The laboratory assessment of haemoglobin, Ret-He, IRF, plasma ferritin, serum vitamin B12 and folate deficiency in anaemic and non-anaemic women during pregnancy: can laboratory screening predict outcomes?

Ransome, Nicola Jane (2022) The laboratory assessment of haemoglobin, Ret-He, IRF, plasma ferritin, serum vitamin B12 and folate deficiency in anaemic and non-anaemic women during pregnancy: can laboratory screening predict outcomes? Doctoral thesis (DClinSci), Manchester Metropolitan University.

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Abstract

Anaemia in pregnancy affects women in both developed and developing countries. In the UK a high incidence of iron deficiency has been reported, although the incidence of women with iron deficiency in the absence of anaemia is unknown. High incidence has been attributed to socioeconomic background. Iron deficiency is thought to be the main contributor of anaemia during pregnancy, although vitamin B12 and folate deficiency may also be associated. The aim of the study was to evaluate the haematinic variables as predictors of three birth outcomes (gestational delivery age, birth weight and pregnancy loss) in concurrent 1st and 2nd trimester pregnancies for women both with or without anaemia (IDWA) and across socioeconomic groups. Methods: This was a prospective observational longitudinal study in the East Riding of Yorkshire examining n= 545 pregnant women presenting in the 1st and 2nd trimesters of pregnancy. Haemoglobin (Hb), reticulocytes and associated variables (reticulocyte haemoglobin equivalent (Ret-He), immature reticulocyte fraction (IRF)), plasma ferritin, C-Reactive protein (CRP), vitamin B12 and folate were measured using univariate and multivariate analysis to establish independent predictors of birth outcomes. Results: At univariate level, associations with birth outcomes were seen for reticulocyte count, Ret-He, IRF, ferritin, delta Hb, delta ferritin, delta Ret-He and delta IRF. There was a significant difference between live birth and pregnancy loss for Ret-He, IRF and vitamin B12. At multivariate level, Hb, reticulocyte count, Ret-He, IRF, delta Hb, delta IRF and IMDD were shown to be independent predictors of birth outcomes. Conclusion: The use of reticulocyte counts together with extended variables (Ret-He and IRF) provides an excellent opportunity to screen women during pregnancy, for iron deficiency, using the existing FBC sample taken providing a low cost alternative to ferritin. These can be used to not only predict birth outcomes but also identify those most at risk and provide earlier intervention.