Determinants of postpartum anemia among women from a rural population in southern India.

Postpartum anaemia is a well known and frequent problem in obstetrics. According to the country, the prevalence varies between 5% and 80% of women who gave birth. The rural population in southern India is certainly a population with a high prevalence of iron deficiency and anaemia before birth, therefore the risk for postpartum anaemia is also high.

The study by Rakesh et al. is well designed and presented. The authors investigated the risk factors for postpartum anaemia in a selected population of 93 women. The medical statistics as well as the inclusion and exclusion criteria (e.g. exclusion of women who had known haematological disease or those who planning to give birth outside the district, making it difficult to gather postpartum information) were carefully selected. After multivariate analysis, anaemia before delivery (around 36 weeks of gestation), young maternal age (<21 years), high blood loss during delivery and inadequate intake of iron tablets during the postpartum period were all significantly associated with anaemia six weeks after delivery. These results certainly make sense and, even if we think it is quite obvious that anaemia before delivery results in anaemia after delivery, it is shown that the risk of postpartum anaemia at 6 weeks was increased 10-fold in women who were anaemic at 36 weeks’ gestation and 12-fold in women with heavy blood loss during delivery. In addition, young mothers with inadequate postpartum iron intake have a 2- to 3-fold risk of postpartum anaemia. In many or most cases, we find a combination of all these risk factors. In the present study, one-third of women were anaemic at 36 weeks’ gestation and half of them had postpartum anaemia. It should be noted that the authors report about a relatively low prevalence of anaemia and iron deficiency in their region, since antenatal care is good compared to many other regions in India. If the authors had used more sensitive parameters for the detection of iron deficiency, such as serum ferritin, and more precise assessment of blood loss (here of blood loss was estimated according to a questionnaire), information abou iron deficiency and volumes of blood loss would probably have been even more precise. However, it is a strong point of the study that it nicely confirms the following points: 1) iron deficiency and anaemia have to be diagnosed and treated during pregnancy using effective preparations including intravenous iron; 2) heavy blood loss during delivery should be managed according to international postpartum haemorrhage guidelines; and 3) postpartum anaemia should not be forgotten and should be diagnosed and treated after birth. In cases of severe anaemia, intravenous iron will be more effective than oral iron. – Christian Breymann