Re: [ozmidwifery] measuring Hb during pregnancy

[leanne wynne]

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

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Re: [ozmidwifery] measuring Hb during pregnancy

[Andrea Quanchi]

That was what I was interested in reading in Odents opinion that suggesting iron supplementation to women with what I would have thought was a low Hb may be contraindicated. If the study he is talking about found that Hb 8.5 - 9.5 resulted in the biggest baby weights why would  you need to be concerned about a low Hb. Even if the iron stores were found to be low ( although what is a normal level for pregnancy) does it matter because if iron supplementation is contraindicated what are you going to do about it anyway.
Andrea
On Wednesday, September 22, 2004, at 10:13 PM, 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 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

[leanne wynne]

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
_
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http://adsfac.net/link.asp?cc=FXT002.7542.0

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Re: [ozmidwifery] measuring Hb during pregnancy

[Jo Bourne]

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 
>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?


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Virtual Artists Pty Ltd
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Re: [ozmidwifery] measuring Hb during pregnancy

[Mary Murphy]

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

[Liz Newnham]

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

[Marilyn Kleidon]

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

[ozmidwifery] measuring Hb during pregnancy

[Andrea Quanchi]

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