REVIEW ARTICLE
Postpartum anemia I: definition, prevalence, causes,
and consequences
Nils Milman
Received: 22 February 2011 /Accepted: 7 June 2011 /Published online: 28 June 2011
#
Springer-Verlag 2011
Abstract This review provides a status on the definition,
prevalence, causes, and consequences of anemia in women
who have given childbirth, i.e., postpartum anemia. The
diagnosis of iron deficiency anemia relies on a full blood
count including hemoglobin, serum ferritin, and serum
soluble transferrin receptor, which appear to be reliable
indicators of anemia and iron status 1 week postpartum
while serum transferrin saturation is an unreliable indicator
several weeks after delivery. It is recommended that
postpartum anemia should be defined by hemoglobin
<110 g/L at 1 week postpartum and <120 g/L at 8 weeks
postpartum. The major causes of postpartum anemia are
prepartum anemia combined with acute bleeding anemia
due blood losses at delivery. Normal peripartum blood
losses are approximately 300 ml, but hemorrhage >500 ml
occur in 5–6% of the women. In healthy women after normal
delivery, the prevalence of anemia (hemoglobin <110 g/L)
1 week postpartum is 14% in iron-supplemented women and
24% in non-supplemented women. In consecutive series of
European women, the prevalence of anemia 48 h after
delivery is approximately 50%. In developing countries, the
prevalence of postpartum anemia is in the range of 50–80%.
Postpartum anemia is associated with an impaired quality of
life, reduced cognitive abilities, emotional instability, and
depression and constitutes a significant health problem in
women of reproductive age.
Keywords Anemia
.
Iron deficiency
.
Ferritin
.
Hemoglobin
.
Iron
.
Postpartum hemorrhage
.
Postpartum
period
.
Pregnancy
.
Transferrin receptor
Introduction
An adequate iron status is essential for an uncomplicated
course of pregnancy, a normal development of the fetus,
and maturity of the newborn [1]. Iron deficiency anemia
(IDA) in pregnancy, i.e., prepartum anemia, is associated
with premature birth, low birth weight, and small for
gestational age of the newborn and is furthermore closely
associated with the occurrence of anemia after delivery of a
child, i.e., in the postpartum period [1].
There is no consensus on the length of the postpartum
period. Some authors consider it to be the period 8–
32 weeks after delivery [2]. Other options could be to
define the postpartum period either to the woman’s
menstruation recurs, which display great inter-individual
variation, or to the end of the lactation period, i.e.,
approximately 24 weeks after delivery.
Postpartum iron deficiency and anemia are associated
with an impaired quality of life from a physical and a
psychological point of view and constitutes a significant
health problem both in developed and developing countries
[2–4]. The aim of this review is to focus on the definition,
prevalence, causes, and consequences of postpartum
anemia.
Assessing iron status in the postpartum period
Body iron status can be assessed by appropriate biomarkers
including hemoglobin, serum/plasma ferritin, serum/plasma
N. Milman
Department of Clinical Biochemistry, Næstved Hospital,
4700 Næstved, Denmark
N. Milman (*)
Lindevangen 87B,
2830 Virum, Denmark
e-mail: nils.mil@dadlnet.dk
Ann Hematol (2011) 90:1247–1253
DOI 10.1007/s00277-011-1279-z