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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