Thank you, Liz. - Original Message - From: Marilyn Kleidon To: [EMAIL PROTECTED] Sent: Thursday, September 23, 2004 5:04 AM Subject: Re: [ozmidwifery] measuring Hb during pregnancy Exactly Andrea. There is an article in the Journal of Nurse-Midwifery (now the Journal of Midwifery and Women's Health) Volume 39, No.2 (Supplement), March/April 1994, pp.133 - 148 Nurse-Midwifery Management of iron-deficiency anaemia during pregnancy by Janet L.Engstrom, CNM, Ph.D and Claudia P. Sittler, CNM, MS which discusses these issues and is excellent reading. It gives you an algorithm for a differential diagnosis and pathophysiology of the various anemias and the beneficial and normal haemodilution of the healthy second trimester (no pathophysiology here). I have a photocopy of this article and could send copies by snail mail to anyone who wants, though I am sure you can find this journal in some Uni library. marilyn - Original Message - From: Andrea Quanchi To: ozmidwifery Sent: Tuesday, September 21, 2004 6:30 PM Subject: [ozmidwifery] measuring Hb during pregnancy All this talk about haemaglobin reminded me about something I read recently and thought would make a good discussion. I have just finished reading Michel O'Dent's book 'The Casarean' ( available from Birth International) which was very interesting reading. In it he discusses measuring Hb during pregnancy and I will type the relevent section from pages 115-116 He states that '... there is a widespread belief that this test can effectively detect anaemia and iron deficiency. In fact this test cannot diagnose iron deficiency because the blood volume of pregnant women is supposed to increase dramatically, so the haemoglobin concentration indicates first the degree of blood dilution, an effect of placental activity. A large british study, involving more than 150,000 pregnancies found the highest average birth weight was in the group of women who had a haemaglobin concentration between 8.5 and 9.5. Furthermore when the haemaglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, pre term birth and pre-eclampsia. The regrettable consequence of routine evaluation of haemoglobin is that all over the world, millions of pregnant women are wrongly told that they are anaemic and are given iron supplements. there is a tendency both to overlook the side effects of iron (constipation, diarhhoea, heartburn etc) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is an oxidative substance that can exacerbate the production of free radicals and might even increase the risk of pre-eclampsia. ' of course he gives references Well I knew the first bit about blood dilution but was not aware of the study that showed the higher birth weight amongst the women with lower Hb or the tendancy to pre eclampsia to women with higher Hb. Makes sense though that if there is higher blood pressure then placental function/flow will be decreased and lead to lower foetal growth. Makes the whole thing a bit of a joke though doesnt it as Hb is the one thing I thought was worth knowing of the battery of tests that women are subjected to. Maybe we should be celebrating when there Hb comes back lower that 10.5 and 'worrying' when it doesn't. Cant you see it now new indication for keeping an eye on BP Hb above 10.5'. Food for thought though. As it will make any though of supplements virtually obsolete. Andrea Quanchi Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ FREE* Month of Movies with FOXTEL Digital: http://adsfac.net/link.asp?cc=FXT002.7542.0 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] measuring Hb during pregnancy
All this talk about haemaglobin reminded me about something I read recently and thought would make a good discussion. I have just finished reading Michel O'Dent's book 'The Casarean' ( available from Birth International) which was very interesting reading. In it he discusses measuring Hb during pregnancy and I will type the relevent section from pages 115-116 He states that '... there is a widespread belief that this test can effectively detect anaemia and iron deficiency. In fact this test cannot diagnose iron deficiency because the blood volume of pregnant women is supposed to increase dramatically, so the haemoglobin concentration indicates first the degree of blood dilution, an effect of placental activity. A large british study, involving more than 150,000 pregnancies found the highest average birth weight was in the group of women who had a haemaglobin concentration between 8.5 and 9.5. Furthermore when the haemaglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, pre term birth and pre-eclampsia. The regrettable consequence of routine evaluation of haemoglobin is that all over the world, millions of pregnant women are wrongly told that they are anaemic and are given iron supplements. there is a tendency both to overlook the side effects of iron (constipation, diarhhoea, heartburn etc) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is an oxidative substance that can exacerbate the production of free radicals and might even increase the risk of pre-eclampsia. ' of course he gives references Well I knew the first bit about blood dilution but was not aware of the study that showed the higher birth weight amongst the women with lower Hb or the tendancy to pre eclampsia to women with higher Hb. Makes sense though that if there is higher blood pressure then placental function/flow will be decreased and lead to lower foetal growth. Makes the whole thing a bit of a joke though doesnt it as Hb is the one thing I thought was worth knowing of the battery of tests that women are subjected to. Maybe we should be celebrating when there Hb comes back lower that 10.5 and 'worrying' when it doesn't. Cant you see it now new indication for keeping an eye on BP Hb above 10.5'. Food for thought though. As it will make any though of supplements virtually obsolete. Andrea Quanchi
Re: [ozmidwifery] measuring Hb during pregnancy
Exactly Andrea. There is an article in the Journal of Nurse-Midwifery (now the Journal of Midwifery and Women's Health) Volume 39, No.2 (Supplement), March/April 1994, pp.133 - 148 " Nurse-Midwifery Management of iron-deficiency anaemia during pregnancy" by Janet L.Engstrom, CNM, Ph.D and Claudia P. Sittler, CNM, MS which discusses these issues and is excellent reading. It gives you an algorithm for a differential diagnosis and pathophysiology of the various anemias and the beneficial and normal haemodilution of the healthy second trimester (no pathophysiology here). I have a photocopy of this article and could send copies by snail mail to anyone who wants, though I am sure you can find this journal in some Uni library. marilyn - Original Message - From: Andrea Quanchi To: ozmidwifery Sent: Tuesday, September 21, 2004 6:30 PM Subject: [ozmidwifery] measuring Hb during pregnancy All this talk about haemaglobin reminded me about something I read recently and thought would make a good discussion.I have just finished reading Michel O'Dent's book 'The Casarean' ( available from Birth International) which was very interesting reading. In it he discusses measuring Hb during pregnancy and I will type the relevent section from pages 115-116 He states that'... there is a widespread belief that this test can effectively detect anaemia and iron deficiency. In fact this test cannot diagnose iron deficiency because the blood volume of pregnant women is supposed to increase dramatically, so the haemoglobin concentration indicates first the degree of blood dilution, an effect of placental activity. A large british study, involving more than 150,000 pregnancies found the highest average birth weight was in the group of women who had a haemaglobin concentration between 8.5 and 9.5. Furthermore when the haemaglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, pre term birth and pre-eclampsia. The regrettable consequence of routine evaluation of haemoglobin is that all over the world, millions of pregnant women are wrongly told that they are anaemic and are given iron supplements. there is a tendency both to overlook the side effects of iron (constipation, diarhhoea, heartburn etc) and to forget that iron inhibits the absorption of such an important growth factor as zinc. Furthermore, iron is an oxidative substance that can exacerbate the production of free radicals and might even increase the risk of pre-eclampsia. 'of course he gives referencesWell I knew the first bit about blood dilution but was not aware of the study that showed the higher birth weight amongst the women with lower Hb or the tendancy to pre eclampsia to women with higher Hb. Makes sense though that if there is higher blood pressure then placental function/flow will be decreased and lead to lower foetal growth. Makes the whole thing a bit of a joke though doesnt it as Hb is the one thing I thought was worth knowing of the battery of tests that women are subjected to. Maybe we should be celebrating when there Hb comes back lower that 10.5 and 'worrying' when it doesn't. Cant you see it now new indication for keeping an eye on BP "Hb above 10.5'. Food for thought though. As it will make any though of supplements virtually obsolete.Andrea Quanchi
