{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:45:40Z","timestamp":1790876740519,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Globally, 36.5% of pregnancies are affected by anemia, particularly in low-and middle-income countries, posing significant risks to maternal and perinatal health. In rural Pakistan, 44.3% of pregnant women suffer from iron deficiency, contributing to the high prevalence of anemia. Limited accessibility to antenatal care exacerbates the challenge, necessitating innovative solutions. This study assessed a midwife-led continuity of care model, utilizing intravenous (IV) iron therapy for the management of anemia in Karachi, Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective analysis of data from a prospective cohort study conducted in two primary healthcare facilities, which employed a community midwife (CMW)-led continuity of care model for antenatal care, including IV iron therapy. We extracted data from February 2021 to March 2022 for women who were diagnosed with anemia based on hemoglobin (Hb) levels, categorized as mild (10.0 to 10.9\u2009g\/dL), moderate (7.0 to 9.9\u2009g\/dL), or severe (less than 7.0\u2009g\/dL). Assessment occurred at the initial antenatal care (ANC) visit to establish baseline anemia severity, and approximately 2\u2009weeks after intravenous (IV) iron therapy administration to evaluate post-treatment changes were considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 114 pregnant women, where the majority presented with moderate (88.6%) anemia. After IV iron treatment, 48.5% improved to normal-mild levels, while 50% remained unchanged. Severe anemia affected 10.5% at baseline; 42% shifted to moderate and 50% to normal-mild post-treatment, with one remaining unchanged (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Among women enrolled in the first and second trimesters, severe anemia improved to normal-mild (50%) and moderate levels (50%) (pre-treatment: <jats:italic>n<\/jats:italic>\u2009=\u200910, post-treatment: <jats:italic>n<\/jats:italic>\u2009=\u20090), and moderate anemia decreased by 48% (pre-treatment: <jats:italic>n<\/jats:italic>\u2009=\u200992, post-treatment: <jats:italic>n<\/jats:italic>\u2009=\u200947).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our midwife-led model of care demonstrated an improvement in iron levels among pregnant women. The model addressed the challenges of anemia prevalence in Pakistan and underscored the significance of empowering front-line healthcare providers, such as community midwives (CMWs) for managing these common conditions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2024.1400174","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T05:00:57Z","timestamp":1716526857000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of iron deficiency anemia during pregnancy: a midwife-led continuity of care model"],"prefix":"10.3389","volume":"11","author":[{"given":"Sabahat","family":"Naz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahira","family":"Shahid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahir","family":"Noorani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishrat","family":"Fatima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jaffar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Kashif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nida","family":"Yazdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjumand","family":"Rizvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Imran","family":"Nisar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fyezah","family":"Jehan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Hoodbhoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"ref1","volume-title":"Anaemia in women and children: WHO global Anaemia estimates","year":"2021"},{"key":"ref2","year":""},{"key":"ref3","volume-title":"Guideline: Daily iron and folic acid supplementation in pregnant women","year":"2012"},{"key":"ref4","volume-title":"Levels & Trends in estimates developed by the United Nations inter-agency Group for Child Mortality Estimation 2022","year":"2022"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/JCMA.0000000000000215","article-title":"Association between maternal anemia at admission for delivery and adverse perinatal outcomes","volume":"83","author":"Chu","year":"2020","journal-title":"J Chin Med Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2012\/454601","article-title":"Preventive treatments of iron deficiency anaemia in pregnancy: a review of their effectiveness and implications for health system strengthening","volume":"2012","author":"Osungbade","year":"2012","journal-title":"J Pregnancy"},{"key":"ref7","first-page":"241","article-title":"Management of Iron Deficiency Anemia","volume":"11","author":"Jimenez","year":"2015","journal-title":"Gastroenterol Hepatol"},{"key":"ref8","article-title":"Iron deficiency and other Hypoproliferative anemias","volume-title":"Harrison's principles of internal medicine","author":"Adamson","year":"2014"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"173","DOI":"10.4274\/tjod.01700","article-title":"Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report","volume":"12","author":"Api","year":"2015","journal-title":"Turk J Obstet Gynecol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2012\/630519","article-title":"Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy","volume":"2012","author":"Khalafallah","year":"2012","journal-title":"J Pregnancy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"296","DOI":"10.2450\/2014.0094-14","article-title":"Safety of intravenous iron formulations: facts and folklore","volume":"12","author":"Auerbach","year":"2014","journal-title":"Blood Transfus"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"996","DOI":"10.3390\/healthcare11070996","article-title":"Pregnant Women's perceptions of the quality of antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: a cross-sectional study","volume":"11","author":"Tasneem","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"CD001271","DOI":"10.1002\/14651858.CD001271.pub2","article-title":"Substitution of doctors by nurses in primary care","volume":"18","author":"Laurant","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e078222","DOI":"10.1136\/bmjopen-2023-078222","article-title":"Cohort profile: the pregnancy risk infant surveillance and measurement Alliance (PRISMA) - Pakistan","volume":"13","author":"Naz","year":"2023","journal-title":"BMJ Open"},{"key":"ref15","volume-title":"Protocol for the use of intravenous Iron sucrose (Venofer","author":"Practitioner","year":""},{"key":"ref16","volume-title":"PC-1 National Maternal, newborn and child health program (MNCH)","year":"2006"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"102553","DOI":"10.1016\/j.midw.2019.102553","article-title":"Maternal and newborn outcomes of care from community midwives in Pakistan: a retrospective analysis of routine maternity data","volume":"79","author":"Mubeen","year":"2019","journal-title":"Midwifery"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1093\/heapol\/czt026","article-title":"Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence","volume":"29","author":"Dawson","year":"2014","journal-title":"Health Policy Plan"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.bpobgyn.2019.07.007","article-title":"WHO guidelines and the role of the physician in task sharing in safe abortion care","volume":"63","author":"Kim","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"762","DOI":"10.4103\/jfmpc.jfmpc_303_17","article-title":"Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural northern India","volume":"7","author":"Haldar","year":"2018","journal-title":"J Family Med Prim Care"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/S0020-7292(12)61706-8","article-title":"Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy","volume":"138","author":"Kriplani","year":"2013","journal-title":"Indian J Med Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"847693","DOI":"10.3389\/fnut.2022.847693","article-title":"The prevalence and risk factors of Iron deficiency Anemia among pregnant women in Malaysia: a systematic review","volume":"9","author":"Abd Rahman","year":"2022","journal-title":"Front Nut"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2024.1400174\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T05:01:05Z","timestamp":1716526865000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2024.1400174\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":22,"alternative-id":["10.3389\/fnut.2024.1400174"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2024.1400174","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]},"article-number":"1400174"}}