Judistiani Raden Tina Dewi, Madjid Tita Husnitawati, Handono Budi, Sukandar Hadyana, Irianti Setyorini, Gumilang Lani, Nirmala Sefita Aryuti, Setiabudiawan Budi
Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Post Graduate Study in Obstetrics and Gynecology Specialists, Faculty of Medicine, Universitas Padjadjaran, Dr Hasan Sadikin Hospital, Bandung, Indonesia.
Anemia. 2020 Oct 8;2020:8880045. doi: 10.1155/2020/8880045. eCollection 2020.
Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting.
This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. , . This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (Sysmex). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR).
One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, < 0.0001, Youden index 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml.
This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.
孕晚期贫血已被确定为孕产妇和胎儿发病的危险因素，可能导致死亡。由于成本高昂，寻找最佳的贫血预测标志物对于早期预防变得更为重要。在资源匮乏地区，尤其在孕晚期预测贫血时，铁蛋白、铁调素或可溶性转铁蛋白受体中只能选择其一作为预测指标。
本研究旨在确定孕早期铁蛋白、铁调素或可溶性转铁蛋白受体（sTfR）中预测孕晚期贫血的最佳标志物。 。这项诊断性研究嵌套于印度尼西亚关于维生素D及其对孕期影响的队列研究中。在孕早期从印度尼西亚西爪哇的四个城市招募单胎妊娠且胎儿正常的孕妇。对304名孕妇的血清进行铁调素、铁蛋白和sTfR水平筛查。所有生物标志物均通过酶联免疫吸附测定（ELISA）法检测。全血细胞计数（CBC）采用阻抗法测量（希森美康）。仅纳入具有完整数据的受试者进行诊断性研究分析，通过找到最佳的受试者工作特征曲线（RoC）、似然比（LR）和风险估计值（RR）来比较这三种标志物。
181名孕妇符合分析条件。本研究结果表明，孕早期血清铁蛋白水平是预测孕晚期贫血的最佳标志物。铁调素和sTfR表现不佳。铁蛋白水平≤27.23 ng/ml的新临界值产生了最佳的ROC曲线，曲线下面积为67%（95%可信区间60%-75%，P<0.0001，约登指数0.28），特异性为86.29%（95%可信区间79.0%-91.8%），LR（+）为3.07（95%可信区间1.8-5.3），RR为2.48（95%可信区间1.67-3.68）。这些最终数据优于之前使用的铁蛋白水平低于30 ng/ml的临界值。
本研究提供了证据，表明孕早期血清铁蛋白水平≤27.23 ng/ml是预测孕晚期贫血的最佳标志物。它对于孕期贫血的二次筛查非常有用，可针对那些在预防孕期贫血中可能需要严格缺铁治疗方法的对象。
