Evaluation of Repeated Antenatal Blood Testing for Anemia, Human Immunodeficiency Virus, and Syphilitic Infection Screening during the Third Trimester: A single-center university hospital setting

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Wipada Laosooksathit
Kasem Raungrongmorakot
Pawin Puapornpong
Aurasa Hemachandra
Maysita Suksamarnwong
Tharangrut Hanprasertpong

Abstract

Objectives: To compare first and repeated antenatal blood tests for screening anemia, human immunodeficiency virus (HIV), and syphilis serology status. Factors influencing maternal anemia were also evaluated utilizing multivariate analysis.
Materials and Methods: A prospective descriptive study involved 1,089 pregnant women who attended an antenatal care unit in a university hospital setting. Participants were asked to fill in a questionnaire. Blood tests at the first antenatal visit and again during the third trimester, approximately 12 weeks apart, were performed routinely (in all women). An analysis was performed to compare the results from both blood sampling periods.
Results: Hemoglobin and hematocrit levels were found to be significantly lower in the third trimester (first vs. third trimester; hemoglobin 12.2 ± 1.2 vs. 11.9 ± 1.2 g/dL, hematocrit 36.6 ± 3.5% vs. 36.1 ± 3.3%, p < 0.001). The incidence of anemia was 14.9% and 23.9% in the first and second laboratory tests, respectively (p < 0.001). Anemia diagnosed in the first trimester (odds ratio (OR) 5.46, 95% confidence interval (CI) 3.74–7.57), maternal underweight (OR 1.59, 95%CI 1.02–2.49), and poor compliance (OR 2.56, 95%CI 1.25–5.21) with ferrous supplementation were considered significant risk factors for anemic status being observed in the third trimester. The prevalence of HIV and syphilis infection were 3.6/1,000 and 1.8/1,000, respectively. Four syphilis seroconversions were observed in which 2 of these 4 were subsequently confirmed as syphilis infection by specific Treponemal test (0.2%). There was no HIV seroconversion in the study population.
Conclusion: A significant decrease in hemoglobin and hematocrit levels warrants the need for a repeated complete blood count in the late trimester. Patients with risk factors, including i) first trimester diagnosis with anemia, ii) low body weight, and iii) poor compliance with taking antenatal supplements, require close monitoring to alleviate the severity of anemia at delivery. Due to a 0.2% seroconversion rate of syphilitic infection, the authors recommend repeat syphilitic serologic testing regardless of the sexual transmitted infection risks. Despite a high prevalence of HIV infection, absent of seroconversion in the study population warrants re-consideration of universal repeated screening of HIV infection in the third trimester. Further cost-utilization studies are required to draw conclusion regarding repeated serologic screening blood tests.

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Laosooksathit, W.; Raungrongmorakot, K. .; Puapornpong, P. .; Hemachandra, A. . .; Suksamarnwong, M. .; Hanprasertpong, T. . . Evaluation of Repeated Antenatal Blood Testing for Anemia, Human Immunodeficiency Virus, and Syphilitic Infection Screening During the Third Trimester: A Single-Center University Hospital Setting. Thai J Obstet Gynaecol 2022, 30, 302-312.
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References

World Health Organization. WHO Recommendations on antenatal care for a positive pregnancy experience. In: 2017/01/13 ed. Geneva: World Health Organization 2016.

Wolff T, Shelton E, Sessions C, Miller T. Screening for syphilis infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009;150:710-6.

Committee opinion no: 635: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2015;125:1544-7.

ACOG Committee Opinion No. 418: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2008;112:739-42.

Kim LH, Cohan DL, Sparks TN, Pilliod RA, Arinaitwe E, Caughey AB. The cost-effectiveness of repeat HIV testing during pregnancy in a resource-limited setting. J Acquir Immune Defic Syndr 2013;63:195-200.

Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.

Bernstein IM, Ziegler W, Badger GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol 2001;97:669-72.

Zeeman GG, Cunningham FG, Pritchard JA. The magnitude of hemoconcentration with eclampsia. Hypertens Pregnancy 2009;28:127-37.

World Health Organization. The global prevalence of anaemia in 2011. Geneva: World Health Organization 2015.

Zhao SY, Jing WZ, Liu J, Liu M. Prevalence of anemia during pregnancy in China, 2012-2016: a meta-analysis. Zhonghua Yu Fang Yi Xue Za Zhi 2018;52:951-7.

Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Del Campo R, Ciapponi A, et al. False-negative results of initial RT-PCR assays for COVID-19: A systematic review. PLoS One 2020;15:e0242958.

Herzog SA, Leikauf G, Jakse H, Siebenhofer A, Haeusler M, Berghold A. Prevalence of anemia in pregnant women in Styria, Austria-A retrospective analysis of mother-child examinations 2006-2014. PLoS One 2019;14:e0219703.

Baig-Ansari N, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O, et al. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull 2008;29:132-9.

Gomes da Costa A, Vargas S, Clode N, L MG. Prevalence and risk factors for iron deficiency anemia and iron depletion during pregnancy: a prospective study. Acta Med Port 2016;29:514-8.

Ugwu NI, Uneke CJ. Iron deficiency anemia in pregnancy in Nigeria-A systematic review. Niger J Clin Pract 2020;23:889-96.

Agbozo F, Abubakari A, Der J, Jahn A. Maternal dietary intakes, red blood cell indices and risk for anemia in the first, second and third trimesters of pregnancy and at predelivery. Nutrients 2020;12.

Badfar G, Shohani M, Soleymani A, Azami M. Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019;32:1728-34.

Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr 2016;103:495-504.

Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth 2017;17:137.

Nyoyoko NP, Umoh AV. The prevalence and determinants of HIV seroconversion among booked ante natal clients in the University of Uyo teaching hospital, Uyo Akwa Ibom State, Nigeria. Pan Afr Med J 2016;25:247.

Kiss H, Widhalm A, Geusau A, Husslein P. Universal antenatal screening for syphilis: is it still justified economically? A 10-year retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2004;112:24-8.

Asavapiriyanont S, Chaovarindr U, Kaoien S, Chotigeat U, Kovavisarach E. Prevalence of sexually transmitted infection in teenage pregnancy in Rajavithi Hospital, Thailand. J Med Assoc Thai 2016;99 Suppl 2:S153-60.

Boonchaoy A, Wongchampa P, Hirankarn N, Chaithongwongwatthana S. Performance of chemiluminescent microparticle immunoassay in screening for syphilis in pregnant women from low-prevalence, resource-limited setting. J Med Assoc Thai 2016;99:119-24.

Plewes K, Lee T, Kajeechewa L, Thwin MM, Lee SJ, Carrara VI, et al. Low seroprevalence of HIV and syphilis in pregnant women in refugee camps on the Thai-Burma border. Int J STD AIDS 2008;19:833-7.

Albright CM, Emerson JB, Werner EF, Hughes BL. Third-trimester prenatal syphilis screening: A cost-effectivenessa nalysis. Obstet Gynecol 2015;126:479-85.

Bowen V, Su J, Torrone E, Kidd S, Weinstock H. Increase in incidence of congenital syphilis - United States, 2012-2014. MMWR Morb Mortal Wkly Rep 2015;64:1241-5.

Rac MW, Revell PA, Eppes CS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol 2017;216:352-63.